Lianne is a 66-year-old widow who lives alone at home. She also has Alzheimer's disease. Her daughter Charlotte is a telephone technician who lives nearby with her family. When Charlotte's company offered the Long-Term Care Insurance Plan to parents and parents-in-law of active employees, Charlotte showed the information to her mother. Together they made the decision to enroll Lianne in the plan. At that time, Lianne was in good health and was approved for coverage immediately. Charlotte has never regretted that decision she and her mother made to enroll in the plan.

When Lianne first began exhibiting symptoms of Alzheimer's - forgetfulness, unpredictability, mood changes - Charlotte called a John Hancock patient advocate. The patient advocate, after obtaining information from Lianne's physician, determined that Lianne met the requirements to be certified for benefits under the plan. Lianne completed her Qualification Period (the time between being certified for benefits and when reimbursements can begin for covered services), and thus became eligible for benefits. Knowing how important familiar people and surroundings are to Alzheimer's patients, however, Charlotte initially tried to deal with the problem of Lianne's care herself. "I went to the house each morning before work," she says. "I dressed her and got her ready for the day and did my best to make sure she'd be all right."

Though the time spent with her mother added to Charlotte's busy schedule as a full-time employee, wife, and mother, both she and Lianne found the morning visits reassuring. However, as Lianne's illness progressed, Lianne began to wander away from home, and she often forgot to eat if she wasn't reminded. Charlotte began to feel uncomfortable each time she left her mother. And her concern about Lianne began to affect her work. "I was constantly worrying. I couldn't concentrate on what I was doing for fear of what might be happening with mother at home, alone."

Charlotte spoke with her sister Ruth, who was employed full-time as well and lived several hours away by car; they discussed the problem at length and decided Lianne needed care throughout the day. Charlotte enrolled Lianne in an adult day care center. A van picked Lianne up each morning and dropped her off at the end of the day. Charlotte continued to look in on her mother each morning and evening. This schedule placed increased stress on Charlotte, but served Lianne's needs well, at first.

However, after six months, the center began to experience difficulties in dealing with Lianne. They were unequipped to provide the constant supervision she required as her condition became worse. "The assistance of our patient advocate at John Hancock was invaluable at that point in helping us find an adult day care center that specialized in meeting the needs of Alzheimer's patients," says Charlotte. "The staff at the center that was suggested is trained to deal with the disease, and they provide a full schedule of well-organized, appropriate activities."

The new center addressed Lianne's needs during the day: the next challenge was to deal with her needs around the clock. She now required help with such day-to-day activities as eating, getting dressed, and completing personal hygiene tasks. She also needed overnight supervision, as Alzheimer's patients often have trouble sleeping and may get up, wander out of the house, or injure themselves.

Charlotte and Ruth again discussed alternatives with their patient advocate at John Hancock. They considered placing Lianne in a nursing home, but eventually decided on home health care. Home offers comfort and reassurance, making the confusion that accompanies Alzheimer's somewhat less because of the familiar setting. The combination of adult day care and home health care provided Lianne with 24-hour care during the week. On the weekends, her daughters would take turns caring for her.

Now, each Monday through Friday, a home health aide arrives in the morning to help Lianne dress and bathe. The aide feeds her breakfast and takes her to the adult day care center. There Lianne enjoys a hot lunch and social recreational activities designed to help Alzheimer's patients maintain some abilities they would otherwise lose more quickly. In the evenings, another aide picks her up, takes her home, and feeds her dinner. The aide stays with her through the night. If Lianne gets up, the aide is there to direct her back to bed. She has the security of a daily routine, the same two home health aides take care of her each day and night, and she has a familiar environment with a daily program designed specifically to help manage her illness as well as possible.

Meanwhile, Charlotte is able to focus once again on her job responsibilities, husband and children, with the peace of mind that comes from knowing her mother is well cared for in appropriate, supportive surroundings. Both Charlotte and Ruth can go to work each day during the week without feeling anxious about their mother's care, and they approach the weekends as fresh and effective care givers. "If we didn't have long-term care insurance through John Hancock," Charlotte notes, "we wouldn't be able to afford both home health care and adult day care. I don't know what we would have done."

Charlotte and Ruth also had discussions with Lianne's claim approver at John Hancock to make sure the Long-Term Care Insurance would cover expenses for the care provided by two home health aides. Since Lianne does not need skilled nursing care, Charlotte and Ruth were able to choose independent certified home health aides who work at a lower hourly rate. This enables Charlotte and Ruth to conserve more of Lianne's benefit dollars for future use. "Mom could be like this for years," says Charlotte, "and we want her cared for properly the entire time."

While conserving benefit dollars is important to the family, maintaining appropriate, high-quality care is equally important. With the help of Lianne's John Hancock patient advocate and claim approver, Charlotte and Ruth are able to make decisions that assure their mother is receiving the necessary care in the most economical way possible. Charlotte gives her mother's patient advocate and claim approver much of the credit for this successful outcome. "They're wonderful," she says. "They are always there when you need them. We've had a very positive experience with the Long-Term Care Insurance offered through John Hancock."

[ Suzanne ]