***This is the 400th LTC Bullets newsletter provided for you courtesy of The Center for Long-Term Care Financing. Thanks for reading.***

LTC Bullet: "For the Benefit of My Patients"

Thursday, November 21, 2002


*** PLEASE READ THIS. If there were a simple, cost-free solution to the long-term care problem, would you take the time to read it? If some people were willing to fight for a solution that would provide new revenue for cash-strapped LTC providers, unleash the potential of private insurance, and save Medicaid, would you help them? If your answers are "YES," here's your chance. First read our LTC Bullet: Let the Revolution Begin at http://www.centerltc.com/bullets/current/396.htm (If that link fails, just change "current" to "archives2002" in the address). That's the call to action. Then read "LTC Choice: A Simple, Cost-Free Solution to the Long-Term Care Financing Puzzle" at http://www.centerltc.com/pubs/CLTCFReport.pdf . That's the action plan. If you are willing to participate in a coalition to explore implementation of an exciting new approach to long-term care financing, please contact the organizer Jerry Reilly: e-mail would be best at mailto:jerryreilly@msn.com or phone at 360-561-4212. ***

*** 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. For more information, contact The Constellation Group at mailto:Fraser@theconstellationgroup.com or consult the company's website: http://www.theconstellationgroup.com/ . Thanks so much to The Constellation Group for their generous support of the Center. Won't you help too? Go to http://www.centerltc.org/support/sponsor_bullets.htm 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 amy@centerltc.org . ***

*** New content added today to the donor-only zone includes "The LTC Week in Review for November 18-22, 2002: LTC E-Alerts #266-#270." Every LTC E-Alert contains some news or information that will help people understand the need to prepare early for the risk and cost of long-term care. If you already qualify for The Zone, you can click the following link, enter your user name and password, and go directly to the latest E-Alerts: http://www.centerltc.com/members/ltc_week_in_review.htm .

LTC E-Alert #266--Will LTCI Premiums Soar Amid Sales Slump?
LTC E-Alert #267--CMS' Scully Promises LTC Providers the Check's in the Mail
LTC E-Alert #268--GAO Says CMS Quality Reports Premature
LTC E-Alert #269--More Medicare Mediocrity
LTC E-Alert #270--Alzheimer's Research Report

To Zone In, mail your tax-deductible contribution of $100 or more to the Center for Long-Term Care Financing, 2212 Queen Anne Avenue North, #110, Seattle, WA 98109. Then email damon@centerltc.org your preferred password and user name (up to 10 characters each). You can also contribute online by credit card or direct withdrawal at http://www.centerltc.com/support/index.htm . ***


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 fourth and last article in that series. To read the first article, titled "Ominous Parallels--Medicine and LTC," go to the LTC Bullets archives at http://www.centerltc.com/bullets/archives2002/393.htm . To read the second article, titled "First Do No Harm," go to http://www.centerltc.com/bullets/archives2002/395.htm . To read the third article, titled "What Can One Physician Do About Long-Term Care?," go to http://www.centerltc.com/bullets/current/398.htm . To read the entire series together, go to the appropriate link on the Center's home page: http://www.centerltc.org/ . 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 fraser@theconstellationgroup.com 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 (http://www.centerltc.org/) for The Constellation Group (http://www.theconstellationgroup.com/)

Part Four: "For the Benefit of My Patients"

Some of your patients and their families are suffering unnecessarily. The malaise is long-term care. You can be a remedy. The Hippocratic Oath says "I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients . . ." Make it part of your professional regimen to understand the complicated issue of long-term care. Consider both the medical and the financial aspects. Advise the people whose lives you touch wisely on this subject.

This is the last of a four-part series of articles on long-term care service delivery and financing. Its primary purpose is to encourage physicians who have not yet read the first three parts to do so. If you've read the foregoing articles, then this one is a summary and reminder. Email, fax or snail-mail this article to friends, family members, patients and colleagues. Encourage them to take the long-term care issue as seriously as you have.

Long-term care is already a severe problem. With the aging of the baby boom generation, it will become an epidemic. Even as the challenges of retirement security (Social Security) and acute health care (Medicare) for the elderly remain unsolved by government, long-term care looms just around the next bend in public policy as the 800-pound gorilla of social problems.

Today, 80 percent of all long-term care services are provided informally by friends and family of frail and infirm elderly in their homes. Women especially are sacrificing their time and often their livelihoods to care for ailing parents and in-laws. Daughters, wives and sisters go to great lengths to avoid placing their loved ones in nursing homes, because nursing homes have such a negative reputation.

Nevertheless, most formal, professional long-term care services are provided in nursing homes and they are paid for by Medicaid, a welfare program on the verge of insolvency. Other, more desirable levels of care and the investment or insurance products to pay for them have evolved very slowly. This is true because heavy government financing of nursing home care over the years has desensitized the public to the risk of long-term care and skewed the delivery system toward institutionalization.

For over a decade, Medicaid estate planning attorneys have eased the way onto welfare-financed nursing home care for the middle and upper-middle classes. Imagine how easy it is for a lawyer to garner clients by waving a magic legal wand after the insurable event has occurred. Compare that to the challenge facing long-term care insurance agents. Agents must convince healthy prospects to purchase expensive insurance against a risk they're in denial about and for which the government pays anyway, however inadequately.

Studies indicate that a primary reason for the deficiencies in America's long-term care system is the inadequacy of nursing home financing provided by Medicaid and Medicare. (Footnote 1) Low reimbursements drag down quality, invite liability lawsuits, and cause the continuing downward spiral. Even to gain admission to the better nursing homes nowadays, people need "key money" sufficient to pay privately for at least a year. Assisted living facilities, the highly desirable alternative to nursing homes, are almost entirely private pay. Experts express little or no hope that national social health insurance will ever ameliorate, much less eliminate, these problems.

Low Medicaid and Medicare reimbursement rates have also discouraged physicians from accepting new patients dependent on these government payment programs. This fact may also account for the dearth of doctors, nurses, and other medical professionals who pursue and practice geriatric specialties.

In a nutshell, long-term care service delivery and financing in America is in serious trouble. The only practical way for individuals to ensure access to quality long-term care at the most appropriate level--home care, assisted living and nursing home care only as a last resort--is to be able to pay privately. But the cost of long-term care is comparable to the cost of one's house burning down, while the probability this catastrophic event will occur is much higher.

Medical doctors should study the issue of long-term care, learn about the risks of Medicaid dependency, investigate the alternative of private long-term care insurance protection, and use your influence with family, friends, and patients to become part of the solution to this challenging national dilemma.


(1) Center for Long-Term Care Financing, The LTC Triathlon: Long-Term Care's Race for Survival, Seattle, 2000, http://www.centerltc.com/pubs/triathlon.pdf.

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 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 http://www.centerltc.org/.

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. For more information, contact The Constellation Group at mailto:Fraser@theconstellationgroup.com or consult the company's website: http://www.theconstellationgroup.com/ .