The vocabulary frequently used in long-term care insurance

This is a fundamental notion in long-term care insurance; these activities fall into the following five categories:

• Personal hygiene
• Elimination
• Nutrition
• Dressing
• Mobility

Care and support in these areas are decisive when it comes to determining whether a person is in need of long-term care insurance within the meaning of the law. The need for assistance in activities of daily living must represent at least 3½ hours per week. These 3½ hours per week constitute what is called the threshold for receiving benefits under the long-term care insurance (seuil d’entrée).

The State office for Assessment and Monitoring of the long-term care insurance  is under the authority of the Ministry of Health and Social Security.

It is tasked with assessing the level of the applicant’s dependency and defines the services and benefits the dependent person is entitled to receive.

It also has the mission of providing information and advice as well as monitoring the quality of the services provided.

A caregiver is a third person who provides some or all of the care and support for the dependent person in the home, without belonging to a care and assistance network.

This third person may be a relative or friend, a person bound by an employment contract, or a professional who does not belong to a care and assistance network.

In its assessment, the AEC decides whether the person providing care and support may be accepted as a caregiver within the meaning of the law. If its decision is favourable, it is possible to convert part of the benefit in kind into a cash benefit.

Subject to certain conditions, the long-term care insurance pays the pension insurance contribution of a caregiver who provides care and support in the home. You can obtain more information from the Joint Social Security Centre (Centre Commun de la Sécurité sociale - CCSS): tel. (+352) 40141-1 / website at www.ccss.lu.

The CNS is the management body for the long-term care insurance.

Applicants send the CNS an application for the services and benefits of long-term care insurance to be granted; the CNS checks that the applicant is affiliated to the Luxembourg social security system and makes sure the application is complete.

The CNS is also the body that makes decisions (following the AEC’s opinion), and is responsible for paying benefits. It draws up the budgets of the long-term care insurance and checks expenditure.

This is a facility that receives dependent people during the daytime. It is often referred to as a day centre (centre de jour, foyer de jour).

Dependent people receive all the care and support they need during the time they spend at the facility. They can join in supervised activities adapted to their state of health.

A professional in a care and assistance network responsible for organising the work of the staff providing care and assistance in the home. The dependent person may contact this coordinator about anything involving the everyday actual organisation of his/her care and support under the long-term care insurance.

The decision is made by the CNS on the basis of the opinion of the AEC and sent by the National Health Fund (CNS) to the applicant.

The decision informs the applicant if he/she has been recognised as being dependent and indicates the date on which entitlement to benefits starts.

With the decision, the applicant receives a summary of care and assistance (synthèse de prise en charge), which provides information on the various benefits to which the dependent person is entitled, on the level of weekly needs in terms of care and support, and on the applicable lump-sum payments (forfaits de payement).

It also explains how to contest the decision if the applicant does not agree with the benefits granted.

Once the person’s state of dependency has been assessed, the contact person for the case (référent) sets out in summary document the care and support the dependent person needs and to which he/she is entitled per week.

This summary also makes it possible to check whether the person concerned has reached the threshold (seuil d'entrée) for receiving benefits under the long-term care insurance or not.

A facility that provides accommodation for dependent people both during the daytime and at night, and provides them with all the care and support they need.

There are two types of long-term care facilities:

• long-term care facilities – continuous stay,
• long-term care facilities – intermittent stay.

These are facilities where dependent people live permanently; they are mainly for the elderly. They include integrated centres for the elderly (centres intégrés pour personnes âgées - CIPA), often referred to as retirement homes (maisons de retraite) and care homes (maisons de soins).

At these facilities, dependent people alternate between staying in a facility and living at home. These facilities are exclusively for handicapped people.

A health professional (doctor, nurse, psychiatric nurse, physiotherapist, ergotherapist, psychologist) from the State Office for Assessment and Monitoring (Administration d’évaluation et de contrôle - AEC) who assesses the level of the applicant’s dependency, at home, at the AEC’s premises, or at a facility. The assessor is normally the contact person and ensures the follow-up of the dependent person’s case.

The assessment of the applicant’s degree of dependency is carried out by a health professional (doctor, nurse, physiotherapist, ergotherapist, psychologist) from the AEC. The assessor is normally the contact person and ensures the follow-up of the dependent person’s case.

During the assessment, the contact person examines the applicant’s ability to carry out activities of daily living and talks to the applicant and anyone who helps with care and support.

The assessment is carried out at the applicant’s home, at the AEC’s premises or at the facility attended by the applicant. The applicant will be informed of the appointment for the assessment by phone and/or post.

Both benefits in kind and cash benefits are paid according to a system of lump-sums.

If the dependent person lives in a facility, the lump-sum for benefits in kind is paid directly to the facility.

If the dependent person lives at home and is assisted by a care and assistance network (RAS), the lump-sum for benefits in kind is paid directly to the RAS. If the person is assisted by an AEC-recognised caregiver, the lump-sum for cash benefits is allocated to the dependent person; it is intended for paying the caregiver.

According to his/her needs in terms of care and support in activities of daily living (ADLs), the dependent person is allocated one of the fifteen levels of weekly care and support needs.

Each of these fifteen levels corresponds to a number of minutes of care covered by the insurance that the dependent person is entitled to per week.

A professional service (care and assistance network, semi-inpatient facility or facility) under contract with the CNS, providing all the care and support the dependent person needs.

If the dependent person is living at home and has an AEC-recognised caregiver, it is possible to convert part of the benefit in kind (assistance provided by a care and assistance network (RAS)) into a cash benefit.

Only the benefits in kind for activities of daily living and for assistance with household chores can be replaced by a cash benefit.

There are ten different lump-sums for cash benefits, depending on the amount of care provided by the caregiver. This lump-sum is allocated to the dependent person; it is intended for paying the caregiver who provides care and support.

Cash benefits are payable from the date of the notification of the decision if the applicant is recognised as being dependent and if the private individual providing care and support is recognised as a caregiver.

For the purposes of the long-term care insurance, the assistance provided by a professional care and assistance service provider (care and assistance network, semi-inpatient facility or facility) is a benefit in kind.

There are sixteen different lump-sums, depending on the amount of care and support needed in carrying out activities of daily living. The CNS pays the lump-sum amount directly to the providers. The cost of the various activities granted is also paid directly to the provider.

Benefits in kind are payable from the date of the application if the applicant is recognised as being dependent.

A health professional or doctor at the State Office for Assessment and Monitoring (AEC) who is more particularly in charge of the dependent person’s case.

This is often the person who assesses the dependent person’s state of dependency. A dependent person who has any questions about his/her case may contact this person directly. The name of the contact person together with contact details are communicated at the time of the assessment on a visit record.

If a dependent person remains in his/her home, there is a division of services if both a care and assistance network (RAS) and a caregiver provide the dependent person with care and support. The division of care and support between the RAS and the caregiver is determined by the contact person of the State Office for Assessment and Monitoring (AEC) at the time of the assessment.

The payment lump-sums will depend on this division of services:

• the lump-sum for benefits in kind will be paid to the network in exchange for the care it provides;
• the lump-sum for cash benefits will be paid to the dependent person in order to compensate the caregiver for the care he/she provides.

Care and assistance networks are professional care and assistance service providers under contract with the CNS, providing care and support to dependent people living at home.

Term used in long-term care insurance to refer to the minimum amount of care and support that must be required in order to receive benefits under the long-term care insurance. This minimum corresponds to 3½ hours per week for activities of daily living (ADLs).

This summary always accompanies the decision on care and support under the long-term care insurance.

It provides information on:

• the various benefits to which the dependent person is entitled;
• the level of weekly needs in terms of the amount of care and support;
• detailed descriptions of the care and support to be provided;
• the identification of the caregiver, the division of care and support between the caregiver and any care and assistance network;
• the payment lump-sums;
• any assistive technology or home adaptations to be granted following the assessment.

The summary is communicated to the dependent person and any provider.