4 HR Training/Renewal

Question 1

ADLs (6)

Answer 1

• eating
• bathing
• dressing
• toileting
• maintaining continence
• transferring

Question 2

Instrumental ADLs (7)

Answer 2

Tasks required for independent community living

• using the telephone
• driving
• shopping
• preparing meals
• light housework
• taking medications
• managing money

Question 3

Factors that influence risk of needing LTC

Answer 3

• Age
• Marital Status
• Gender
• Lifestyle (diet, exercise, etc.)
• Health and family history

Question 4

“chronic” care meaning

Answer 4

the aim of management, control of symptoms, and maintenance of function

Question 5

“Acute” care meaning

Answer 5

medical care aimed at treating physical problems directly in an attempt to permanently cure or control them

Question 6

Baby-boomer demographics

Answer 6

2008 - 9M over 65 needed LTC

2020 - increases to 12M

Question 7

Percentage using LTC that are aged 18-64

Answer 7

40%

Question 8

Formal vs Informal Care

Answer 8

Unpaid care from friends and family is termed informal care. Formal care is furnished by nurses, home aides, homemakers, and other paid providers.

Question 9

Home-Based Care

Answer 9

• Personal care services
• Homemaker services
• Telephone reassurance/friendly visitor/companion services
• Meal delivery services
• Transportation services
• Home health aides
• Case managers/geriatric care managers
• Hospice support

Question 10

Community-Based Care

Answer 10

• Adult day services programs
• Senior centers
• Respite care
• Caregiver support groups

Question 11

Facility-Based Care

Answer 11

• Board and care homes
• Assisted living
• Adult foster care
• Congregate housing/senior retirement communities
• Continuing care retirement communities (CCRCs)
• Skilled nursing facilities (SNFs)

Question 12

Primary funding source of LTC

Answer 12

Medicaid

Question 13

comprehensive policies

Answer 13

combine home and facility care

Question 14

noncomprehensive policies

Answer 14

nursing home only policies (now outlawed in some states)

Question 15

“Visits”

Answer 15

2 to 4 hour blocks of time for health services

Question 16

Typical Home care costs

Answer 16

$19/hr for homemaker service

$20/hr for home health aid service (not medical care)

Question 17

Community Based Care costs

Answer 17

$65/hr

Question 18

Assisted Living Facilities Costs

Answer 18

1 bed unit….3.5k monthly and about 35% have a one time fee ranging form $25 to $120,000

Question 19

Nursing Home costs

Answer 19

Private room…$240/day

Double room…$212/day

Question 20

Medicare Coverage

Answer 20

100% first 20 days in SNF, co-pay for days 21-100

Question 21

Medicare Coverage Requirements

Answer 21

• The nursing home must be a Medicare-certified SNF providing 24-hour nursing care to convalescent patients.
• The patient must require daily continuous skilled nursing care or skilled rehabilitation services, as defined by federal law.
• The patient must have spent at least three consecutive days in a hospital, and admission to the SNF must occur within 30 days after discharge from the hospital.
• A physician must certify that SNF services are needed for the same or related illness for which the person was hospitalized

Question 22

What skilled nursing services does Medicare cover?

Answer 22

• a semiprivate room
• custodial care
• meals, including special diets
• regular physician and nursing services
• rehabilitation services
• laboratory tests
• drugs furnished by the facility
• medical supplies

Question 23

What home care services does Medicare cover?

Answer 23

Limited to reasonable, necessary, part-time or intermittent skilled nursing care and home health aide services and some therapies that are ordered by a physician and provided by a Medicare-certified home health agency. Does not pay for ongoing personal care or custodial care needs

Question 24

Medicaid qualifications (3)

Answer 24

General - 65, permanently diabled, or blind US citizen living in the state where applied

Functional - functional assessment administered by a medical specialist and is used to determine where the care should be delivered

Financial - asset (

Question 25

Medicaid must cover what basic services (8)

Answer 25

* inpatient and outpatient hospital services * laboratory and X-ray services * skilled nursing services * home health services * physician and certified nurse practitioner visits * family planning * periodic health check-ups * diagnosis and treatment for children

Question 26

Countable assets or non-exempt assets

Answer 26

* cash * checking and savings accounts * certificates of deposit and money market accounts * stocks, mutual funds, bonds, and other investment holdings * IRAs and other retirement investments * nonresident property

Question 27

noncountable assets

Answer 27

primary residence—A primary residence is not countable as long as the home’s equity is less than $500,000...exempt if a spouse, a child under the age of 21, or a blind or permanently disabled child is living in the home. • automobile—One automobile of any value is exempt if one spouse is institutionalized. One auto of any value is exempt if the spouse needs the auto for employment or if the vehicle has been modified to be handicapped accessible. • household belongings • personal possessions • business property essential to self-support—A business property is exempt if it produces income sufficient to justify possession of the business assets (equipment and supplies, inventory, cash on hand). • burial contracts • burial plot • cash surrender value of life insurance—The cash value of any life insurance owned is exempt as long as the value of all such policies does not exceed a certain amount.

Question 28

Countable income

Answer 28

* salaries and wages * pensions * Social Security * veterans’ benefits * interest earnings and dividends

Question 29

non-countable income

Answer 29

* Temporary Aid to Needy Families (TANF) payments * supplemental security income (SSI) * food stamps * Low Income Home Energy Assistance Program (LIHEAP) benefits * foster care payments * certain housing subsidies

Question 30

Allowable Transfers

Answer 30

For example, a transfer to a spouse, a transfer to a third party for the benefit of a spouse, a transfer to a child over age 21 living in the home for at least two years before the applicant’s institutionalization and who provided care to delay institutionalization, and transfers to disabled children are allowed and will not result in a Medicaid penalty period, even if made during the look-back period.

Question 31

An indemnity basis policy

Answer 31

Policy for a specified amount

Question 32

A reimbursement basis policy

Answer 32

A policy for actual costs incurred

Question 33

Section 7702B

Answer 33

establishes standard requirements for qualified LTC contracts, subject to certain rules and restrictions

Question 34

Tax Qualified Policy Requirements (5)

Answer 34

* provides insurance only for LTC services. * cannot provide for a cash surrender value. * guaranteed renewable. * must use standard benefit triggers (2 of 6 ADLs or cognitive impairment) and must pay its benefits if the insured is certified as chronically ill * must specify that once the insured qualifies for benefits an approved plan of care developed by a licensed health care practitioner must be in place.

Question 35

Tax treatment of premiums

Answer 35

If the policy is qualified, they can be itemized (only helps if health costs are more than 10% of AGI)

Question 36

Tax treatment of benefits

Answer 36

Non taxable for a reimbursement policy. Tax free (up to $330/day) for indemnity policies.

Question 37

LTC Disability Policy

Answer 37

benefits are paid when the insured qualifies for benefits, regardless of whether the insured is actually receiving care or incurring expenses.

Question 38

gatekeeper

Answer 38

The person who verifies that coverage has been triggered.

Question 39

Policy Exclusions (6)

Answer 39

* alcohol and drug addiction * illnesses and/or injuries caused by acts of war * self-inflicted injury, such as attempted suicide * treatment covered by Medicare * services delivered by family members or friends * some mental and nervous disorders

Question 40

dollar-for-dollar method

Answer 40

asset protection is equal to the amount of benefits paid from the partnership policy. For example, if Tom buys a partnership policy with a maximum lifetime benefit of $100,000, he would be entitled to up to $100,000 worth of LTC benefits paid by his policy.

Question 41

total asset protection method

Answer 41

all assets are protected from Medicaid

Question 42

DRA 2005 minimum standards for partnership (6)

Answer 42

* Insured must be a resident of state when the policy is issued. * The policy must meet the definition of a tax-qualified LTCI policy. * The policy must meet specific requirements of the NAIC’s Long-Term Care Model Act and Regulations. * The policy must include some measure of inflation protection for purchasers younger than 76 and the offer to purchase inflation protection for those who are 76 and older. * Issuers of partnership policies must conform to certain reporting requirements and must make this information available to the agency that administers the state’s partnership program. * The state cannot impose any requirement affecting the terms or benefits of a partnership policy unless it imposes the same requirements on all LTC insurance policies.

Question 43

Partnership requirements for home care

Answer 43

Must be at least half of the full benefit