LTC Bullet: "First Do No Harm"

Tuesday, November 5, 2002


*** Today's Bullet, which follows the ***news***, will help LTC professionals encourage the medical profession to educate the public about the importance of long-term care planning. This Bullet is sponsored by The Constellation Group, LLC, a Business and Tax Strategy Think-Tank in Miami Beach, Florida, founded by Mr. Fraser Allport. Constellation specializes in Income Tax Reduction and Asset Protection. Contact Mr. Allport at 305-532-1231 or . Thanks so much to The Constellation Group for their generous support of the Center. Won't you help too? Go to to sponsor an LTC Bullet. Find out how you can sponsor other Center activities (e.g., articles, speeches, conference exhibits) by contacting Amy Marohn at 425-377-9500 or ***

*** Long-Term Care Meeting News:

* The "National Caregiving Conference and Trade Show," scheduled for Washington, DC from December 9-11, 2002, has been cancelled. The website is still up as of this writing in case you need to track down the sponsors for a refund: .

* The National LTCI Producers Summit and "The Great LTC Debates" (November 17 to 19, 2002) in St. Louis. For details and to register, go to for the conference brochure and to for the full line-up of sessions and speakers.

* The LTC Graduate Seminar (November 20, 2002) in St. Louis, Missouri. For details, go to . Contact Amy Marohn-McDougall to hold your reservation for the LTC Graduate Seminar: 425-377-9500 or .

* The Third Annual Intercompany LTCI Conference (January 26-29, 2003) in Las Vegas, Nevada. For details and to register, go to . Highlights: six education tracks offering 47 interactive sessions; network with your peers and LTCI experts; expert speakers from the LTCI industry; two new sub-tracks: Group LTCI and LTCI 101 - The Basics; current, practical and informative discussion opportunities; three national LTC designation programs on Saturday and Sunday before the Conference.

* The 16th Private Long-Term Care Insurance Conference (February 12-14,2003) in San Antonio, Texas. For details and to register, go to . Hosted by the LTC Insurance Educational Foundation, "this conference provides a non-partisan forum for educating attendees about the evolving long term care insurance market, discussing the impact of state and federal legislative policies on the marketplace, and fostering the development of public-private partnerships to finance the nation's long term care bill."


Fraser Allport of The Constellation Group, LLC commissioned the Center for Long-Term Care Financing to write a series of four short articles designed to encourage physicians to get actively involved in long-term care planning. What follows is the second article in that series. To read the first article, titled "Ominous Parallels--Medicine and LTC," go to the LTC Bullets archives at . The remaining two articles will be published in LTC Bullets over the next few weeks. If you would like to use these articles to help educate the medical profession in your locality about the importance of long-term care financial planning, please contact Mr. Allport at 305-532-1231 or for authorization.

"The Unnecessary Tragedy of Long-Term Care: A Four-Part Series for Medical Doctors," by Stephen A. Moses, President, Center for Long-Term Care Financing ( for The Constellation Group (

Part Two: "First Do No Harm"

Our parents and grandparents fought two great wars to make the world safer and more free for us. They struggled through the Depression, scrimped and saved, so we could enjoy greater prosperity. For the past four decades, however, we have rewarded their long, hard efforts with an inadequate long-term care system based on nursing-home institutionalization and welfare financing. Most people would agree we owed our "Greatest Generation" better treatment. Surely, no one believes the current service delivery and financing system can meet future needs. Our challenge today is to find and finance a better way of providing long-term care before time runs out for us baby boomers. Otherwise, we will leave an even bigger problem for the next generation. We must not fail our children as we have let down our own parents and grandparents. The demographic clock is ticking.

Part One of this four-part series explained how long-term care in America sank to its current sorry state. In Part Two, we will address the question: "Is the medical profession part of the problem or part of the solution for long-term care?" At first glance, the answer does not seem encouraging.

"Teach them this art" says the Hippocratic Oath. Unfortunately, America already faces a severe shortage of trained and qualified geriatricians. The Alliance for Aging Research recently reported that "the U.S. currently needs 20,000 physician-geriatricians to care adequately for our population of 35 million older people. Yet of the 650,000 licensed physicians practicing in the U.S., fewer than 9,000 physicians have met the qualifying criteria in geriatrics." Nor is the outlook promising for the future. The report continues: "Furthermore, this number is projected to decrease to as few as 6,100 by 2004. The U.S. will fall far short of the 36,000 geriatricians needed by 2030 unless effective steps are taken to train new providers." (Footnote 1)

Can primary care physicians compensate for this shortage of geriatrics specialists? Perhaps, but evidently, not yet. According to Patricia P. Barry, MD, MPH, Executive Director of the Merck Institute of Aging and Health (MIAH), speaking on the release of the MIAH Physician 2002 Survey: "Only half of the physicians we surveyed believe that their colleagues can adequately treat a number of common geriatric conditions, such as falls, memory loss and incontinence, and only about one in three believe they can treat sensory impairments. These disturbing numbers imply that older adults are not getting the care they need to live longer and better lives. Obviously, there's a definite gap between what primary care physicians know, and what they need to know, to ensure that their older patients not only survive but thrive." (Footnote 2)

Service delivery, however, is only part of the problem of long-term care. People also have to be able to pay for the services they receive. Unfortunately, most professional long-term care is provided in nursing homes today and paid for by Medicaid. Medicaid is a means-tested public assistance program, i.e. welfare. It has a dismal reputation for problems of poor access, doubtful quality, low reimbursement, frequent discrimination, and institutional bias. Many seniors see admission to a Medicaid nursing home as a sentence worse than death. To purchase quality long-term care in their home or an assisted living facility, the preferred venues, or in the better nursing homes, people must be able to pay privately. To pay privately, however, they need substantial assets or private insurance. At an average of $55,000 per year for nursing home care, over $25,000 for assisted living, and even more for round-the-clock home care, only the most prosperous of the elderly can afford the cost.

Are medical doctors educating their patients about the financial risks of long-term care and encouraging them to prepare? Surely some are, but not enough. The only hard evidence we have is that certain physicians have succumbed to the siren's song of "Medicaid estate planning." Medicaid planning is the practice used by some "elder law" attorneys to impoverish infirm elderly people prematurely and artificially. The purpose of Medicaid planning is to qualify the senior for welfare-financed nursing home care while diverting his or her assets to an early inheritance for an heir. Usually the heirs are the clients and the vulnerable seniors (and taxpayers) are the victims of Medicaid planners. Medicaid planning has such a bad reputation nowadays that it is practiced, although widely, mostly in the shadows. Ten years ago, however, law and medical journal articles co-written by lawyers and physicians with advice like this were commonplace: "[L]awyers specializing in welfare law can assist individuals in obtaining public entitlements and preserving private assets. . . . Physicians can make an important contribution to the welfare of their patients who are at risk by informing them of such services. . . ." (Footnote 3) Physicians who follow the Hippocratic Oath will "abstain from whatever is deleterious or mischievous," eschew such advice, shun the practice of Medicaid planning, and advise their patients to do the same.

Clearly, the medical profession is less than fully prepared to provide long-term care services and good advice about long-term care financing to America's elderly. By the time baby boomers, who are turning 50 every eight seconds, start turning 85 nearly as fast, it will be too late. What can one physician do? We'll answer that question in Part Three of this series.


(1) Alliance for Aging Research, "Medical Never-Never Land: 10 Reasons Why America’s Not Ready for the Coming Age Boom," February 2002, p. 4, .

(2) Statement by Patricia P. Barry, MD, MPH, Executive Director of the Merck Institute of Aging & Health (MIAH) on the release of the MIAH Physician 2002 Survey, .

(3) Feinbloom, Richard I., M.D., and Ira S. Schneider, J.D., "Protecting Assets During Catastrophic Illness Through Financial Planning: The Physician's Role," The Journal of the American Board of Family Practice, Vol. 1, No. 1, Jan-Mar 1988, pps. 46-49.

Stephen A. Moses is President of the Center for Long-Term Care Financing in Seattle, Washington. He was formerly a Medicaid state representative for the Health Care Financing Administration (now CMS) and a Senior Analyst for the Office of Inspector General of the United States Department of Health and Human Resources. He is widely recognized as an expert and innovator in the field of long-term care. For further information, please consult

The preceding article was commissioned by The Constellation Group, LLC, a Business and Tax Strategy Think-Tank in Miami Beach, Florida, founded by Mr. Fraser Allport. Constellation specializes in Income Tax Reduction and Asset Protection. Visit them online at . Contact Mr. Allport at 305-532-1231 or .