Senior Market Advisor. September 2004. www.SeniorMarketAdvisor.com

LTC Insider. With Margie Barrie.

Understanding LTCI Home Health Care Provisions

Q: Home health care is very important to my clients. Florida requires an LTCI policy to reimburse for services whether they are provided by a home health agency or a nurse registry. Is that true for all states? What other advice can you provide to help me advise clients who are going on claim? - B.C., Miami

A: Home health care is a hot button in the long term care sale. Although flexibility is the trend in policy language — meaning that the policies will pay for home health aides from various types of agencies — there are still many policies with more restrictive language. You must be familiar with the type of home health care agencies specified in the policies you sell.

Why? Advisors are usually the first to be contacted when a client goes on claim.

Make sure that the policy will pay for incurred home health care costs. Nothing will anger a client more than incurring thousands of dollars in services that will not be reimbursed.

To understand how agencies differ, I turned to Marc Catalano, president of Catalano’s Nurse Registry in southern Florida. The information he provided is based on Florida regulations, which are more flexible than most states.

Florida defines three main sources of home health care: nurse registries, home health agencies and companion/ sitter agencies. This column will only discuss these in the context of home health aides.

Nurse Registry — Serves as an agent for the caregivers it represents. A registry is similar to an employment agency in that the caregivers are self-employed. This is often referred to as a "Consumer Directed Approach" because the caregivers provide services in coordination with the client’s objectives and the client can modify or terminate the relationship.

Home Health Agency — Provides health services with its direct employees. The agency maintains supervision over the client-caregiver relationship and controls the assignment of its caregivers. Catalano calls this an "Agency Directed Approach."

Companion/Sitter Agency —These agencies only provide companion services or homemaker services. The sitter cares for the client and may accompany him on outings or prepare meals, but can’t provide hands-on personal care.

Here are some suggestions to ensure your client hires the right type of agency:

• As soon as a client knows he will need home health care, put him in touch with the carrier’s claims department. The carrier will determine if the agency meets the policy’s definitions. This is particularly important when the client purchased an earlier policy form.
• Fax your client a copy of his policy.
• Suggest your client ask the following questions when hiring or contracting with an HHC aide:

• Does the agency have the right to send a substitute caregiver without client approval?
• If the client is dissatisfied with a caregiver, can he get a replacement? If so, how long will it take?
• What items are reviewed during the company’s background screening process?
• Will the agency permit the client and caregiver to independently negotiate the time and location where the services will be performed?
• Is the client permitted to negotiate and develop the job description with the caregiver, or does the home care agency dictate the terms of the engagement?

Margie Barrie is president of LTCI Consulting Group Inc., where she specializes in providing marketing and sales solutions to the long term care insurance industry. She can be reached at (410) 653-9600 or at margiebarrie@comcast.net.

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