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I have very low vision, legally blind in one eye with vision of 80/20 in the other eye. I have macular degeneration, which is getting worse. I need assistance with showering and with dressing, two of the activities of daily living. I also need help around the house as I cannot see well enough for meal preparations or cleaning and of course I can’t drive. Nevertheless, my claim was denied. Is there an ombudsman? Where can I get help?

Call your County Disabilities Dept and see what resourses they may have for you.
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Reply to JoAnn29
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You may want to check out CANHR website for California info on resident's rights and appealing LTC rejections. They have a ton of info, contacts, legal connections, and insight to the many protections within LTCs and MediCal for California residents. https://www.canhr.org/transfer-and-discharge-rights
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Reply to Chalyse
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I am uncertain what you mean by LTC insurance that is run by the state of California. I can find none other than Cal-pers for teachers and those not covered by SS but instead by State of California retirement programs, and Medicaid-which in Cal. is called Medi-CAL.

Whatever, while Macular degeneration does impair vision greatly, making one "legally blind" in terms of signing papers and so on, there is often quite a lot of peripheral vision. You say that you have this in one eye. I am uncertain why this would impair you ability to shower, to dress and etc. but I CAN imagine it would be difficult to do certain things in the house.

Can you tell me what OT you have had and whether not you have been assessed by OT for ADLs (activities of daily living)? As you can imagine, the bar for paying for LTC is very high. I think that the plan may be more working on ADLs than just raising one's hands in the air and saying "I am done; I can do anything". But you will want to look closely at the rules about what is called "ABD rules for Medicaid" (aged, blind and disabled) rules which are a bit different that younger blind persons who often live whole lives without special assistance for the most part.

I would discuss all of this with whomever is helping you to apply on appeals. It is important to know what their criteria is. I would ask for special counselors in the program and explain that for all intent and purpose you are too blind to be able to read their rules. You may get a nurse manager. And you may need to HIRE a nurse manager or even an Elder Law Attorney.

I do wish you good luck. The rules for each state and for each level of care needed and for each LTC policy are so variable that this is really a one on one situation in which you need help with understanding applications, requirements, qualifying and etc.
I hope you will update us as you go.
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Reply to AlvaDeer
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