No one wants to be cared for by strangers. So it's no surprise that many people look to family members and other trusted helpers to assist them with dressing and housekeeping when they’re too old or ill to do so themselves.

Unfortunately, long-term care insurers often take a dim view of such unofficial assistance. "There are almost no insurers that will pay for family members to provide care," says Bonnie Burns, a training and policy specialist with California Health Advocates.

Long-term care insurance policies generally pay a set daily dollar amount for a certain number of years. Benefits kick in when someone needs help performing specified daily activities such as bathing or dressing. The insurance typically covers care provided in a nursing home, assisted living facility or at home.

Not every state requires that home health aides be licensed. But if they do, it’s a good bet that long-term care insurance policies sold in that state will only pay for home care if it’s provided by someone with that credential.

That’s exactly the roadblock that John Mills ran into when his dad wanted to use his long-term care insurance policy to pay for his housekeeper to help him at his New York City apartment with cooking, cleaning and personal care as his Parkinson’s disease worsened. "My father was very comfortable with Yvonne," says Mills. "He could be very difficult, but she knew how to deal with him."

That didn't matter to the insurer. New York requires home care aides to be licensed. Since the housekeeper wasn’t, the insurer refused to pay for her. So Mills’ father, who died three years ago, paid her out of his own pocket to come in a few days a week. They hired a licensed aide to come in as well, whose services were covered by the long-term care insurance policy.

Mills says the licensed aides were helpful, but it wasn’t a perfect solution. Turnover was high, they discovered. "We’d find someone he liked, but then every three or four months we’d have to find a new aide," he says.

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