Long term care plans leave frail vulnerable


BERKELEY, Calif. – Older people who buy long-term care insurance policies are generally satisfied with their coverage, but significant gaps in the care of frail elderly people remain, according to a University of California, Berkeley, study.

The largest gap in care is a lack of sufficient follow-up and monitoring to assure that policyholders actually receive the full range of services they need, the study found.

This is the first comprehensive examination of consumer protections in long-term care insurance taken from the perspective of the policyholders. Led by UC Berkeley professor of social welfare Andrew Scharlach, researchers tracked 35 elderly policyholders.

“We found that people generally were quite satisfied with their benefits,” said Scharlach. “They were getting home care services paid for, just like they were supposed to. No one’s claim was denied inappropriately. That’s all to the good.”

Unmet needs.

But, he said, that policyholders were dealing with a range of problems the insurance companies knew nothing about, such as theft by providers, helpers who did not show up, and unmet needs for transportation, medication and other problems.

“Care managers” contracted by insurance companies to monitor the home assistance typically did not adequately track the care after an initial assessment of a policyholder’s needs and development of a plan, said Scharlach.

“Care managers were helpful initially in getting the services that people needed,” said Scharlach. “But we found many needs that the care managers apparently were not aware of.”

In some cases, he said, policyholders chose not to reveal their condition, fearful that if they complained, they would lose benefits. But in most cases, the monitoring was too cursory to get good information.

Takes trust.

“People, especially frail elderly people, need to know that when they call, care managers will know who they are by name. They have to build trust in you, and it takes time. For older people with complex physical and mental conditions, it doesn’t work to come in, do an assessment, and simply give the policyholder a list of providers,” said Scharlach.

Among the problems Scharlach’s team identified that care managers were not aware of were the following:

* One provider took the client’s car and didn’t return it.

* Several providers didn’t show up; one falsified time sheets.

* Depression, isolation and other social/emotional problems on the part of the client were not recognized or treated.

* Lack of transportation and other essential services went undocumented; medications were sometimes delayed.

* Overwhelmed caregivers in the client’s family were not helped.

Most policyholders did not understand the concept of care management or how to use it, so they didn’t ask for it, said Scharlach.

Care manager limitations.

Care Managers – the linchpin in dealing with disabled or frail elderly people – are advisers or advocates who, either privately or under contract with insurance companies, assess a client’s needs, and keep in touch with implementation plans. Ideally, they follow a policyholder’s condition, advise and, in general, support the client in dealing with the long-term care system.

This study revealed, however, that consumers do not ask for, nor do insurance companies typically provide, a level of care management that could avoid many preventable, undesirable outcomes. These limitations in care management are found outside the insurance business as well, said Scharlach.


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