Dementia of any kind is one of the most difficult medical conditions to experience and manage. At this time, there is no cure and medical professionals can only speculate as to the ways one can help prevent or delay it from developing. It is also important to note that dementia care can be quite expensive, as individuals require far more attention than with many other diseases that can often be managed at home without much disruption to the lives of their loved ones. Dementia can also lead to many other injuries or illnesses as a result.

Fortunately, disability benefit programs from the Social Security Administration (SSA) may be able to help. These programs exist to provide a monthly disability benefit to help replace lost wages for people unable to work because of a physical and/or mental disability. These programs also provide, if eligible, medical coverage.

Dementia Benefit Options

If you or a loved one meets one of the the SSA’s “Blue Book” disability listing for neurocognitive disorders, which covers Dementia, you could qualify for one or both the SSA’s disability benefits programs, which are the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. There are other ways to qualify for these programs, as will be discussed below, as well. You should be aware that these two programs do have age restrictions, however; an applicant will have to be found disabled before retirement age.

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One way to qualify for SSI or SSDI is to meet the Blue Book listing of dementia. An individual may also qualify by meeting the SSA’s definition of disability through a combination of medical conditions, or by demonstrating that they are unable to do the same work as before or another job that they might be qualified for.

There are several other important factors involved in qualifying. To access these disability benefits programs, you typically have to be under the age of 65; however, some exceptions do exist. To qualify for SSI, you will have to meet certain financial limitations. To qualify for SSDI, you must have contributed enough taxes (to earn “work credits”) to Social Security in recent years.

To meet the dementia disability requirements following the listing in the Blue Book, you will need a doctor to verify your condition and meet the Blue Book listing guidelines under Section 12.02 for neurocognitive disorder, which can be found in section 12.00 for mental disorders. It must be determined that you meet at least one significant decline in specific areas, for instance:

  • Paying attention
  • Lacking social behavior
  • Losing language skills
  • Remembering in the short term
  • Limiting physical coordination
  • Learning new concepts
  • Understanding old concepts

You will likely also have to prove that you are severely limited in additional areas, including interacting with co-workers or others appropriately, making independent plans, adapting to circumstances, applying knowledge and more.

The important thing to remember is that you don’t have to fit the definition exactly to be approved. The Social Security Administration is interested in determining if your medical conditions prevent you from returning to your past work or sustaining full time competitive work in the national economy. If dementia alone or in combination with other medical conditions prevents you from being able to engage in “substantial gainful activity,” you will likely be approved.

Dementia and SSI and SSDI

Once you receive your diagnosis, it is important to apply for SSI and SSDI benefits quickly, as it can take months (at a minimum) to over a year or longer to receive benefits. You may be eligible for retroactive benefits, to cover some or all of the time between the “onset date” of your disability to the date upon which your benefits are approved.

You should know that to apply for SSDI benefits,you must have a work history that demonstrates you contributed a minimum requirement to Social Security through taxes. If you do receive SSDI benefits with dementia, once you reach retirement age, the SSA will automatically convert your benefits from SSDI disability benefits to retirement benefits.

SSI is a program for people that are disabled who have not paid enough into the system to qualify for SSDI. Unlike SSDI, SSI is a needs-based system that takes into consideration not only if you are disabled but also if you meet non-disability based economic considerations such as household income and assets.

For both SSI and SSDI, some dementia conditions can allow individuals to apply for a “compassionate allowance,” which can greatly help speed up the approval process.

Meeting the Residual Functional Capacity Terms

In some cases, your dementia may not yet have resulted in a decline such that you meet the disability listing requirements. But, even if you have not yet met the Blue Book qualifying factors, you may still qualify for benefits based on your Residual Functional Capacity (RFC) or the side effects of dementia that prevent your ability to work a full-time job or a previous job in the same capacity. Again, if you have other medical conditions along with dementia, the Social Security Administration will take all of the conditions into account when determining your Residual Functional Capacity.

All of these factors will be taken into consideration to determine your RFC. They will then use the medical-vocational guidelines to determine if you are qualified for other jobs based on your work skills, education and age.

Finding the Right Doctor Can Help

All applicants should make sure to find the right doctor. Be sure to ask your doctor before you begin the application process as to whether or not they will help with documentation requirements. Doctors will need to complete various paperwork for someone with signs of dementia in order to qualify for disability benefits. It is possible they will have to run more tests and be willing to send results to the appropriate person or persons.

You will almost certainly have to present documentation from treating medical professionals to complete the application process for disability benefits. Each case will be different, of course, because every person’s situation is different. A Disability Advocate can help you determine the right paperwork to present and can help to increase your chances of being approved for benefits.

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About Citizens Disability, LLC:

Since 2010, Citizens Disability has been America’s premier Social Security Disability institution. Our services include helping people in applying for SSDI benefits, managing the process through Reconsideration, and representing people in person at their Hearing, and if necessary, bringing their case to the Appeals Council. Our mission is to give a voice to the millions of Americans who are disabled and unable to work, helping them receive the Social Security Disability benefits to which they may be entitled. Learn more about us and disability benefits like SSDI & SSI or give us a call at (800) 492-3260.

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