Head Injury (residual functional or cognitive impairment)
Heart Transplant
Hemiplegia
Hemophilia
Hepatitis (chronic, active, alcohol related, residual liver damage)
HIV Positive
Hoarding
Home Health Care (within 6 months)
Huntington�s Chorea Hydrocephalus
IADL Deficit
Immune Deficiency
Implantable Stimulator
Irritable Bowel Syndrome (uncontrolled or with weight loss)
Kidney Failure
Kidney Transplant
Lacunar Infarct (2 or more)
Liver Transplant
Lou Gehrig�s Disease
Lupus (systemic)
Marfan�s Syndrome
Medicaid Recipient Memory Loss
Mental Retardation
Mixed Connective Tissue Disease
Multiple Myeloma
Multiple Sclerosis
Muscular Dystrophy
Myelodysplasia
Myelodysplastic Syndrome
Myelofibrosis
Myasthenia Gravis (generalized)
Neurofibromatosis
Neurogenic Bowel or Bladder
Neuropathy (related to diabetes or alcohol, or with history of falls or skin ulcers), or severe
Nursing Home resident (within 6 months)
Occupational Therapy
(within 3 months*) *contact Underwriting to prequalify if within 3 months
Organ Transplant
Organic Brain Syndrome
Osteoporosis (T score -4.0 or worse)
Oxygen use
Pancreas Transplant
Pancreatitis (alcohol related, or >2 episodes)
Paralysis
Paraplegia
Parkinson�s Disease Pemphigus Vulgaris Physical Therapy (within 3 months*) *contact Underwriting to prequalify if within 3 months
Pick�s Disease
Polycystic Kidney Disease
Polymyositis
Polyneuropathy
Post Herpetic Neuralgia
Post Polio Syndrome (with progressive weakness, fatigue, or limitations)
Pregnancy (Is pregnant or receiving medical treatment to become pregnant)
Primary Biliary Cirrhosis
Pseudotumor Cerebri
Psychiatric Hospitalization (within 3 years, or 2 or more)
Psychosis
Pulmonary Hypertension
Quad Cane use Quadriplegia
Reflex Sympathetic Dystrophy
Retinal Vein Occlusion (2 or more)
Schizophrenia
Scleroderma
Sclerosing Cholangitis
Shingles (within 6 months)
Sjogren�s Syndrome (systemic)
Social Withdrawal
Speech Therapy (within 3 months*) *contact Underwriting to prequalify if within 3 months
Spina Bifida
Stroke (2 or more)
Surgery (requiring general anesthesia scheduled or planned)
Systemic Lupus
Thalassemia Major
Transient Ischemic Attack (TIA) (2 or more)
Tuberculosis
Underweight
Ventriculoperitoneal shunt Von Willebrand�s Disease
Walker use
Wegener�s Granulomatosis
Weight loss (unintentional or unexplained)
Wheelchair use

Long Term Care - Instrumental Activities of Daily Living

NPR #

10182586