LTC Bullet:  LTCN&C Lives


Monday  April 3, 2001



Faithful readers of LTC Bullets will recall that the Center for Long-Term Care Financing tried to revive "LTC News & Comment" when that highly respected newsletter ceased publication last year. (LTC Bullet:  Should CLTCF Publish LTCN&C?, 11/8/00)  We were unsuccessful for reasons explained in a subsequent bullet. (LTC Bullet: LTC News & Comment, 12/1/00).  All LTC Bullets are archived at

Now the good news! "LTC News & Comment" is alive and well today with the same inimitable editor, Dr. George Sherman, and a new publisher, Harley Gordon, J.D. and his Corporation for Long-Term Care Certification, Inc.  True, LTCN&C is now published online not in hard copy, bi-monthly instead of monthly, and you'll have to pony up $149.95 per year to get it (instead of the previous $199), but those are small prices to pay to keep this valuable resource available.  You can see a sample copy of LTCN&C and subscribe online at

For those of you who remember we've criticized attorney Gordon's CLTC program in the past, don't bother to remind us.  LTC Bullets will heap praise on anyone who advances the cause of long-term care service delivery and financing just as fast as we'll pile on criticism when we think someone is wrong.  On that score, we hear the CLTC's certification program is being improved and we'll re-evaluate it when we receive the revised training manual.

Now for a taste of "LTC News and Comment."  The following is an article from the March 2001 issue of the newsletter.  No surprise why we picked this example—it's about the Center's LTC Triathlon project and report.  The same issue of the newsletter also contains an outstanding article by Tim Hale of Munich Re on the meaning and importance of reinsurance for long-term care insurance.  Other features in the March issue include "Snapshot of Assisted Living," "Effects of Aging Boomers on Medicare's Costs," and "Olmstead Could Bankrupt Medicaid Program."

Editor Sherman tells us that his subscribers also receive frequent, brief, "LTC Alerts" by email at no extra charge. We close this Bullet with a sample of one of those alerts. "LTC News and Comment" and "LTC Alerts" are a must-read for anyone serious about staying current on public and private long-term care financing issues.

We would be remiss not to give credit where credit is due to one of the pioneering visionaries of long-term care financing. Dale Larson, formerly President of LTC, Inc. and the Larson Long-Term Care Group, founded "LTC News & Comment" and supported the publication at considerable personal expense for a decade.

Sample article from March 2001 edition of "LTC News & Comment":

"Three for LTC Road"

The last three years have been marked by unparalleled upheaval in the LTC industry:  unprecedented percentages of nursing homes in bankruptcies, at least one-fourth of all home care agencies closing, and the darling of LTC, assisted living, hitting the wall of disenchanted investors. As a result, the media is in a feeding frenzy about inadequate staffing and resulting poor care in nursing homes, and recently has focused on assisted living. HCFA in turn is pressuring the states to rev up their inspections of SNFs, and regulators are responding by  increasing the numbers of fines for violations by 1000%.  When you add to this mix the numerous projected shortfalls in state Medicaid budgets, you can safely predict that no facile
solutions are in the cards for soon solving the current crisis in the financing of LTC.

The LTC Triathlon, by Steve Moses of the Center for Long-Term Care Financing, performs a valuable service for those serious about the financing of LTC.  Moses first presents and analyzes the views of key players in LTC, i.e., the investors, the providers, and the payers. He then  suggests a process to promote understanding, and to begin working on a solution.

Moses personally interviewed 22 financiers and investment analysts, 47 providers, and 50 people representing various aspects of the LTC insurance business. He asked four questions:

1) Why is the LTC system having so much trouble?,
2) What is your opinion of public financing for LTC?,
3) What do you think about private LTC insurance?, and
4) Should there be more communication among the three players? How? What are the obstacles?

Moses' analysis of the responses to these questions is revealing.  He shows that each of the stakeholders knows little about the others' business. "The lack of communication between these (stakeholders) solidifies and exacerbates ignorance and misunderstanding, which in turn discourage further attempts at communication," he writes.

What To Do?

The LTC Triathlon concludes with some simple but worthwhile suggestions for bridging the gaps in understanding between the stakeholders:  Initiate discussions that cross-cut specialties, pursue understanding of each other's businesses and challenges, identify and promulgate common perspectives of solutions, develop a public policy proposal, mobilize to promote private financing of LTC.

Triathlon must be read to savor the intensity of the feelings stakeholders have, the best of which are highlighted in the report.  You can access the report at under  pubs/recent/htm/.  A hard copy is available for $49.95.  Email your order to We also recommend that our readers subscribe to the Center's free LTC Bullets by requesting them via the Center's email address.

Sample LTC-Alert ("Oregon ALFs fight for Medicaid dollars," 3/29/01)

Oregon's governor, John Kitzhaber (D), has proposed slashing the state Medicaid payment to ALFs by up to 45%, or $766 per month.  Advocates for the assisted living industry complain that the state stimulated the growth of ALFs to where it has more of them than nursing homes, but now wants to dismantle the system.  Supporters of the proposed cuts, on the other hand, complain that taxpayers are paying for empty beds.

LTC COMMENT:  While the great majority of residents in ALFs nationally are strictly private payers, some facilities accept Medicaid reimbursement for some residents.  The state saves the nursing home reimbursement rate, and the operators can fill empty beds with paying customers. Until the state's economy begins to slacken.  ALFs, which operate on the margin, will be hit hard with decreased Medicaid payments, and could well be forced to close.  The lesson:  People with LTC insurance would be wise to choose ALFs that are exclusively private pay.


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