Any advice about LTC insurance and what options there are for care at home?

Their LTC plan, @ $120 a day is somewhat low as SNF/ NH cost 8-12K a month. Maybe coverage for AL, but I don’t think a needs assessment on them (which the policy will want done) will show AL placement, their more SNF. It’s $120 for each of them, right?

I imagine they are all insistent on staying at home, right? Imo the issue will be in finding a In-home health agency who will take them on as clients in their home without someone else living there as they do not sound capable & cognitive enough to be just them. Once he finds policy, look at how needs assessment is done / required. Going to be super important as the insurance payment will depend on appropriate placement.

So next ?, Why ineligible for Medicaid?
Is it an issue of being over resourced (too much $ in the bank), then they spend down to get to the point of whatever the $ amount are needed for them to be eligible. If I’m not mistaken that LTC policy $ will count into “income” as resource. It’s not an “asset”, it’s income. Excess income can be dealt with, like a Miller Trust or QIT done.

How you described their health needs, it sounds like 1 becomes a NH spouse (stepmom) and community spouse (your dad) situation. The system on getting this done correctly for LTC Medicaid, imho, is not at all simple as there’s a segregation of income and assets that has to happen and likely changing of existing legal (like will in which they are each others beneficiary aka a pour over, that needs to be changed so codicils gets done) needs to happen. It’s CELA level of elder law attorney work so dad stays in the home, dad seeks a waiver to get as much of her income as plausible so he’s ok financially; she’s LTC Medicaid eligible even if her required copay of her solo income to the NH is teeeny tiny + the $120. But isn’t simple, best off attorney expertise to do.
OR
ineligible for Medicaid due to them gifting $ or assets fairly recently? Way different type of problem. Sometime those can be dealt with by an experienced in Medicaid attorney.
OR
is it they refuse to leave?? If so sadly wait it out till one or both have a fall. Fall places them in a hospital (Medicare) then discharged for rehab (post hospitalization Medicare benefit) then determine they cannot safely return home so stay in the NH and private pay till impoverished, file the LTC policy benefits & spend down 2b eventually ok for LTC Medicaid.

fwiw their home remains an exempt asset for Medicaid for their lifetime. If need be, and they both end up in a NH, the house could essentially get locked up and then over t…i..m..e, the family deal with getting the crap moved out. If the folks flat won’t hear about selling it, this might be a way to manage the situation. Like you kinda fib and tell them eventually they will go back but knowing that is not happening. If it takes 3 years to have time and energy and sense of humor to deal with it, it is what it is.

Now if doing this, property costs will need to be paid by the family cause if both are in a NH, their income (SSA, pensions, LTC insurance, etc) becomes a required copay to the NH under LTC Medicaid rules. But a modest value older house, paid off so no mortgage, left empty so low utilities could be manageable $ for the kids to do the costs on while over time y’all get in and jettison stuff, knowing they are safe & secure & being cared for and no more of that drama/ emotion & time of dealing with them in that nasty home. Something for you, hubs & SiL to think about.

Keep in mind, that Medicaid cannot make family / heirs deal with the house. We do it under a sense of familial responsibility or a fiduciary duty as a POA if feasible. Families do choose not to deal with homes.

"What sort of options might be available for someone to come in to their home? "

Are you referring to the hoarder's home? The one that is...

"...an unmitigated disaster. Just piles a stuff everywhere... papers and junk and filth everywhere. There’s so much you can’t even begin to dust, sweep, mop." ?

I don't think any agency would allow their workers to be forced into such an environment. It's a health and liability issue. I'm not sure any private aid would want to, either. You will need to give full disclosure up front to anyone you are thinking of bringing into their home to provide care.

You may need to use some of their funds to clean up the house first. If no other reason but for the sake of your SIL.

They both need to be in a facility, probably memory care. From what you describe, this is way too much for care at home. That seems to have been true for a long time!

Care at home is very hand to manage. Care in a facility provides 24/7 care and you won't have ongoing emergencies such as home caregivers not showing up,

Please get your family to rally around and change their thinking. No matter what you promised before about keeping them at home, don't. You need them to have the best professional care possible, and good luck.

Contact their health insurance company about that long term insurance plan. They should be able to locate the plan and advise you of the benefits available. Then, call the local home health care agencies for information. Good ones will offer to send an RN to make assessments of your parents' needs and make suggestions of the types of care they offer. Start by setting up each of your parents with a pill box of their daily medications. Home health aides can not dispense medications, but they can "remind." Most home health care aides are contracted for at least 4 hour shifts to provide personal care. Some will also provide some care of the home. However, the home issues you describe may require a cleaning crew to come in and clean majority of the home first.

You've received a lot of good advice here, but I just want to add that there is so much variation in LTC policies that I don't think any of us can advise you without knowing the specifics of the coverage. At best, we can describe our own experiences. For example, several posters have mentioned a daily limit on coverage. My husband's policy did not have a daily limit on coverage for at-home care, nor was here any specific number of years of coverage specified. I don't believe there was a daily limit for nursing home care either. There was a total lifetime benefit and he could use it however it worked best. In addition, one nice surprise for us was that once he stared drawing benefits we no longer had to pay premiums. We did have to hire aides through an agency that was on the insurance company's approved list; the agency nurse paid a home visit to certify initially, and the agency had to provide certain documentation annually to the insurer. After the first year there was an outside nurse contracted by the insurer who came to our home to re-evaluate. I was impressed with how thorough she was. She even had us demonstrate how my husband did with toileting and showering--what he could do himself and what he needed help with. We didn't have any more outside evaluations after that year, I think because Covid hit so they weren't doing them.

If they have a long term care policy I would find it and see if you can use it. It sounds like you have more than enough on your plate and that policy would help greatly! Momma has one and since I am out of town and the primary caregiver it has been a huge help. She is in assisted living. Once I filled out the huge amount of paperwork and she got qualified they pay every dime of her assisted living fee and that is now almost $6,000.00 a month. Just went up an additional $500.00 a month. Last year it went up $200.00 a month but this time it more than doubled. She still has a pretty good portion left on her policy. She is 89.

I would recommend hiring a professional organizing company; I am one and we handle situations like that. Go online and look at the NAPO organization to find one in your area (National Association of Professional Organizers). My dad has LTC insurance that we are currently using. We had a social worker give us several recommendations for in home care companies. In home care company we chose was great. Told us what dad needed to do for his assessment to get LTC to approve it. His caregiver does light housework (sweeping).
Good luck!

I'll talk about what long term care aides are likely to be able to do once the home is cleaned up. The house needs to be cleaned up first. That is a must. You can get an agency to clean out their home for them - if you pay for it, of course. There are agencies that deal specifically with the situation that you have described. I would look for an agency that deals with "downsizing" and relocating of the elderly. Well you don't intend to relocate these folks, they have the expertise to clean the place up and perhaps even remove some furniture - if it's too cluttered. Once that is accomplished, an agency can be identified with care aides that can come to the home. There will be an intake interview to make sure that there is a good match between the agency and the people being cared for. And keep in mind that one aide is responsible for one person, not both. The agency does not have to sign on if the situation seems too difficult . Depending on your community this will cost you maybe $25.00 an hour or more. $120 a day will not go far. For the money, they will watch one loved one, help shower and toilet one of them, take one of them to doctor's appointments, prepare meals, perhaps do some light house keeping and laundry. One thing that aides cannot do, by law, is dispense prescription medicine. Only medical professionals can do that. The clients must be able to take their own pills or have a friend or family member give them pills. The aide can remind them to take their pills but the patient must be able to take the pill out of the bottle and take it themselves. In my experience there's a lot of turnover in these agencies and you must expect to do a lot of prep work to make sure that they keep coming and are useful to you. You'll need to prepare guidelines for them, watch over them carefully, make sure they show up and do the tasks for which they are assigned. When I used aides for my husband, I had a whole binder full of instructions, even photographs, to show them what needed to be done. I realize that the aides only were valuable because I was there everyday watching them. To do this long distance is really tough. Good luck!

Igloo572 has thoroughly explained the legal path your step-sister and/or you need to take in order to care for your dad and step-mother in the future.

First, you need a copy of the policy to answer your question about LTC insurance and whether it covers in-home care. One way to find the insurer's name is to check their bank statements for monthly LTC insurance payments to the insurer. You pay premiums, usually for as long as the policy is in effect, and make claims if you ever need the covered services. The only way to be certain your dad and step-mom have LTC insurance is to verify it. They should still be paying monthly premiums. A copy of the policy will spell out exactly the terms of the policy.

Not all LTC insurance policies are the same. Most policies require policyholders to need 90 consecutive days of services or disability. For example, if your elimination period was 90 days, you would need to be in a hospital or disabled for 90 consecutive days before any coverage begins. After the elimination period is satisfied, the benefits of the maximum monthly pay-out may kick in or not. My LO's LTC policy would only pay one-third of the maximum monthly benefit for in-home care. After LO moved to AL, the monthly benefit increased to 2/3 of the maximum monthly benefit. LO's LTC paid the maximum monthly benefit only when he was in Skilled Nursing Care. In my LO's case, Memory Care did not qualify for a maximum monthly benefit payout.

Obtaining a copy of the LTC policy is a must. Good luck!

Searching for the paperwork on the policy...does this mean they do not know the name of the company? Have they been making payments yearly? If so contact the bank for copies of checks.
If they have not been making payments it is possible that the policy has been cancelled/forfeited. . If there was any value to it if they are entitled to any the State Treasurer may have it in "Lost Cash" check their State Treasurer Website for any cash in their names.
If dad is a Veteran he may qualify for some services through the VA. Contact your local Veteran's Assistance Commission and they can help. (there is no fee for their service)