Service Use and Transitions: Decisions, Choices and Care Management among an Admissions Cohort of Privately Insured Disabled Elders. G. Effect of Having a Long-Term Care Policy on Paid Care Use and Choice

12/01/2006

We were interested in knowing what perceived effect having a long-term care policy had on a person’s choice of service setting. Conversely, we wanted to know what people think they would do in the absence of having their insurance policy. All questions were asked in reference to a person’s specific provider. Figure 34 details the results.

FIGURE 34: Effect of Having an LTC Policy by Care Setting

First, we asked if the claimant would still receive care in their current setting (i.e., would you still receive care in an ALF) if they did not have their LTC insurance policy. The majority in all three settings seemed to indicate that they would. Only 15% of home care recipients seemed to think that they would not be able to receive care at home if they did not have their policy and almost the same for ALF residents. Even fewer nursing home residents thought that they would not be able to receive nursing home care if they did not have their policy. This may be due to the fact that nursing home care is covered by public payer sources (Medicaid and perhaps some level of Medicare).

We also asked if participants would have waited longer before going to their current setting (i.e., before going to a nursing home) if they did not have their LTC insurance policy. Again, nursing home residents were least likely to indicate that they would have waited, although only a small number in all service settings thought they would have. Given the functional and cognitive profile of these policyholders, it is unlikely that they could have waited much longer.

Next, we asked if the participant would have chosen a less costly provider (i.e., a less costly nursing home for those currently in a nursing home) if they did not have a LTC insurance policy. There was really no variation by care setting and only a small proportion indicated that they would have chosen a less costly provider. The income profile of this sample supports this.

Finally, we asked if the definition of what is covered by the LTC insurance policy restricted a person’s choice of provider type. Keeping in mind that everyone in the sample has coverage for all three services settings, this question was designed to capture those who might be seeking alternative or unlicensed caregivers. For instance, some policies require a person to hire a licensed and/or certified caregiver to provide home care. It may be the case that a person may be receiving help from a close friend, neighbor or son/daughter of a friend and they want to continue to use them. The results in Figure 34 show that while only a small proportion of each sample answered in the affirmative, a statistically larger percentage of paid home care recipients did so relative to those in nursing homes and ALFs. This could be due to the reason mentioned above. Still, over 90% of respondents did not feel that the insurance restricted their use of specific service providers.

Overall these results would indicate that this group of people would have made nearly the same choices in the absence of their LTC insurance policy. It is possible that recognition of the relative effect of having a LTC insurance policy may not occur until further in to a person’s care episode. At the outset there are so many other factors that an insured is dealing with like where to get care, who to get it from and when it is going to start that they do not fully appreciate the difference having a policy has on receiving paid care. Questions about the effect of having LTC insurance are included on the subsequent telephone wave interviews; therefore, we will be able to see if these responses change over time.

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