Eating is one of the six activities of daily living (ADLs) that are used to trigger long term care benefits. If you have a long term care insurance policy, you are entitled to benefits if you can no longer independently perform either two or three out of six ADLs, depending on the policy. Besides eating, the other ADLs are dressing, bathing, transferring, continence and toileting.
Eating disability is generally defined as an inability to feed oneself. Feeding oneself includes setting up, arranging and bringing food or liquid from the plate or cup to the mouth. As people age, they may experience cognitive and/or physical changes that can make it difficult or impossible to perform one or more of the steps required for self-feeding. Conditions that may impact self-feeding independence include dementia, Parkinson’s disease, arthritis, multiple sclerosis, cerebral vascular accident, range of motion limitations, decreased fine motor control in hands, muscle atrophy, dysphagia, certain cancers, and decreased vision, among others.
About 1 in 25 U.S. adults will have swallowing difficulty at some point in their lives, according to the American-Speech-Language-Hearing Association. This leads to an increased risk of aspiration, aspiration pneumonia, or choking. More than 5,000 people died of choking in 2019, according to Statista. Other risks associated with eating disability include under-nutrition and poor quality of life.
Depending on the condition, its cause and the severity of the symptoms, the use of medications, therapies, a modified diet, and/or adaptive drinkware and utensils could lead to improvement in some individuals who struggle to feed themselves independently.
Gather Evidence of Your Disability
If you or a loved one is no longer able to eat independently, you will need to provide evidence to your long term care insurance company. This should include a report from your doctor, who should review your medical history and provide results of physical exams, neurological exams, imaging and/or lab tests that provide objective evidence of your disability. If applicable, your doctor’s report should detail interventions such as therapies or medications that were tried but were not or are no longer effective in allowing independent feeding.
In addition, a close family member or friend could provide a written statement detailing your need for assistance with eating. Alternately, you can hire a nurse or another healthcare professional to observe and document challenges that you face while feeding yourself.
Prepare for the Insurance Company Assessment
Your insurance company will most likely send its own nurse or other healthcare professional to your home to evaluate your ability to eat independently. Prior to the visit, read and understand your rights and obligations under your long term care policy. Consider consulting with an attorney who concentrates in long term care insurance claims prior to the visit, so that the attorney can prepare you and/or be present during the visit to protect your rights. At the very least, be sure to have a family member or friend by your side when the insurance company’s representative visits. Your trusted family member or attorney can help ensure that you provide the representative with all the relevant information about the struggles you face, in addition to taking detailed notes about what goes on at the evaluation. This record will be helpful if the insurance company later disputes what occurred or was said during the visit.
If you are considering filing a long term care insurance claim, or if your claim is being challenged or has been denied, give us a call. We regularly represent clients with long term care claims and have the experience, knowledge and tenacity to make sure insurance companies keep the promises made to you or your loved one.
Contact us today for a free consultation.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack