The very first case that I got involved in, like I said earlier was my father’s case. He had what was called a home care policy. A home care policy is designed to pay for an aide or attendant to come into the home to provide what is called assistance with the activities of daily living. Those activities include bathing, dressing, feeding, walking, transferring from a sitting to a standing position, and all those types of things that we all take for granted.
When my father went into assisted living and the insurance company denied the claim, I started getting into the law, reading all about assisted living and reading about these long-term care insurance policies. What I learned was that assisted living facilities are considered by Florida law to be an individual’s home. So it just seemed to me so logical that if the assisted living facility is my father’s home and he has a home care policy, then how could the policy not be paying for the care he receives there. That was as simply as I looked at it and I built the case around the simplicity of that concept and of course it worked as it should have.
Assisted living facilities are important, they’re not for everyone but they are very important because there are people who are not totally independent and you have people who are not totally dependent. So people who are totally dependent wind up in nursing homes and facilities or institutions like that. People who are not totally independent need help. So they can get help in their apartment or house or they can enter an assisted living facility that takes care of a lot of things that people have to do for themselves when living in a house or apartment. They provide cooking, meals, supervision, assist with activities of daily living, which is obviously the significant part of my father’s claim. There’s also companionship, a community of people there so people aren’t alone or lonely. They also have extracurricular activities, all the different things someone may not be able to get if they’re just living at home and they have needs.
I believe that the policies that people bought many years ago that are called home care policies should be able to afford individuals the option of moving out of their house or apartment and into a place like assisted living and the policy should be working for them. We’ve been successful in applying as in my father’s case a home care policy to the care portion of the assisted living fees.
Most recently, in the last three or four weeks we got a decision out of the United States federal court involving exactly that issue and it was a very nice eight or nine page order that was issued by the judge in that case, essentially saying that assisted living facilities are a person’s home and home care policies do apply or should apply. Now not every policy is the same and I’m not suggesting that every single policy is going to work that way but it opens up the door for what I believe to be the vast majority of home care policies to be applied in assisted living. It affords people the option of moving if they want to; they’re not stuck staying at home.
What I’ve found is that a lot of people actually inquired about assisted living when someone without the understanding of how to read the policy and/or called the insurance company and asked whether the policy would cover assisted living were told it doesn’t. So they either stayed where they were (and obviously not comfortable where they are because they’re inquiring about how to get out of that and into something else) or they gave up their policies and went into assisted living anyways. We’ve been able to get dozens of people placed into assisted living and have their policies pay for part of it (because the policies don’t pay for food and rent but they do pay for care). We’ve been able to get a substantial portion of the assisted living facilities fee paid by insurers of home health care policies.