WEBVTT

00:00:09.086 --> 00:00:11.879
Anyone who wants to claim long-term care benefits

00:00:11.879 --> 00:00:15.279
has to apply to a long-term care insurance provider.

00:00:16.445 --> 00:00:18.566
The provider will only approve the application

00:00:18.566 --> 00:00:21.292
if it determines that there is a need for care.

00:00:22.485 --> 00:00:24.801
A person is deemed to be in need of care if:

00:00:24.801 --> 00:00:29.792
• they have physical, intellectual or
psychological impairments,

00:00:29.792 --> 00:00:32.365
causing them to be dependent on support

00:00:33.205 --> 00:00:36.432
• it is likely that these impairments

00:00:36.432 --> 00:00:39.838
will persist for at least 6 months

00:00:40.285 --> 00:00:42.618
• and the impairments meet a certain level of severity.

00:00:44.058 --> 00:00:47.558
The long-term care insurance provider
instructs the medical review service

00:00:47.558 --> 00:00:49.744
to verify that the claimant is in need of care.

00:00:50.884 --> 00:00:53.464
This “care assessment” is usually

00:00:53.464 --> 00:00:56.604
conducted as part of a house visit.

00:00:57.490 --> 00:01:01.223
During a care assessment,
the assessor from the medical review service

00:01:01.223 --> 00:01:06.423
determines how independently
the person copes with everyday life

00:01:06.423 --> 00:01:10.777
despite their health issues and the extent to which

00:01:10.777 --> 00:01:13.777
they require the support of a carer.

00:01:15.689 --> 00:01:17.529
For example, they assess:

00:01:17.529 --> 00:01:20.922
• how the person is able to move
around their living space.

00:01:20.922 --> 00:01:25.622
whether they can climb stairs unassisted or require help

00:01:26.515 --> 00:01:30.455
• how the person can orient themselves
independently in time and space

00:01:31.621 --> 00:01:34.000
• whether the person requires support

00:01:34.000 --> 00:01:36.273
because they have a mental health condition

00:01:36.273 --> 00:01:39.953
or shows certain behaviors, such as nighttime unrest

00:01:41.253 --> 00:01:45.000
• whether they can wash,
dress and feed themselves independently

00:01:45.746 --> 00:01:48.847
• how they are coping with illnesses and therapies

00:01:48.847 --> 00:01:52.000
and, for example, if they are able
to take medication unassisted

00:01:53.073 --> 00:01:56.000
• whether they consciously plan out their daily routine

00:01:56.000 --> 00:01:58.753
and are able to contact other people.

00:01:59.947 --> 00:02:04.340
Important: For the medical review service,
“independent” means

00:02:04.340 --> 00:02:08.593
that someone is able to do something
alone and unassisted

00:02:08.593 --> 00:02:11.000
or can handle a situation

00:02:11.000 --> 00:02:13.486
without the support of another person.

00:02:14.346 --> 00:02:18.560
A person is also considered independent
if they use patient aids to complete tasks.

00:02:20.000 --> 00:02:21.000
For example:

00:02:21.000 --> 00:02:23.793
Mrs. Miller has limited mobility.

00:02:24.606 --> 00:02:28.000
However, she gets about independently
using her wheeled walker

00:02:28.000 --> 00:02:29.766
and can take care of herself.

00:02:30.693 --> 00:02:33.593
Therefore, she is not assigned a care grade at present.

00:02:34.780 --> 00:02:38.746
The situation would be different
if her physical impairment was so severe

00:02:38.746 --> 00:02:42.666
that she would be unable to manage
without support from another person

00:02:42.666 --> 00:02:46.313
for a significant portion of her day
– even with a wheeled walker.

00:02:46.999 --> 00:02:50.299
In this case, Mrs. Miller would be deemed
to be in need of care

00:02:50.299 --> 00:02:53.698
and would be assigned one of the 5 defined care grades –

00:02:53.698 --> 00:02:56.425
based on whether she has any additional impairments.

00:02:57.238 --> 00:03:01.438
The care grade assigned to a person depends
on how much support they need

00:03:01.438 --> 00:03:04.477
– the greater their need for support,

00:03:04.477 --> 00:03:06.438
the higher the care grade assigned to them.

00:03:07.364 --> 00:03:10.470
A higher care grade also means greater benefits.

00:03:11.604 --> 00:03:13.777
Benefits include, for example:

00:03:13.777 --> 00:03:16.330
• Care allowance for care provided by loved ones

00:03:17.077 --> 00:03:20.530
• Care benefits in kind for care
provided by nursing care services

00:03:21.683 --> 00:03:24.663
• Care in a full-time residential care facility

00:03:25.690 --> 00:03:28.543
• Respite care for family carers

00:03:29.470 --> 00:03:32.196
• Financial subsidies for modifications to the home

00:03:32.196 --> 00:03:34.296
or setting up a care group home

00:03:34.916 --> 00:03:38.429
• Support options,
such as advisory services and training

00:03:39.889 --> 00:03:41.249
To recap:

00:03:42.282 --> 00:03:45.662
To receive long-term care benefits,
people must submit an application

00:03:45.662 --> 00:03:47.783
and have their need for care verified by

00:03:47.783 --> 00:03:50.302
the medical review service.

00:03:51.235 --> 00:03:53.596
Having an illness or disability

00:03:53.596 --> 00:03:56.042
is not enough on its own to qualify
as being in need of care.

00:03:56.042 --> 00:03:57.215
Rather, this is determined by

00:03:57.215 --> 00:04:00.862
• how much support the person requires from a carer

00:04:00.862 --> 00:04:05.476
• their impairments being expected
to last for a minimum of 6 months

00:04:05.476 --> 00:04:08.286
• and their severity meeting a certain defined level