Researchers examined insurance claimants´ functional status at the start of the claims process for those who notified their insurance company that they received or intended to receive paid services for claims they had filed, or would file, under their long-term care (LTC) policy. This study used longitudinal information collected from a sample of over 1,400 individuals with LTC insurance. These individuals comprised "an admissions cohort" of new LTC service users. This study focused on the findings from the baseline interviews with study participants who were interviewed in person by nurse assessors who also assessed their functional status. These nurses regularly do assessments for insurers for claims adjudication and are familiar with insurance eligibility requirements. Although the results of the nurses´ assessments performed at baseline for the study were not used (or allowed to be used) for claims adjudication, they enabled the researchers to judge independently whether claimants met functional eligibility requirements to trigger their policies.
The study compiled and analyzed data about initial functional status, insurance company claims denials/approval rates, and how and why approved claimants chose to purchase home care, assisted living, or nursing facility services.
A striking finding was the low level of nursing facility use. Although nearly half of all claimants chose to use residential care, most chose to enter assisted living rather than nursing facilities. Claimants who chose nursing homes were significantly more physically disabled than those who used home care or assisted living. Assisted living claimants had significantly fewer activities of daily living dependencies but significantly more cognitive impairments than claimants who used their insurance benefits to purchase home care services. About one-third of all private insurance claimants who received care at home directly hired/fired and supervised individual home care aides rather than contracting with an agency for such services.
Report Title: Service Use and Transitions: Decisions, Choices and Care Management among an Admissions Cohort of Privately Insured Disabled Elderly; http://aspe.hhs.gov/daltcp/reports/2006/admcohort.htm
Agency Sponsor: ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Pamela Doty, 202-690-6443
PIC ID: 8642