SENIOR/LTC ASSESSMENT TRAINING MODULE

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2 Welcome to the Superior Mobile Medics Senior/LTC Assessment Training i Module Learning Objectives Gain familiarity with the Senior/LTC Assessment process, including company-specific requirements. Know the importance of professionalism, politeness, patience, tactfulness and attentiveness. Appreciate the potential for hearing and/or vision difficulties in the age 70+ population. Understand the components of the Senior/LTC Assessment. Realize the necessity to provide complete, accurate and objective observations/documentation. t

3 Introduction To help assess additional risk factors sometimes associated with the elderly, insurance carriers have developed various versions of a Senior Assessment Form. These forms have a number of different of names, depending on the company. For example: Supplemental examiner s report for age 70 and over (Genworth) Mature Supplement for Age 71 and Older (John Hancock) Aged 71+ Questionnaire (Ing) Senior Assessment Form (SMM generic) Etc. Senior Assessments are often performed as part of an application for long-term care insurance. Long-term care insurance is a type of insurance developed specifically to cover the costs of long-term care services, most of which are not covered by traditional health insurance or Medicare. These may include in- home assistance with Activities iti of Daily Living i as well as care in a variety of facility and community settings. There is generally a great deal of choice and flexibility in long-term care insurance policies.

4 General Instructions for the Examiner A Senior Assessment is a face-to-face interview performed by an approved medical/paramedical examiner. The assessment should be completed in the applicant s residence so that observations of the applicant s living environment may be made. The Senior Assessment is a supplement. It is to be completed in addition to the usual underwriting requirements. Be sure to use the correct form! Read all pages of the exam form completely before meeting with the applicant. Every company s form is different than the next, so it is important to be familiar with the form ahead of time. All questions should be asked exactly as written and company-specific requirements followed. Results should be recorded in a consistent manner. To complete the assessment, you must have a stopwatch and measure tape. Some companies include word recall flash cards as part of their assessment. These should but cut out prior to the assessment. Please be sure that all answers are complete and printed legibly.

5 General Instructions for the Applicant The Senior Assessment may be introduced to the applicant as an assessment of living, mobility and memory. The assessment is required based on age, regardless of health. Instruct applicant to listen closely to the instructions and ask for clarification if not fully understood. A sturdy straight backed chair without wheels or soft cushions (e.g., kitchen or dining room type chair) will be required. Applicant should wear properly fitting shoes that do not slip and that have flat heels. You should inquire as to whether the applicant has any history of dizziness upon standing.

6 Components of the Senior/LTC Assessment Components of Senior Assessments vary from company to company. It is important to be familiar with the company s form that you are going to use ahead of time. Typical assessment components include: 1. Applicant Information/Identification 2. Orientation 3. Cognitive Questionnaire 4. Delayed Word Recall: Introducing the Words 5. Questions on Activities of Daily Living 6. Get Up and Go Test (Mobility Test) 7. Clock Drawing 8. Delayed Word Recall: Recalling and Recording the Words 9. Examiner s Observations 10. Signature(s), Date, Stamp, etc. 11. Addendum: Chair Stand Test (Select Companies)

7 Senior Assessments are Unique As a Superior Mobile Medics examiner, it is important to dress and conduct yourself in a professional manner at all times. Because of the nature of some questions in Senior Assessments, it is particularly l important t to develop a good rapport with the applicant. This includes exercising patience, tactfulness, politeness and objectivity when interacting with the applicant. It is also important to be an attentive listener. Remember that poor vision and/or poor hearing may be factors in communicating effectively with the elderly. The sequence of events in Senior Assessments varies from company to company. Be sure to understand and follow the specific instructions provided with each exam form. The assessment should be conducted in a private and quiet The assessment should be conducted in a private and quiet location, free of distractions and conducive to good communication and concentration.

8 Senior Assessment Procedures If more than one person is being assessed, they should be completed one at a time, and the second applicant should not observe or overhear the first interview. A different set of delayed word recall words are required for the second applicant s exam. Be sure to sit close enough to the applicant to ensure that you can be easily seen and heard. Speak clearly, audibly, and in a non-rushed manner. Ask all questions exactly as stated on the form. Allow the applicant adequate time to think about each question before answering. Record the applicant s responses exactly as they are given. Be objective and avoid any judgment or interpretation of the applicant s answers, behaviors or performance. Any observations or remarks that you make will be taken seriously. Any observations or remarks that may be of a sensitive nature should be recorded after leaving the applicant s premises.

9 1. Applicant Information/Identification ifi i Record the following applicant information, as instructed: Name DOB Driver s License Number Driver s License State ID verified

10 2. Orientation Oi i Record the applicant s answers to questions such as: Today s date Current month Current year Day of week Day of month Home address Home telephone number Current season

11 3. Cognitive ii Questionnaire i The Cognitive Questionnaire includes orientation questions as well as mental exercises such a subtraction or noting the similarities between two objects. Ask applicant the questions and check "Y Yes " or "N No " to indicate correct or incorrect answers. For example: Date Day of Week Address Telephone number Age Birthdate Current US President Immediate prior US President How are the following objects alike (e.g., orange/banana, horse/dog) Subtraction exercise

12 4. Delayed Word Recall: Introducing the Words Note: If required, be sure that single word flash cards are separated (by cutting along the dashed line) prior to beginning the evaluation. Explain to applicant that this is a memory test. Tell the applicant that you are going to read out loud a list of words (or have applicant read words off of flash cards) one at a time. Then, ask the applicant to say the word and then use the word in a sentence. The sentence may be as long or as short at the client likes. Proceed through the list of words, one at a time, having the applicant repeat/read each word and use it in a sentence. Be sure that the applicant understands each word before going on to the next. Continue until all the words have been used and a sentence for each has been given. Many companies ask that the applicant then repeat/read each word a second time and use it once again in a sentence. The second sentence may be the same as or different from the first. The sentences do not need to be recorded. Note the time when completed. The recall part of this test should occur with 5 and 10 minutes after this time. If there is a spouse on a joint application, i use a different set of words for the second applicant.

13 5. Questions on Activities i i of Daily Living i Activities of daily living include such things as bathing, dressing, toileting, transferring, continence, and feeding. Ask the series of questions related to activities of daily living exactly as written. Record the applicant s exact responses. Please provide any additional information, as requested. Some companies have an additional advanced Some companies have an additional advanced activities of daily living section. In such cases, please ask the applicant the additional questions and record answers as provided, along with any additional information requested.

14 6. Get Up and Go Test (Mobility Test) Note: You will need a stopwatch and tape measure for this task. Applicant should provide a hard-backed chair without wheels or soft cushions (e.g., kitchen or dining room type chair). Applicant should wear properly fitting shoes that do not slip and that have flat heels. You should inquire as to whether the applicant has any history of dizziness i upon standing. If required, please ask the applicant the questions provided regarding mobility, along with additional information as requested. Tell the applicant that this is a walking test. If the applicant does not feel able to perform the test, do not proceed. Record this on the exam form, and follow any indicated indicated company-specific guidelines. Similarly, the test should be stopped immediately if you have any concerns about the applicant s safety. The instructions for the Get Up and Go Test (Mobility Test) generally include recording how long it takes (in seconds) for the applicant to get up from a seated position, walk 10 feet, return and sit down again. Sample instructions: Please stand up, walk 10 feet, turn around, walk back to the chair and sit down. You should be in a position such that you are adequately able to observe and assess the applicant s gait.

15 6. Get Up and Go Test (Mobility Test) - continued Be attentive in observing whether the applicant appeared steady, with arms swinging alternately at the sides or if the applicant s gait showed any difficulties or abnormalities, such as lack of balance, inability to walk straight, any limping or shuffling of feet, etc. Also be sure to document whether any assistive devices (e.g., cane, walker, etc.), physical assistance of another person or any supportive structures (holding onto arms of chairs, furniture, walls, etc.) were used. Timing should begin when the applicant first starts when they get out of the chair and end when he/she sits back down again. Some companies ask that the time be recorded to the tenth of a second (e.g., 11.4 sec), if possible. If you do not have a measuring device, take ten steps heel-to-toe (or three strides) for measuring purposes. At the ten foot measurement, put a pencil or piece of paper on the floor to identify the distance to be walked. Note the applicant s mobility, any abnormalities (e.g., was unable to do so without help, lost balance, require more than one attempt, used walking aid, mild staggering but catches self, almost falls, or collapses into chair when sitting back down), or if it took the applicant greater than 20 seconds to complete the task.

16 7. Clock Drawing Read the exact instructions to the applicant as instructions for this test may vary slightly from company to company. Have applicant complete/draw a clock face in the designated area on the exam form. The clock face should include all of the numbers, 1 to 12, within a circle (as if it were a clock). Have the applicant draw the hands of the clock to reflect the time indicated in the instructions.

17 8. Delayed Word Recall: Recalling and Recording the Words If at least five minutes (but no greater than 10 minutes) have lapsed since completing the first part of the Delayed Word Recall test (Introducing the Words), it is now time to finish the test. Tell the applicant that a few minutes ago you asked them to read/repeat a list of words and use them in sentences. Ask the applicant to please recall as many of these words as possible. Confirm and indicate the correct words recalled on the form as well as how many of the works were correctly recalled. Be sure to record the recall start and end times as indicated on the form.

18 9. Examiner s Observations Please answer the questions listed and provide any additional comments. Any observation or remarks you make will be taken seriously. Please be detailed and clear in offering observations. Any comment of a sensitive nature should be recorded after leaving the applicant s premises. This may include such things as applicant demeanor, living environment, anything unusual not previously mentioned in the assessment, etc. Be sure that any supplemental pages are properly identified.

19 10. Signature(s), Date, Stamp, etc. Please provide all information required. For example: Examiner name Examiner signature Date SMM info Location of exam APPLICANT SIGNATURE (Most companies do not require an applicant signature on Senior Assessment/LTC Forms, but some do. Please be sure to check carefully!) Thank the applicant for his/her time and cooperation!

20 11. Addendum: d Chair Stand Test (Select Companies) In the event that the timed Get Up and Go Test cannot be completed, some companies ask that a Chair Stand Test be completed instead. Do not administer i the test t for any of the following reasons: You are at all concerned that the applicant cannot safely complete the test. The applicant cannot perform the test or is unwilling to do so. The applicant is confined to a wheelchair or has any other mobility problems that prevent him/her from rising from a chair. The applicant does not understand the directions. A chair as described in the Chair Stand Test is not available.

21 11. Chair Stand Test - continued Chair Stand Test Overview: You will ask the examinee to rise 5 times from a sitting position in a chair without using his or her hands. You will record the time the examinee needed to perform this exercise. If the test runs past 60 seconds, stop the test. Also stop the test if you have a concern that the examinee is not stable. The most important thing is the safety of the examinee.

22 11. Chair Stand Test - continued Important things to remember in order to administer the test correctly: Use a stable, straight-back chair, preferably one without arms. Make sure the examinee can sit with his or her feet flat on the ground. Do not use a chair with wheels, that will slide, or with soft seat cushions. Make sure the area around the chair is clear of all obstacles. Prepare the examinee for the test using the script below. Conduct the test using the script below. You must record the exact number of seconds required to rise from a sitting position 5 times. Begin timing as the examinee starts to rise the first time and end the test when the examinee is standing the fifth time. Accuracy in timing is critical. Even one second can make a difference in the final assessment. Record the time and any comments in the fields provided.

23 11. Chair Stand Test - continued Instructions for the Applicant (Script): EXAMINER: This is a short physical test that I will be conducting today. First, I m going to explain the test. Do not start the test until I tell you to do so. You will start in the chair as you re currently sitting with your feet flat on the ground. I will ask you to fold your arms across your chest and rise from the chair without using your arms or hands for support. You will do this once for practice to make sure that we are both comfortable with you continuing the test. After the practice try, we will start the test. I will ask you to rise from the chair 5 times and I will record the total time it takes you to rise from the chair 5 times. I will count for you each time you complete a rise so that you know how many times you have done it. The test will be over when you have risen for the 5th time. Do you understand these directions? (Make sure that you receive an affirmative response.)

24 11. Chair Stand Test - continued EXAMINER: If at any time you feel uncomfortable, dizzy or like you are going to fall, let me know and we will stop the test. Do you have any questions or concerns before we begin? (Answer any questions. If you or the applicant has concerns about his or her ability to do this test, do not continue.) (Position yourself so you can help the examinee if they stumble.) EXAMINER: Ok, let's try a practice rise. Fold your arms across your chest and stand up whenever you re ready. (Observe closely. If you believe the examinee will have difficulty with this test, do not continue. Instead, record your concerns in the comment section.)

25 11. Chair Stand Test - continued EXAMINER: How was that? Are you ready to continue with the test? Do you have any other questions before we begin? (Answer any questions. Once you both are comfortable that the examinee can perform test, continue.) EXAMINER: When I say begin, I want you to rise from your chair, sit back down and rise again. You will rise 5 times in total, and I will count for you each time you rise. Are you ready? (Make sure your stop watch is set. You will need to look at both your watch and the examinee to make sure there are no concerns during the test. Remember: safety is most important. Begin when you are ready.)

26 11. Chair Stand Test - continued EXAMINER: Begin. (When the examinee rises for the 5th time, stop the test. If the examinee takes more than 60 seconds, stop the test and thank them for trying.) (Record the time to complete in seconds. If the examinee had any difficulty performing the test, please add observations to the comments section.) (This completes the Chair Stand Test.)

27 SENIOR/LTC ASSESSMENT SlfCh Self-Check (Choose the best answer to each question.) Question #1 The objective of a Senior/LTC Assessment is to provide complete and accurate information to insurance underwriters in order to make an informed decision regarding an applicant s insurability? A. True B. False A. True. To help assess additional risk factors sometimes associated with the elderly, insurance carriers have developed d various versions of a Senior/LTC Assessment form to provide a report of complete and accurate information. This assessment enables insurance underwriters to make an informed decision regarding the issuance of an insurance policy.

28 SENIOR/LTC ASSESSMENT SlfCh Self-Check Question #2 Unless otherwise specified, Senior/LTC Assessments should be completed in the applicant s residence. A. True B. False A. True. Senior/LTC Assessments should be completed in the applicant s residence so that observations can be made related to the applicant s living environment. The assessment should be conducted d in a private and quiet location, free of distractions ti and conducive to good communication and concentration. Be sure to sit close enough to the applicant to ensure that you can be easily seen and heard.

29 SENIOR/LTC ASSESSMENT SlfCh Self-Check Question #3 Things to do prior to conducting a Senior/LTC Assessment include: A. Review the exam form and all instructions B. Be sure that you have a stopwatch and measuring tape C. Cut out word flashcards for the Delayed Word Recall testt D. All of the above. D. All of the above should be performed prior to conducting a Senior/LTC Assessment.

30 SENIOR/LTC ASSESSMENT SlfCh Self-Check Question #4 Senior/LTC Assessments on husbands and wives may be conducted d together. th A. True B. False B. False. If more than one person is being assessed, they should be completed one at a time, and the second applicant should not observe or overhear the first interview. A different set of delayed word recall words are required for the second applicant s exam.

31 SENIOR/LTC ASSESSMENT SlfCh Self-Check Question #5 The recalling and recording of words portion of the Delayed Word Recall test t should be performed how long after the words were introduced. A. 3-5 min B min C min D. None of the above B 5 10 i Th lli d di f d ti f th D l d W d R ll t t B min. The recalling and recording of words portion of the Delayed Word Recall test should be performed no sooner than 5 minutes and no later than 10 minutes after the words were introduced.

32 Congratulations! You have completed the Superior Mobile Medics Senior/LTC Assessment Training Module. ( )