Genetic Testing and Long-term Insurance: conflict?

[Fc1345linville]

I doubt that there is an easy answer to your question. There are several variables that will determine your premium, including years of coverage, "elimination period", inflation protection and of course your own age and health. Lots of info available if you google LTC insurance.

[circular]

A growing problem in the assisted living facilities is the large number of new residents in assisted living that come in with undiagnosed (or undeclared) mild cognitive impairment and early dementia, but the staff of Certified Nursing Aides (CNAs) have not been properly trained to handle them.

Hi Fc, How interesting that you have the ombudsman background. I've been researching facility options for my mother who has MCI. One thing *every single* assisted living facility I've spoken with has told me is that they handle MCI and into Alzheimer's. At least one has even said they would keep her if she has advanced Alzheimer's even though they're not strictly speaking a memory care facility. So I think maybe the problem is coming from both ends, patients/caregivers who don't disclose (or have dx) the memory issues, and assisted living facilities trying to get the business even knowing there are memory issues. What you say makes, sense, that once into an AL facility the staff may not provide the right kind of support, especially as dementia advances; on the other hand, one can't put a parent with MCI directly into a MC facility. Placement is quite a maze to work one's way through with all its variables. I think it's incumbent on the family (whether or not it should be) to determine when to transition to MC for their loved one's safety.

Thank you for sharing your experience. It was very helpful. Don't hold back

[Fc1345linville]

Circular, I think you have identified several important issues.

But first, for those who are not familiar with the volunteer position of "Long Term Care Ombudsman", we are primarily retired people with wide ranging backgrounds who act as advocates for the residents of assisted living facilities, skilled nursing homes and Dementia/memory facilities to which we are assigned. We report to the County government department which oversees the operation of the facilities. We visit our facility, with full access to the residents, two to three times a week for a total of about four hours. We all go through an initial training program lasting about three weeks and receive one-day training updates six times a year. Residents and/or family members may seek our assistance/guidance on a wide range of non-medical issues that are not being resolved by the facility staff, or about which they still have questions or concerns. My current assignment is to an 80 bed assisted living unit that also has a separate 30 bed memory unit. For more info, here's our local County web site: http://www.fairfaxcounty.gov/dfs/oldera ... ombudsman/ Also here in the Virginia area (as well as other areas in the US), there is public access to a wonderful periodical published twice a year, web site (retirementlivingsourcebook.com). Lots of info on how to work through the "placement maze".

Sorry, circular, for that interlude. Assisted Living and Memory Care facilities, with the growing number of older citizens, have become a growth industry, with both for-profit and non-profit participation. The labor costs to run these facilities are relatively high, so cutting back on staff numbers and/or levels of training (i.e. RN, LPN, CNA) can be an easy financial solution for the company share holders, and, at the same time, a resident care problem. The facility might claim they can handle Alzheimer's residents, but the staff may be minimally trained to do it. NIH has studied this and the for-profit facilities are much more likely to squeeze on resident care investment than non-profit facilities. And remember that most assisted living and memory units have only part-time physicians (usually general practice focus) who make on-site visits about twice a week. So it is important, as circular points out, that residents have access to a personal physician to assist families in making medical decisions, including placement.

Finally, consideration should be given to Continuing Care Retirement Communities (CCRCs) that usually have a campus environment that includes Independent Living apartments/cottages, separate but close by Assisted Living facility which also often includes a Memory unit. Older people are selling their large, expensive-to-maintain homes and going to smaller apartment/cottages
in CCRC communities, knowing that when their health deteriorates to a certain point, they can easily move next door to the assisted living quarters and/or the memory unit.

[E4me]

There is no ethical conflict here; insurance companies have no claim to our genetic test results in a circumstance where those results can be used to deny us coverage or boost our rates to unaffordable levels. The ethical conflict lies elsewhere, for we deny millions of Americans, pre-Alzheimer's citizens included, of our right to universal healthcare. This is the right every advanced country offers to its citizens, except us. Medicare For All, (including access to Long Term Care), or a variant program is the only civilized solution to the healthcare crisis we face, and it's a crisis of our own making.

[Fc1345linville]

But even today's Medicare offers no coverage in Assisted Living and short-term coverage (100 days) for nursing homes. Medicaid offers some coverage, but terms vary from state to state. But I certainly agree that universal coverage is the right, and ironically most affordable, solution.

[circular]

Also the limited Medicare coverage for nursing homes is only if you go straight from a three day hospital stay.

[doriswise]

I'm thinking after reading the below posts, that I will forgo the genetic test and start the therapy, vitamins, supplements, sleep and stress and hope for the best!!

[circular]

A perfectly legitimate approach in my book. Some doctors are starting to recommend the testing, but it's not for everyone, especially if you can be motivated to live a protective life without knowing whether you have e4. What people often forget is that many people who test and learn they're 3/3 may feel they can get away with more, but that could backfire for a number of reasons. When a friend asks me if they should test I ask them if a 3/3 result would make them feel off the hood and less diligent about their health.