Chapter 8 (LTC) Flashcards
Define LT care. [2]
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]
Contrast LTC to acute medical care. [1.5]
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]
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 needs that are covered by a LTC product. [4]
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.✓✓
Home Modifications✓: Some LTC products offer coverage for modifications to the home to make it more accessible and safe for individuals who need assistance with mobility or other daily activities. This can include ramps, grab bars✓, and other modifications to improve safety and accessibility.
Respite Care✓: LTC products often provide benefits for respite care, which gives primary caregivers temporary relief from caregiving duties✓.
Support Services✓: LTC products might also include coverage for support services such as care coordination, case management, or counseling services✓✓ that help manage and organize care✓.
Describe how the cost of care for LTC products can be divided. [4]
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”. [1.5]
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.✓
From an insurer’s point of view the key issue is that nursing care will be more expensive than other forms of personal care.✓✓
Describe the term “Formal Care”. [2.5]
FC has a direct cost.✓
It can be delivered in many different settings.✓
(1) Care can be provided in the older person’s home✓ or
(2) in the homes of near relatives✓ These are examples of “care in the community”.✓
(3) 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.✓✓
Describe the cost impact of “Informal Care”.
[1]
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.✓✓
Describe the factors that affect the availability of informal care. [3]
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.✓✓
(If the IC sector shrinks, for whatever reason, then the demand for insurance products may increase.✓)
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.✓✓
