Beyond the nursing home (2012 ICA)

Long Term Care: Beyond the Nursing Home

International Claim Association 2012 Annual Education Conference

Orlando, FL October 2, 2012

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Robert R. Pohls, Esq. Pohls & Associates

Walnut Creek, California

Peter K. Burke AVP, LTC Claims Operations

John Hancock Financial Services Boston, Massachusetts

Rita Bennett, RN, BSN, LTCP

Director, LTC Operations Bankers Life and Casualty

Chicago, Illinois

Lori M. Watson

Director, LTC Claims Genworth Life

San Rafael, California

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Session Agenda

• Goal of session

• Interactive session – audience participation!

• Long Term Care

• Past

• Present

• Future

• Wrap up

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The Early Years:

1970’s – Early 1980’s

A Walk Down Memory Lane…

LTC Options • Nursing Homes

• Slow emergence of Assisted Living Facilities

• Concept of “graduated care” emerges

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LTC Insurance • Traditional health insurance generally did not cover LTC

options

• LTC offered by only a few companies

• Medical Necessity trigger determined by admitting physician

• Indemnity-based benefit structure

• Prior hospital stay requirement

The Early Years: 1970’s – Early 1980’s

A Walk Down Memory Lane… 5

The Early Years:

1980’s – Early 1990’s

A Walk Down Memory Lane…

LTC Options • Nursing Homes

• Assisted Living Facilities

• CCRCs/Life Care Communities

• Home Health Care, Adult Day Care, etc

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LTC Insurance • Comprehensive policies

• HIPAA impact and NAIC influence

– Chronically Ill trigger

– Qualified Long Term Care Services defined

– Non-duplication of Coverage

The Early Years: 1980’s – Early 1990’s

A Walk Down Memory Lane… 7

The Early Years:

Mid 1990’s – Present

A Walk Down Memory Lane…

LTC Options • Nursing Homes

• Assisted Living Facilities

• CCRCs/Life Care Communities

• Home Health Care

• Adult Day Care

• Supportive Equipment

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LTC Insurance • Comprehensive policies

• More insurers enter the market

• Expense reimbursement benefit

• Popular and sought out coverage

• Growing media, Departments of Insurance and consumer interest

The Early Years: Mid 1990’s – Present

A Walk Down Memory Lane… 9

Lessons Learned and the Future of LTC

• Lessons learned?

• Gaps - what are they and how do we address them?

• Alternate Plans of Care – what are they being used for?

• Long term care delivery – what are the expectations?

A Few Thought Provoking Questions… 10

Wrap up – Questions?!?!

Robert R. Pohls Managing Attorney Pohls & Associates

1550 Parkside Drive Suite 260

Walnut Creek, CA 94596 Ph: (925) 973-0300

rpohls@califehealth.com www.califehealth.com

Peter K. Burke Assistant Vice President LTC Claims Operations

John Hancock Financial Services 200 Berkeley Street, B5

Boston, MA 02117 Ph: (617) 572-1979

pkburke@jhancock.com

Rita Bennett, BSN, RN, LTCP Director, LTC Consumer Relations,

Risk Management Banker’s Life

111 E. Wacker Drive Chicago, IL 60654 Ph: (312) 396-6747

r.bennett@banklife.com

Lori M. Watson, CLTC, LTCP Director, LTC Claims

Genworth Life 1650 Los Gamos Drive San Rafael, CA 94903 Ph: (415) 492-7916

lori.watson@genworth.com

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