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Lts provider training_webex1


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Lts provider training_webex1

  1. 2. Fine Tuning Functional and Cognitive Assessments of the Long Term Insurance Claimant
  2. 3. What Is the Role of LTS? <ul><li>Provide an unbiased assessment of the claimant’s needs for the insurance company </li></ul><ul><li>“ Policy Blind” </li></ul><ul><li>Develop a Plan of Care that meets the needs of the claimant and caregivers </li></ul><ul><li>Evaluate eligibility for Tax Qualification status </li></ul>
  3. 4. Some General Guidelines <ul><li>Use the correct assessment tool </li></ul><ul><li>Refer claimant to insurance company with questions regarding coverage and payment; do not speculate </li></ul><ul><li>Do Not provide copies of the assessment </li></ul><ul><li>Do Not discuss eligibility of paid caregivers </li></ul>
  4. 5. Some General Guidelines <ul><li>Do answer all questions on the tool </li></ul><ul><li>Do return entire tool to LTS </li></ul><ul><li>Do write legibly, no white out, so scribbling </li></ul><ul><li>Note if someone else is signing for claimant </li></ul><ul><li>Remember: This is a legal document! </li></ul>
  5. 6. Quality Assurance and Improvement <ul><li>Rating Policy </li></ul><ul><li>Turnaround Time </li></ul><ul><li>Stay in contact with your LTS Client Service Manager (CSM) </li></ul>
  6. 7. Residence <ul><li>Home * </li></ul><ul><li>Independent Living * </li></ul><ul><li>Assisted Living </li></ul><ul><li>Facility </li></ul><ul><li>Always conduct the assessment where you have been instructed to. </li></ul>
  7. 8. Formal and Informal Caregivers <ul><li>Paid vs Unpaid </li></ul><ul><li>Take informal care into consideration when making POC recommendations </li></ul>
  8. 9. Medications <ul><li>Not under ADL or IADL </li></ul><ul><li>Inability to manage may support cognitive or functional deficits </li></ul><ul><li>May support risk for “self harm” </li></ul><ul><li>Consider ability to manage all routes that meds are taken </li></ul><ul><li>Choices: None, Reminder, Set up, Administration </li></ul>
  9. 10. ADLs: What do they consist of? <ul><li>Bathing </li></ul><ul><li>Dressing </li></ul><ul><li>Toileting </li></ul><ul><li>Continence (Bladder and Bowel) </li></ul><ul><li>Transferring </li></ul><ul><li>Eating </li></ul><ul><li>Mobility (Indoors and Outdoors) </li></ul>
  10. 11. Leveling ADLs <ul><li>Independent </li></ul><ul><li>Independent with Equipment </li></ul><ul><li>Reminders or Cueing </li></ul><ul><li>Supervision or “Arms Length” </li></ul><ul><li>Hands On </li></ul><ul><li>Dependent </li></ul>
  11. 12. Assisting Persons <ul><li>Formal (HHA, C.N.A., PCG, Homemaker) </li></ul><ul><li>Informal (Family, friends, neighbors) </li></ul><ul><li>Choose all that apply to each ADL </li></ul><ul><li>Human Assist Required for Reminders and Higher Levels of Assist </li></ul><ul><li>Assisted by: No One Facility Staff Skilled Nurse CNA/HHA Private Caregiver </li></ul><ul><li>Spouse Family Other: </li></ul>
  12. 13. Example: Genworth <ul><li>Bathing: Wash body/hair in tub, or shower, with or without adaptive equipment. If sponge bathes, get basin, soap and washcloth independently.  Tub x Shower  Sponge Bath </li></ul><ul><li> Independent </li></ul><ul><li> Independent; requires only equipment to complete ADL </li></ul><ul><li> Requires reminder or cueing to initiate or complete ADL (oversight) </li></ul><ul><li> Requires supervision at arms length to complete ADL; provide for safety </li></ul><ul><li>x Requires hands-on assist of another to complete some or all of ADL </li></ul><ul><li> Totally dependent on one or more to perform ADL, unable to participate </li></ul>
  13. 14. Example: Genworth <ul><li>Assisted by: No One Facility Staff Skilled Nurse CNA/HHA Private Caregiver </li></ul><ul><li>Spouse Family Other: ________________________________________ </li></ul><ul><li>Frequency: daily List Adaptive Equipment Used: tub bench, HHS </li></ul>
  14. 15. Example: TransAmerica <ul><li>How much assistance is needed if the insured were to take a SHOWER : </li></ul><ul><li>CHECK ONLY ONE </li></ul><ul><li>requires no assistance or supervision </li></ul><ul><li>requires minimal assistance from another person </li></ul><ul><li>due to cognitive impairment unable to perform independently: cueing and supervision needed </li></ul><ul><li>requires substantial assistance from another person </li></ul>What type of assistance would be needed to complete SHOWERING : CHECK ONLY ONE <ul><li>Verbal guidance/Cueing </li></ul><ul><li>Stand-by assistance </li></ul><ul><li>Hands on assistance </li></ul><ul><li>Totally dependent (UNABLE to perform or participate in any way ) </li></ul>
  15. 16. Example: Prudential <ul><li>BATHING - the ability to wash oneself by sponge bath, or in a tub or shower (this includes getting in and out of the shower. </li></ul><ul><li>Assessor : Direct the insured as follows: Stand, raise your right leg, put it down. Raise you left leg, put it down. </li></ul><ul><li>1 . Was this task completed with ease? </li></ul><ul><li>‪ yes ‪ X no </li></ul><ul><li>If no, explain :_ Holds onto the wall when lifting legs </li></ul><ul><li>2 . How does the insured bathe? </li></ul><ul><li>‪ Bed Bath </li></ul><ul><li>‪ Sponge Bath </li></ul><ul><li>‪ Tub </li></ul><ul><li>‪ Shower </li></ul><ul><li>3 . Does the insured receive assistance with bathing? </li></ul><ul><li>‪ yes </li></ul><ul><li>‪ no </li></ul><ul><li>If yes, complete the following chart. </li></ul>
  16. 17. Example: Prudential <ul><li>Task, Type, Frequency: </li></ul><ul><li>Getting to or from the tub or shower </li></ul><ul><li>X Getting into or out of the tub or shower </li></ul><ul><li>Obtaining/disposing of water for sponge bath </li></ul><ul><li>X Turning faucets on/off or controlling water temperature. </li></ul><ul><li>X Washing the back, Washing hair, Washing feet </li></ul><ul><li>Washing all other body parts </li></ul><ul><li>X Toweling dry all parts of the body. </li></ul>
  17. 18. Example: Prudential <ul><li>Type of assistance: Frequency of assistance: </li></ul><ul><li>H = Hands on 1 = Always </li></ul><ul><li>S = Stand-by 2=more than 75% of the time </li></ul><ul><li>C = Cueing 3= 50-75% of the time </li></ul><ul><li>I = Independent 4 = 25% -50% of the time </li></ul><ul><li>ID = Independent w/Device 5 = 0-25% of the time </li></ul><ul><li>Who provides assistance? (name/relationship) Daughter, HHA </li></ul>
  18. 19. Example: WeCare+
  19. 20. Folstein Mini-Mental Status Exam <ul><li>Do not “Prompt” claimant </li></ul><ul><li>Do not provide pen and paper for calculations </li></ul><ul><li>Write down any physical impairments that might impact ability to answer any one or all questions </li></ul><ul><li>Questions are strategically sequenced </li></ul>
  20. 21. Orientation <ul><li>1. What is the year </li></ul><ul><li>2. Season </li></ul><ul><li>3. Date </li></ul><ul><li>4. Day </li></ul><ul><li>5. Month </li></ul><ul><li>6. State </li></ul><ul><li>7. County </li></ul><ul><li>8. Town or City </li></ul><ul><li>9. Street Address </li></ul><ul><li>10. Floor (or room in house) </li></ul>
  21. 22. Registration <ul><li>Name three objects (e.g. book, lamp, tree ) taking one second to say each. </li></ul><ul><li>Ask the applicant to repeat all three after you have said them once. Give one point for each correct answer. Before proceeding, repeat the words until the applicant learns all three. Record the words below : </li></ul>
  22. 23. ATTENTION AND CALCULATION <ul><li>A . Begin with 100 and count backwards by 7. Stop after five answers. </li></ul><ul><li>(Correct response = 93, 86, 79, 72, 65) </li></ul><ul><li>Give one point for each correct answer. _____, _____, _____, _____, _____ </li></ul><ul><li>-OR- (only if claimant refuses to do “A”) </li></ul><ul><li>B. Spell “world” backwards (d l r o w) _____, _____, _____, _____, _____ </li></ul>
  23. 24. Recall <ul><li>Ask for names of three objects learned in question #3. Give one point for each correct answer. </li></ul>
  24. 25. Language <ul><li>Show a pencil and a watch. Have applicant name them as you point. </li></ul><ul><li>Point to Pencil </li></ul><ul><li>Point to Watch </li></ul><ul><li>Have the applicant repeat: “No ifs, and’s, or but’s” Write exactly what claimant says </li></ul><ul><li>Have the applicant follow a three-stage command: </li></ul><ul><li>“ Take a paper in your right hand; fold it in half; put it on the floor.” </li></ul>
  25. 26. Language <ul><li>Have the applicant read and obey the following words: “CLOSE YOUR EYES” </li></ul><ul><li>Have the applicant write a sentence: Write on the assessment tool </li></ul><ul><li>Have the applicant copy the design: Copy on the assessment tool </li></ul>
  26. 27. Other Cognitive Tests <ul><li>Judgment Questions </li></ul><ul><li>Short Portable Mental Status Questionnaire </li></ul><ul><li>Behavior Questions </li></ul>
  27. 28. Barriers to Exams <ul><li>If the claimant has a physical barrier to completing exam as intended, document the presence of the barrier. </li></ul><ul><li>Examples: </li></ul><ul><ul><li>If the claimant is blind, he/she cannot read a command and follow it. </li></ul></ul><ul><ul><li>If a claimant has tremors, it may effect the way they write. </li></ul></ul><ul><ul><li>Upper extremity restraint or immobility may effect completion of a command. </li></ul></ul>
  28. 29. Durable Medical Equipment (DME) <ul><li>Document what the claimant has </li></ul><ul><li>Add what you feel the claimant needs for safety and optimum independence </li></ul><ul><li>Consider unconventional DME when reporting devices used by claimant </li></ul>
  29. 30. Plan of Care (POC) <ul><li>Current Service Plan </li></ul><ul><li>Proposed POC (do not be concerned with cost or payer source) </li></ul><ul><li>Specifying goals: Keep it simple; “Home care for assist with ADLs to remain safe in own home” , “Claimant requires 24 hour supervision to be safe at home” </li></ul>
  30. 31. Tax Qualification <ul><li>*This 90 day certification is a Federal requirement for Tax Qualified long term care insurance plans. This requirement intends that a Health Care Professional use their best medical/nursing judgment when determining is treatment for a patients condition can be reasonably expected to last for 90 days or more. </li></ul>
  31. 32. Tax Qualification <ul><li>“ In my professional judgment, I believe this policyholder will require substantial assistance from another individual in at least two Activities of Daily Living: (Bathing, Dressing, Eating, Toileting, Transferring, Continence) due to loss of functional capacity that is expected to last at least ninety (90) days.” AND/OR….. </li></ul>
  32. 33. Tax Qualification <ul><li>“ In my professional judgment, I believe this policyholder requires substantial supervision to protect them from threats to health and safety due to severe cognitive impairment.” </li></ul>
  33. 34. Questions? <ul><li> </li></ul><ul><li>508-907-6290 or toll-free: 877-443-3777 (main numbers) </li></ul>