Assessing the risk of cognitive disorders for LTC insurance

grocery shop clean house do laundry do laundry clean house grocery shop use transportation prepare meals use the telephone manage medications IADL functions tend to be complex, requiring a combination of physical and cognitive capacities. For example, shopping requires mobility and a relatively intact cognition to handle the financial transactions involved. Loss of IADLs are, […]

By Hélène Michaud | August 19, 2009 | Last updated on August 19, 2009
6 min read
  • grocery shop
  • use transportation
  • prepare meals
  • use the telephone
  • manage medications

    IADL functions tend to be complex, requiring a combination of physical and cognitive capacities. For example, shopping requires mobility and a relatively intact cognition to handle the financial transactions involved. Loss of IADLs are, in some ways, a precursor to future loss of ADLs.

    The ability to perform certain IADLs may be gender-related, in that women have traditionally performed some of the activities, while men have more commonly performed others. What matters is not only whether a person currently performs an activity but also whether he or she is capable of performing it if required to do so for an extended period of time — without assistance.

    The interview process as part of underwriting

    Personal history interviews (PHIs), usually over the phone, are being used for younger applicants while face-to-face interviews (FTFs) are conducted with older applicants (aged 70-plus). General information questions, such as those about employment, hobbies, activities and living arrangements, are asked to provide a basic understanding of the applicant. Medical questions are also used both to confirm application details and to elicit additional information on medical history. The applicant will be asked to provide a list of all prescriptions and over-the-counter medications taken and describe any medical equipment being used. In the case of FTFs, the assessor may also record the applicant’s height, weight and blood pressure.

    The applicant is also asked to participate in a cognitive exercise — such as the EMST as described above — to determine if there is any underlying impairment that will affect future memory function. The remainder of the assessment relates to questions about performing daily activities (ADLs and IADLs.

    At the end of the interview, the applicant will be asked to sign and date the face-to-face interview form. The assessor may ask to see a form of picture identification, such as a driver’s licence or passport to verify the signature.

    Along with the interview, medical records obtained from attending physicians complete the risk assessment process.

    Industry practices

    Most insurers are using the EMST as their screening tool for cognitive decline. This screen is easily administered and takes into account age, gender and education level as part of its complex algorithm to accurately determine underlying memory impairment.

    Now, let’s look at two case studies.

    On March 22, 2008, a 71-year-old male applied for a $3,000 per month, three-year benefit duration, 90-day elimination period home care and facility care policy.

    His application denied any medication use and stated that his last doctor’s visit occurred earlier in the month for a sore shoulder. The agent described him as active and independent. A telephone interview revealed the applicant remained medication-free and that the strained shoulder was treated with exercise. He reported being independent and he passed the cognitive portion of the interview.

    The medical records confirmed his shoulder self-report and also indicated a history of prostate cancer with no metastasis in 2005 and degenerative arthritis in his right knee with no limitations. His application was approved.

    On March 11, 2008, a 77-year-old female applied for a $1,500/month, lifetime benefit duration, 30-day elimination period comprehensive policy.

    Her application indicated a history of hypertension treated with Hyzaar and Tiazac, as well as an episode of shortness of breath in May 2007. No details were supplied for this episode or the diagnosis. Her last doctor’s visit occurred in February 2008 for a routine examination.

    During an in-person interview, she reported that her hypertension had been controlled since 1990. Along with the medications noted on her application, she also revealed taking lycopene, Nexium, Clonazepam, Zocor and Combivent. She also admitted a history of forgetfulness and memory loss for which she consulted her doctor but did not recall the complete details of the conversation.

    The assessor noted she was distracted, had wandering thoughts and had trouble remaining focused throughout the interview. She did not pass the cognitive exercise. Medical records were cancelled because she was uninsurable based on cognitive results and reports of forgetfulness/memory loss. Her application was declined.

    If you would like to learn more about LTC, plan to attend Canada’s first Long-Term Care Conference brought to you by Munich Re on Oct. 21. Follow this link for more details.

    Hélène Michaud is assistant vice-president, marketing, at Munich Re.

    (08/19/09)

    Hélène Michaud

  • clean house
  • grocery shop
  • use transportation
  • prepare meals
  • use the telephone
  • manage medications

    IADL functions tend to be complex, requiring a combination of physical and cognitive capacities. For example, shopping requires mobility and a relatively intact cognition to handle the financial transactions involved. Loss of IADLs are, in some ways, a precursor to future loss of ADLs.

    The ability to perform certain IADLs may be gender-related, in that women have traditionally performed some of the activities, while men have more commonly performed others. What matters is not only whether a person currently performs an activity but also whether he or she is capable of performing it if required to do so for an extended period of time — without assistance.

    The interview process as part of underwriting

    Personal history interviews (PHIs), usually over the phone, are being used for younger applicants while face-to-face interviews (FTFs) are conducted with older applicants (aged 70-plus). General information questions, such as those about employment, hobbies, activities and living arrangements, are asked to provide a basic understanding of the applicant. Medical questions are also used both to confirm application details and to elicit additional information on medical history. The applicant will be asked to provide a list of all prescriptions and over-the-counter medications taken and describe any medical equipment being used. In the case of FTFs, the assessor may also record the applicant’s height, weight and blood pressure.

    The applicant is also asked to participate in a cognitive exercise — such as the EMST as described above — to determine if there is any underlying impairment that will affect future memory function. The remainder of the assessment relates to questions about performing daily activities (ADLs and IADLs.

    At the end of the interview, the applicant will be asked to sign and date the face-to-face interview form. The assessor may ask to see a form of picture identification, such as a driver’s licence or passport to verify the signature.

    Along with the interview, medical records obtained from attending physicians complete the risk assessment process.

    Industry practices

    Most insurers are using the EMST as their screening tool for cognitive decline. This screen is easily administered and takes into account age, gender and education level as part of its complex algorithm to accurately determine underlying memory impairment.

    Now, let’s look at two case studies.

    On March 22, 2008, a 71-year-old male applied for a $3,000 per month, three-year benefit duration, 90-day elimination period home care and facility care policy.

    His application denied any medication use and stated that his last doctor’s visit occurred earlier in the month for a sore shoulder. The agent described him as active and independent. A telephone interview revealed the applicant remained medication-free and that the strained shoulder was treated with exercise. He reported being independent and he passed the cognitive portion of the interview.

    The medical records confirmed his shoulder self-report and also indicated a history of prostate cancer with no metastasis in 2005 and degenerative arthritis in his right knee with no limitations. His application was approved.

    On March 11, 2008, a 77-year-old female applied for a $1,500/month, lifetime benefit duration, 30-day elimination period comprehensive policy.

    Her application indicated a history of hypertension treated with Hyzaar and Tiazac, as well as an episode of shortness of breath in May 2007. No details were supplied for this episode or the diagnosis. Her last doctor’s visit occurred in February 2008 for a routine examination.

    During an in-person interview, she reported that her hypertension had been controlled since 1990. Along with the medications noted on her application, she also revealed taking lycopene, Nexium, Clonazepam, Zocor and Combivent. She also admitted a history of forgetfulness and memory loss for which she consulted her doctor but did not recall the complete details of the conversation.

    The assessor noted she was distracted, had wandering thoughts and had trouble remaining focused throughout the interview. She did not pass the cognitive exercise. Medical records were cancelled because she was uninsurable based on cognitive results and reports of forgetfulness/memory loss. Her application was declined.

    If you would like to learn more about LTC, plan to attend Canada’s first Long-Term Care Conference brought to you by Munich Re on Oct. 21. Follow this link for more details.

    Hélène Michaud is assistant vice-president, marketing, at Munich Re.

    (08/19/09)