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4 things you should know: LTCI paramedical exams

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Q. What can I do to help my clients prepare for the nurse’s visit for the paramed exam and cognitive assessment? What specific advice can I provide?

A. I’m finding that some of my clients — particularly those who are older – are very nervous about this face-to-face meeting. I include a page of suggestions in the package sent to clients, along with a copy of the application and other important information. 

To update my suggestions and to better understand what the carriers are looking for with the urine and blood tests, I turned to Ray Dinstel, senior vice president and chief underwriter at Genworth. 

He explained that, typically, the examiner (not all are nurses) who conducts the interview works for an outside company contracted by the insurance carrier. The interview takes about 45 minutes. Family members are not allowed in the room.

Here are four other things to know about the exam process.


Wheel of Fortune

1. What are the carriers looking for?

Ray said the examiners are usually testing for the following conditions: 

  • Cardiovascular risk factors such as high cholesterol and high triglycerides.
  • Liver and kidney function testing, and testing for diabetes.
  • Early signs of heart, kidney and liver disorders.
  • Illegal drugs and HIV. 
  • Sugar level. Only if the glucose is elevated do they then test for the A1C level.



2. What should the client do to prepare?

Ray suggested that the client should: 

  • Get a good night’s sleep.
  • Avoid drinking alcoholic beverages for at least eight hours before the exam.
  • If possible, fast for eight hours.
  • Avoid smoking or drinking coffee for at least eight hours before the appointment.
  • Drink a glass of water just before the exam.

On the instruction sheet I send to clients, I also recommend the following:

  • Before the visit, review the medical questions on the application and have that information with you during the meeting. You may be asked for information about your primary care doctor, any specialists seen, their contact information, and any medications you’re taking. 
  • Be sure to mention your activities, interests and exercise — what you do and how often. 
  • For the cognitive testing, the examiner may use a 10-word recall segment. Be sure to concentrate on the words given because you will be asked to recall them later in the interview.


3. Could there be any surprises?

I always tell clients, “Think before you answer, because you may be asked some in-depth questions.”

Here are three examples. 

  1. Even if the carrier’s application asks if during the last ten 10 years have you received treatment for … X — you could be asked “have you ever received treatment for….”
  2. Instead of asking whether you have neuropathy, the question could be “do you have tingling in your hands or feet?” 
  3. “Have you ever been declined for any type of insurance in the last five years?”


George Washington

4. What should I tell clients who think they’re hilarious?

During the exam: Don’t tell any jokes or make kidding remarks about your health or about anything. These jokes and remarks will be taken seriously.

See also: Guides for a new LTCi world.