CH 3 (WM) Flashcards
Define LT care. [3]
All forms of continuing personal or nursing care and associated domestic services for people who are unable to look after themselves without some degree of support [1] whether provided in their own homes, at a day centre, or in a state-sponsored or care home setting. [1]
LTC is essentially for people who are not going to get better and is distinct from acute medical care, as it is not principally concerned with curing or alleviating particular medical conditions. [1]
However, someone needing LTC may also need acute medical intervention at some stage. [0.5]
Describe the needs that are covered by a LTC product. [4.5]
The main need being met by LT care insurance is the provision of some financial protection against the cost of care and assistance when a person becomes unable to look after him/herself.✓✓ Typically this arrives in old age.✓
There may be uncertainty as to the role of the State in the future in paying for care ✓✓ – it will provide comfort to the person to know that there is an independent source of cash that will be triggered when severe capacity sets in.✓
Claimants needs at the time may entail domestic support, e.g. a nurse or other caregiver visiting the patient’s home periodically to monitor wellbeing. [1]
This may progress to live-in care as the claimant becomes more incapacitated.✓✓
Alternatively, residential care may be sought in establishments that can provide various levels of care and vigilance.✓✓
Finally, there may be a need for medical care, where physical (or possibly mental) breakdown requires the intervention and supervision of doctors and nursing staff.✓✓
With changing social and demographic circumstances some individuals might be worried about the reduction in informal care.✓✓
Avoid dependence on family and friends to provide care and attention.✓✓
Also, Freddie Mercury…Friends will be friends. Additional marks = 0.5
Describe how the cost of care for LTC products can be divided. [4.25]
Living costs – food, clothing, heating and amenities, etc. [1] chaf
Housing costs – rent, mortgage payments and council tax, etc.✓✓✓
Personal care – the additional costs of being looked after, arising from frailty or disability.✓✓✓
Everybody will have living costs, but for those needing care these costs may be greater, eg the need for a warmer home, the needs for special foods. [1]
The housing costs are often referred to as the “hotel” or “accommodation” element of the total costs.✓✓
For living costs and housing costs, it is the increase in costs rather than the total costs that should form part of the provision for LTC.✓✓
Define personal care. [1.5]
Personal care includes all forms of care directly involving touching a person’s body✓, incorporating issues of intimacy✓, personal dignity✓ and confidentiality.✓
This itself should be separated into nursing care and other forms of personal care.✓✓
Define the term “nursing care”. [5]
Nursing care is the narrowest form of LTC✓ and can be defined as care that requires the specific knowledge or skills of a qualified nurse.✓✓
The definition of nursing care is open to individual interpretation.✓✓
At its most restrictive✓ this would include the assessment of healthcare needs and specific interventions✓✓ that require technical competence and knowledge of disease states✓✓, which only a registered nurse can provide.✓
A broader definition✓ of nursing care might cover the costs of a registered nurse✓ providing, delegating or supervising care✓✓✓ in any setting.✓ However, the definition to encompass either State provision or insurer responsibility will invariably depend on the purpose for which it is used.✓✓
From an insurer’s point of view the key issue is that nursing care will be more expensive than other forms of personal care.✓✓
Additional marks = 0.25
Define the term “interim care”. [3]
This focuses on recuperative services following an acute event,✓✓
in order to reduce avoidable hospital admission✓✓ and minimise dependence on ongoing LTC,✓✓
(eg a heart attack, a stroke or an accident requiring a period in hospital) .✓
These services should incorporate intensive therapy and support.✓✓
The care is intermediate between hospital care and care provided in the home.✓✓
Describe the term “Formal Care”. [3]
FC has a direct cost.✓
It can be delivered in many different settings.✓
Care can be provided in the older person’s home or in the homes of near relatives.✓✓ These are examples of “care in the community”.✓
Care outside of a person’s home takes the form of residential homes.✓✓ Residential homes may be provided by the State, or privately owned and managed.✓✓ Some residential homes are owned and managed by charities, particularly religious charities.✓✓
Tip: Each of the last 3 sentences speak about “residential homes”.
Describe the cost impact of “Informal Care”. [1.75]
Whilst FC has a direct cost✓, IC has an indirect cost✓ i.t.o. either
the lost economic activity✓ or
the price replacing care support should it no longer be provided.✓✓
The continuing supply of IC has a direct impact on FC costs.✓✓
*Start with comment about FC and IC and end with both again.”
Describe the factors that affect the availability of informal care. [3.5]
The supply of IC✓ is influenced by factors such as:
* the availability of viable alternatives✓
* the proportion of women working✓
* the geographic dispersion of families✓
* changing family structures✓
* (eg through divorce, re-marriage, falling birth rates)✓✓
* as well as the attitudes of different generations✓
The extent of IC✓ is influenced by the cultural and religious traditions in the community✓✓. So in some countries✓, eg Mediterranean countries✓, the provision of care by the extended family and by charitable organisations may be much more extensive than in other countries.✓✓
What are the objectives of an optimal LTC program? [1.5]
- to help people regain as much independence as possible ✓✓
- slow down the rate of deterioration✓✓, and
- provide the necessary care support and environment to maintain wellbeing.✓✓
Describe the two generic types of LTC cover. [2]
- Pre-funded plans – purchased by relatively healthy people to protect them against the risk of future disability. [1]
- Immediate Needs – purchased by LTC claimants to protect them against the uncertain survival duration. [1]
Describe the claims definition for a pre-funded TC policy. [4]
- The benefit payment is triggered by a single event or by a multiple set of events.✓✓ The single event may itself depend on a level of disability and its continuation for a specified period.✓✓
- This trigger is usually def’d as not being able to undertake a spec’d number of ADLs✓✓ – incl feeding, dressing, washing, toileting, mobility, transferring [1] – with an overriding trigger of severe mental impairment✓.
- The number of ADLs failed denotes the level of dependency.✓✓
- Different benefits may also be payable depending on the level of disability.✓✓
- The claims trigger requires the PH to be incapable of performing a number of these activities alone and without endangering the health or well being of the PH or others.✓✓
Explain the different benefit levels that may be payable on a pre-funded LTC policy. [2]
- Different benefit levels may be payable on the level of disability.✓
- For example it is common for 50% of the benefit to be paid on the failure of two out of six ADLs✓✓ and
- 100% to be payable on the failure of three or more out of six ADLs✓✓, or as a result of mental impairment.✓
- More recent plans have separated the ADL triggers so that the benefit for each level can be individually selected.✓✓
Explain the claims definition on more restrictive pre-funded LTC policies, specially as it relates to multiple event triggers. [2.5]
More restrictive plans may require all of the events to be triggered ✓,
E.g. one or more events, ✓ incl:
* A minimum age
* Prior nursing care,
* Entry into a nursing home
* As well as a minimum level of continuing disability. [1]
The earliest LTCI plans in the US required a period of prior hospitalization, followed by entry into a nursing home.✓✓
The multiple-event trigger may require the disability event to be the 1st event from a list specified in the policy conditions ✓✓, e.g. for an integrated rider plan such as CI cover.✓
Describe the design factors to consider when adding Long-term care benefits to a CI policy. [3]
Long-term care benefits can be added to a CI policy. This is normally structured so that the definition of total and permanent disability changes from occupation-related✓✓ (or activities of daily work)✓ to the loss of independent existence✓ (ie failure of ADLs)✓ at age 60✓.
However, it should be noted that many common causes of long-term care✓
(eg Alzheimer’s disease, stroke, Parkinson’s disease, rheumatoid arthritis, pre-senile dementia and blindness)✓✓✓✓ are already covered by the main CI policy✓.
