What pressure sores mean in a long-term care insurance claim: why they indicate genuine dependency, how to document the daily care required, and what to obtain from the treating team.
A pressure sore is almost always evidence of dependency
Pressure sores form when a person stays in the same position over time and is unable to change it themselves. Their very existence tells a clear functional story.
This is a point families do not always grasp. They present the sore as a medical problem requiring treatment — which it is — but miss the insurance significance: the sore is evidence of an inability to make transfers and change position independently.
In the functional description it is worth saying this explicitly, rather than leaving the conclusion to the reader.
Daily care as documented dependency
Treating pressure sores is not a one-off event. It involves regular dressings, changes of position every few hours, a special mattress, monitoring and sometimes nurse visits.
All of these are evidence of comprehensive daily assistance. It is important to set out who performs each task, how often, and how long it takes.
- The frequency of dressings and who carries them out
- How many hours apart a change of position is needed and who does it
- Whether there is an air mattress or special equipment
- Visits from a nurse or nursing team at home
- Whether full assistance is needed to move the person out of bed
- Documentation of the grade of the sore and monitoring over time
What to ask the treating team for
Where a nurse from the health fund, a clinic or an institution is providing treatment, they hold orderly documentation of the state of the sore and of the treatment — including the frequency of visits.
A document like that is of great value in the file. It is objective, it is professional, and it records a sequence over time. It is worth asking for it rather than settling for a family description.
If the insured person is in an institution, you can ask for a nursing summary setting out the grade of the sore, the treatment and the overall extent of assistance.
The information on this page is general and does not constitute medical, legal or insurance advice. Diagnosis and treatment are carried out by a qualified medical professional only, and entitlement is determined according to the definition in the policy and the documents relevant to the case.
Frequently asked questions
Do pressure sores indicate a long-term care condition?
They are strong evidence of dependency, because they form when a person is unable to change position themselves. That said, entitlement is determined by the definition in the policy, so the dependency behind them has to be described explicitly.
How do you document the treatment of sores?
In detail: the frequency of dressings and who carries them out, how many hours apart a change of position is needed, the existence of an air mattress or special equipment, and visits from a nurse or nursing team.
What should we ask the treating nurse for?
Orderly documentation of the state of the sore, its grade, the treatment given and the frequency of visits. A professional document of that kind is worth far more than a family description alone.
The insured person is in an institution — what do we request from there?
A nursing summary setting out the grade of the sore, the treatment given and the overall extent of assistance with daily activities.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
