2-hour Timed Outline for:

LTC Graduate Seminar

Presented by the Center for Long-Term Care Reform

COURSE DESCRIPTION: Long-Term Care Intensive for Senior Advisors

This course tackles critical questions that anyone who serves or advises seniors should understand in depth. For example:

  • How did America's LTC service delivery and financing system come to be so dysfunctional, e.g. nursing home and home-health bankruptcies, unprofitable ALFs, collapsed LTC stocks, inadequate capital, institutional bias, quality problems, staff shortages, low government reimbursements, skyrocketing liability insurance premiums, slow LTC insurance sales, etc.?
  • Can the current non-system survive and how will it change?
  • Will services be available when seniors need them in the future?
  • Who will pay?
  • What will happen to the government's LTC financing programs?
  • What is the real reason so few people save, invest and insure for LTC expenses?
  • What are the prospects for "above-the-line tax deductibility" for LTC insurance premiums in the coming year?
  • How can advisors help more seniors protect themselves from the LTC risk?
  • How can we build a "phalanx of professionals" around seniors to help them protect themselves from the legal and financial risks of aging?
  • What changes in public policy (state and federal) would have to be made to move LTC in America from a wobbly welfare base to a solid foundation in private insurance?



LTC Graduate Seminar
Stephen A. Moses, President
Center for Long-Term Care Reform in Seattle, WA

This two-hour education program explains why America’s long-term care service delivery and financing system is in such disarray, describes possible public-policy solutions, and invites caring financial and insurance professionals to play their part in protecting America’s aging population from the emotional ravages and catastrophic cost of long-term care.

The instructor, Stephen A. Moses, is President of the Center for Long-Term Care Reform in Seattle, Washington. Mr. Moses is nationally recognized as an expert and innovator in the field of long-term care. The Center for Long-Term Care Reform is a private, nonpartisan think tank and public policy organization dedicated to ensuring quality long-term care for all Americans.

Mr. Moses and the Center for Long-Term Care Reform have published extensively on the topics of this program. Major reports include "LTC Choice: A Simple, Cost-Free Solution to the Long-Term Care Financing Puzzle," "The Myth of Unaffordability: How Most Americans Should, Could and Would Buy Private Long-Term Care Insurance," and "The LTC Triathlon: Long-Term Care’s Race for Survival." Copies of these reports, which will also be used as instructional materials for the LTC Graduate Seminar, are available in .pdf format at the Center for Long-Term Care Reform's website: www.centerltc.org.


The Problem (30 minutes)

3 minutes: Americans are living longer, but dying slower often in need of expensive long-term are (LTC).

5 minutes: Trends in aging demographics guarantee that LTC will become a much bigger and more expensive, possibly catastrophic, social and political challenge in the future.

7 minutes: America's LTC service delivery and financing system is severely dysfunctional in terms of access, quality, reimbursement, discrimination, and institutional bias.

5 minutes: LTC places a huge financial burden on U.S. social programs (principally Medicaid and Medicare) while private financing of LTC, especially insurance, is very limited.

5 minutes: In the absence of adequate public and private third party financing for professional LTC services, American families struggle to provide informal care at home with little help.

5 minutes: Related problems are growing, such as, physical and financial abuse of the elderly exacerbated by economic and emotional pressures on the "sandwich generation."


The Reason (60 minutes)

5 minutes: Ironically, well-intentioned public financing of LTC since 1965, although helping many people in need, has inadvertently created and exacerbated the status quo.

7 minutes: Medicaid financing of nursing home care led to institutional bias. Neither Medicaid nor Medicare can afford to provide the community care most seniors prefer.

8 minutes: Simultaneously, public financing of LTC inhibited the growth of a private market for home care, assisted living and the private insurance products to pay for them.

8 minutes: Limited provider reimbursement by Medicaid and Medicare caused access and quality problems, which led to discrimination against public recipients and in favor of private payers.

6 minutes: Consequently, private payers are migrating to home care and assisted living leaving public payers and nursing homes with the highest acuity, most expensive patients.

5 minutes: Ramifications for staffing, litigation, liability insurance, capital financing, stock prices, and viability of the system are approaching the end game.

10 minutes: In the meantime, relatively easy access to Medicaid nursing home care and Medicare home care has desensitized the American public to the risk and cost of formal LTC.

11 minutes: Thus, most people who need formal long-term care still end up in nursing homes paid for by Medicaid and very few Americans plan, save or insure for LTC.


The Solution (30 minutes)

2 minutes: The good news is that America's LTC crisis is relatively easy to solve, because it is self-inflicted by well-intentioned, but negative incentives in public policy.

3 minutes: In America today, one can ignore the risk of LTC, avoid premiums for private insurance, qualify much more easily for public benefits than is commonly understood, or dodge "spend-down" requirements entirely.

4 minutes: Stricter eligibility rules (e.g., "Throw Granny in Jail") and mandatory estate recovery have failed to save Medicaid or encourage individual responsibility because they come after it is too late to save or insure.

8 minutes: To solve the LTC crisis, we must:

(1) educate everyone by age 50 about the risk and cost of LTC,

(2) enforce "LTC Contracts" before retirement whereby everyone acknowledges the personal responsibility to save or insure for LTC,

(3) extend to all uninsured Americans the "LTC Choice" of a publicly backed line of credit on their estates so they can purchase quality LTC in the private marketplace at the most appropriate level of care, and

(4) faithfully recover these secured loans from the estates of deceased borrowers in order to encourage their heirs and all other Americans to plan early and insure fully for LTC.

3 minutes: Benefit payments can be administered through vouchers or formal loans, but they must be secured by collateral and recovered upon death of the last surviving exempt dependent relative, such as a spouse or disabled child.

5 minutes: With these positive programs and incentives in place, fewer people will depend on Medicaid or Medicare for their LTC and those programs will be better able to serve their legitimate recipients and beneficiaries.

5 minutes: Questions and answers.


Miscellaneous Course Information

TARGET AUDIENCE: financial planners or consultants, attorneys, accountants and CPAs, long-term care insurance agents, geriatric care managers, long-term care providers (home care, assisted living or nursing home care), social workers, medical professionals and home equity conversion specialists.

STYLE OF INSTRUCTION: This course will be conducted as lecture. Every attendee will have ample opportunity to ask questions and share ideas. Participants are urged to challenge the instructor and each other with questions and comments.

TEXTBOOKS: Textbooks for The LTC Graduate Seminar are the Center's major reports including "LTC Choice: A Simple, Cost-Free Solution to the Long-Term Care Financing Puzzle," "The Myth of Unaffordability: How Most Americans Should, Could and Would Buy Long-Term Care Insurance," and "The LTC Triathlon: Long-Term Care's Race for Survival." All three reports, totaling 179 pages, are available in .pdf format at www.centerltc.org. We will provide additional handouts of current interest at the time of the seminar. Textbooks for the LTC Graduate Seminar are free of charge if downloaded and printed from the Center's website at www.centerltc.org. Printed and bound copies of the texts are available for $100. Enrollees will receive a three-month trial subscription to the Center's popular donor-only website zone.

SPONSORING ORGANIZATION: The Center for Long-Term Care Reform is a private, nonpartisan think tank and public policy organization headquartered in Seattle, Washington. The Center's mission is to ensure access to quality long-term care for all Americans. Center representatives speak at conferences, write for publication, testify in state legislatures, and conduct training for professional financial advisors of the elderly throughout the United States. Details on the Center for Long-Term Care Reform, including the bona fides of the organization and its principals, may be found at www.centerltc.org.