Taking Care of Mom and Dad: Prior Hospitalization vs. ADLs

As I mentioned earlier, early LTC policies normally required a period of prior hospitalization before the policyholder would be eligible for benefits. Most of the newer versions of LTC policies no longer require prior hospitalization as a condition of benefits. Admission to the nursing home must be because of an accident or sickness and the elimination period must be satisfied.

However, some insurers may offer prior hospitalization as an optional provision to be elected or rejected by your parents. If they elect it, the cost of the LTC policy will be slightly less than a policy without the prior hospitalization provision.

Some of the newer LTC policies base eligibility for admission to a nursing home on the inability to perform some of the activities of daily living (ADLs) instead of a particular sickness or injury. Consequently, these contracts don't require prior hospitalization.

For example, if your father is no longer able to perform personal hygiene or is unable to walk or "get around," he would be eligible for admission to a nursing home and payment of policy benefits.

LTC insurance that's triggered by ADL problems is becoming more common every year. This kind of policy is a more liberal approach to the needs for LTC protection due to the fact that it does not require that the policyholder's admission to the nursing home be related to a sickness or injury.

The recurring provision found in LTC policies is similar to relapse provisions found in other forms of health insurance. Under this provision, if a parent is released from a nursing home and is readmitted within 180 days of the discharge due to the same or a related condition, the second admission (the relapse) will be considered a continuation of the previous nursing home stay.

If 180 days has elapsed since your parent was released from the nursing home facility, a subsequent admission for the same or a related cause will result in new elimination and benefit periods.