When looking at health-related insurance policies and the care they cover, most people tend to think of more physical disabilities and conditions. This is especially true for long-term care insurance that most people attribute to elderly individuals who have lost control of their daily functioning or people who have been severely disabled and require 24/7 care.

However, long-term care isn’t just for physical ailments due to accidents, diseases, and the natural degradation of capabilities that come with age.

Mental health issues are extremely prevalent around the world, and in the United States, more than 8.4-million adults require some sort of long-term care for their mental illness ((1)).

Luckily, long-term care insurance can pay for the care necessary to not only help meet the daily needs of those suffering from a mental illness, but it can also help this part of the population maintain a high quality of life when it might otherwise be impossible.

Here’s everything you need to know about long term care for mentally ill individuals.

What Mental Illnesses Require Long-Term Care?

Like physical injuries, there are countless variations of mental illnesses. With physical injuries, some people heal quickly and it’s not a big deal, but some end up needing disability insurance to cover months or even years of time off work. Likewise, some mental illnesses might be fleeting or manageable and allow the individual to live a normal life with minimal treatment, but the same disorders might severely impact another individual’s ability just to meet their daily needs.

Because of this variation in how different people are affected by various mental illnesses, there’s no clear-cut list of illnesses that automatically qualify you or your loved ones for long-term care benefits.

Instead, it’s typically based on one’s ability to meet their daily needs independently and survive on their own. You should know these things when applying for disability insurance.

Here is a sample list of the most common illnesses treated with long-term care.

Autism:

While many people with Autism Spectrum Disorder live perfectly normal lives with little need for hands-on help in their daily routines, there are some individuals who, unfortunately, require help with things such as bathing, cooking, safely leaving the house and carrying out errands, or simply maintaining their living areas.

For people with this degree of ASD, it’s common to receive in-home care from their parents or guardians while receiving out-of-home therapy and medical care. However, when those guardians are no longer capable of caring for them due to old age or they pass on, the individual still requires aid. This may be provided via in-home care from a trained professional, homemaker service, or even a family member or friend trained to be a caretaker specifically for them. The situation may also require more intensive care such as a nursing home stay or residing in an assisted living center.

Long-term care insurance can help with both of these situations by paying for caretaker training, in-home services, or the more comprehensive forms of in-patient care.

Down Syndrome:

Like ASD, some people with down syndrome are capable of handling themselves perfectly fine or with minimal help, and they don’t necessarily require the help of long-term care services. However, that’s not the case for everyone, and similar options to those available for those with severe autism are also available for those suffering from down syndrome.

As the benefits available are practically the same, refer to the previous section for further details.

PTSD:

PTSD is a disorder that forms when someone goes through something horribly traumatic, and it causes a lasting impact on their quality of life. For some, this can be flashbacks triggered by certain noises, visuals, or discussions, and for others, it can be debilitating.

This can often require life-long, or at least long-term, intensive outpatient care.

Addiction:

Addiction is an unfortunate affliction, and once it takes hold, it can feel impossible to get away from. This means that breaking an addiction often requires lengthy in-patient recovery services and follow-up care to ensure that the addiction doesn’t once again send the patient into a downward spiral. Luckily, some long-term care providers recognize this and provide coverage.

General Anxiety Disorders:

A little anxiety before a job interview or during intense situations is something that affects everyone. However, for some, that anxiety can be nonstop and completely shut down their lives.

In the worst anxiety cases, long-term care in the form of in-home care can be necessary, and it is a recognized mental illness for long-term care purposes.

Bipolar:

Bipolar disorder has a broad spectrum of symptoms, and it tends to affect everyone differently. In the most basic of terms, it consists of uncontrollable mood swings that vary from manageable to debilitating.

It can be difficult, but with the help of doctors and other professionals, it is possible to get long-term care benefits in severe cases.

Eligibility is determined by the Impact on the Patient

The illnesses listed are only a small sample of what might potentially qualify for long-term care benefits. As you can see, it is less about what the mental illness or disorder is and more about how the individual suffering from it is impacted. There are several reasons for long term care insurance rejection so be careful.

Because of this, it’s a good idea to speak with your doctor and document the impact of your mental illness thoroughly to show that it in fact requires long-term care ((2)).

How Does Long-Term Care for Mental Illness Work?

Long-term care for mental illness can take many forms.

• In-Home Nurse and Homemaker: If your disability prevents you from cleaning the house, taking your medications appropriately, cooking, or other basic things that aren’t so medically intensive that you require a nursing home, you may qualify for in-home nursing or homemaker services covered by long-term care insurance.
• Caretaker Training: If you would prefer that a family member takes care of your in-home care needs, or you have a family member you’d like to take care of, long-term care insurance can pay for caretaker training. This training certifies you to take care of the individual and get paid by the state for it, and it is best paired with respite services that allow you to have a break from time to time.
• In-Patient Care: When a mental health issue is so severe that it requires 24/7 medical care and aid, a nursing home is likely the best option. However, an assisted living center may also be necessary if there are no caretakers available for in-home care or the medical needs required are just slightly more than what a caretaker can handle.

Those are the three main forms of long-term mental illness care, but there are slight variations on it, and some other services may be provided by your long-term care insurance policy if needed.

These are things such as:

• Bed reservation if you need to leave your long-term care facility.
• Adult daycare.
• Respite services for family caretakers.
• In-patient rehabilitation.
• Caretaker training.

However, keep in mind that long-term care insurance is not meant to cover what long-term disability insurance can cover. This is for life-long disabilities that stretch well beyond the age of retirement and affect much more than one’s ability to work full-time ((3)).

Do Mentally Ill People Qualify for Long-Term Care Insurance?

One concern many people have, whether they’re mentally ill themselves or looking to purchase a policy for a family member they want to protect in the long term, is that insurance companies will deny the purchase due to it being a pre-existing condition.

There’s a good reason for this. Insurance companies, in the past, tried not to insure people who were likely to need their benefits. After all, their business is usually profitable when people pay in and never, or rarely, end up needing to make a claim. However, that is no longer legal. A pre-existing condition cannot disqualify you from getting necessary health coverage, and it cannot result in higher rates or limited coverage ((4)).

This means that the old worries about being denied specifically because of the presence of a mental illness are now obsolete, and you or your loved one can expect the same rates and coverage as everyone else.

In fact, there are certain insurance providers who specifically cater to people suffering from various mental disorders to provide them with custom-tailored plans that suit the unique treatment needs of mental illness rather than the more general approach most insurance providers take.

What to Know If Long Term Care for Mentally Ill Individuals is Necessary

So far, you’ve taken a look at what types of illnesses are covered, the type of care insurance will pay for if you happen to have a policy, and whether or not you need to worry about being treated differently by insurers due to the mental illness being a pre-existing condition.

However, since long-term care insurance is practically a requirement if you end up needing long-term care, there are some other key aspects of it that you need to know.