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What Are Cognitive Impairments That Trigger Long Term Care Benefits?

Long Term Care BenefitsLong term care insurance can provide daily benefits for individuals who cannot perform two of the six classified activities of daily living (ADLs) or who suffer from cognitive impairment. Cognitive impairment is the deterioration or loss in mental capacity that poses a danger to oneself and others. These individuals require substantial supervision to protect themselves from threats to health and safety due to their severe cognitive impairment.

Common Causes of Cognitive Impairment 

Cognitive impairment in the elderly is most commonly caused by Alzheimer’s disease or other forms of dementia. Though medication may slow progression, there is no cure for these neurodegenerative diseases. Besides Alzheimer’s and other forms of dementia, cognitive impairment may result from a stroke, traumatic brain injury, and other causes.

Cognitive Impairment Can Interplay With Ability to Perform ADLs 

Even though cognitive impairment is a benefits trigger by itself, it can often impact one’s ability to perform various ADLs – eating, dressing, bathing, personal hygiene, walking, getting in and out of bed – which are also used to determine one’s eligibility for long term care benefits. Individuals with cognitive impairment can also experience mobility issues, problems with bathing and using the toilet, or even getting dressed. Aside from physical limitations, insurance companies can still deem an individual as unable to perform a certain ADL if they need to be directed or prompted to perform them. Inability to perform these various ADLs should be added to the claim in addition to cognitive impairment to strengthen the case and increase the likelihood of approval.

What To Do If You Suspect Cognitive Impairment 

To apply for long term care benefits due to cognitive impairment, one needs to be diagnosed by a physician, typically a neurologist. To achieve a diagnosis, the physician will often analyze the medical histories of the individual and their family members, as well as perform physical and neurological tests to find objective evidence of cognitive impairment. The doctor may also perform cognitive and neuropsychological tests to assess memory, problem-solving skills and other abilities to determine mental capacity. There are a variety of standardized tests that can be used to measure cognitive impairment, with the most common one being the Mini Mental Status Exam (MMSE), also known as the Folstein test. In addition, the doctor will look for signs of treatable underlying conditions, such as vitamin deficiencies or thyroid disorders, that may additional contributors to dementia symptoms. Bloodwork, a brain MRI, or a CT scan may also be used to identify strokes, tumors or other problems that can cause dementia. Genetic testing may also be analyzed, as dementia can sometimes be caused by genetic defects. In addition to a diagnosis and test results, the individual applying for benefits or a close family member should include a written statement detailing the cognitive impairment and how it affects their everyday life, as well as their safety.

An experienced long term care attorney retained early in the process can help you with your claim. For a complimentary consultation to review your claim and to learn how we can help you to obtain the benefits you are entitled to, contact us today.

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