LTC Bullet--Book Report: LTC Planning for Idiots

Thursday, December 19, 2002


LTC Comment: We never expected to read, much less review, even less recommend any book for "complete idiots." It just goes to show: "Never say never." Read our review of Marilee Driscoll's new guide to long-term care planning after the ***news***.

*** Steve Moses' article "Denial is Not a River in Egypt: A Perspective on Public Funding of Long-Term Care," has been published in the December 2002 issue of Health Insurance Underwriter (Vol. 50, No. 11). The article argues that the "denial" impeding LTC insurance sales comes less from consumers than from the insurance industry itself. Read a similar version of this article at . Subscribe to HIU at or call 703-276-3816. ***

*** Would you like to order a tape or CD of The Great Medicaid Planning Debate between Center President Steve Moses and NAELA President-Elect Bill Browning? Go to to order online. Or make a tax-deductible contribution to the Center of $250 or more and we'll send you a free recording of the debate. Mail your check to the Center for Long-Term Care Financing at 2212 Queen Anne Avenue North, #110, Seattle, WA 98109 or contribute online at . Then email and let him know whether you'd like a tape or CD. Keep in mind that there were many other great sessions at the LTC Producers' Summit in St. Louis. To buy tapes or CD's of sessions other than The Great Medicaid Planning Debate, go to . ***

*** New content added today to the donor-only zone includes "The LTC Week in Review for December 16-20, 2002: LTC E-Alerts #286-#290." 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: .

LTC E-Alert #286--Aging and the Arts
LTC E-Alert #287--Ex-Cons, Underpaid Aides, and Medicaid Nursing Homes
LTC E-Alert #288--How to Talk to Parents About LTC
LTC E-Alert #289--On the Medicaid Home Exemption and LTCI
LTC E-Alert #290--Grannie Mae--Another Creative Financing Idea for LTC

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 your preferred password and user name (up to 10 characters each). You can also contribute online by credit card or direct withdrawal at . ***

*** 2003 Medicaid Spousal Impoverishment Levels: The Medicare Catastrophic Coverage Act of 1988 eliminated the problem of spousal impoverishment under the Medicaid program. It established levels of income and assets that community spouses would be allowed to retain without affecting their infirm, institutionalized spouse's eligibility for Medicaid. These levels are adjusted for inflation every year. The new levels, which will become effective January 1, 2003, have been published. You can find them in the Center's donor-only zone at :

The LTC Data Base #42--2003 Medicaid Spousal Impoverishment Levels

You'll find instructions on how to qualify for the Zone in the ***item*** immediately above.

*** Letter to the editor of the Honolulu Advertiser:

Dear Editor:

You cited me thus in an editorial in today's paper: "Critics of CarePlus, including recent visitor Stephen Moses of the Center for Long Term Care Financing in Seattle, contend the program won't work. It will create a false sense of security, slow down the development of a robust private long-term care insurance market and create false incentives for irresponsible health and lifestyle behaviors, he says." (________, "CarePlus Plan Needs to Be Kept Moving," Honolulu Advertiser, December 16, 2002, .)

Just to clarify, the key problem with long-term care is that America and Hawaii already have national social health insurance for it supplied through virtually bankrupt welfare and social insurance programs. The vast majority of all long-term home health and nursing home expenses are paid by Medicaid, Medicare, other indirect government funding, and patients' income, not assets. Despite the conventional wisdom that Medicaid nursing home benefits require impoverishment, they are actually readily available to virtually anyone, regardless of income or assets. This is especially true in Hawaii which has extremely generous Medicaid eligibility rules. For details, see "The Myth of Unaffordability" at Report.pdf . In other words, control public financing of LTC by targeting it to the genuinely needy and you won't need another mandatory government-controlled program like CarePlus. Fail to get the hemorrhage of government financing under control and nothing else, including CarePlus, will help. When you find yourself deep in a hole, the best advice is to stop digging. Good luck.

Sincerely, Stephen A. Moses, President, Center for Long-Term Care Financing ***


Marilee Driscoll's "The Complete Idiot's Guide to Long-Term Care Planning" (Alpha Books, Indianapolis, 2003; $19.95 list, $13.97 on is excellent in most respects, falls short in but a few and is deficient only in one.

We read the 340-page volume cover to cover, which we only do when a book constantly rewards the effort with clear, thoughtful explanations of standard topics and frequent new insights.

You'll get both with this book. Author Driscoll, a professional speaker, trainer, and writer on long-term care planning, knows the subject well and covers it fully. She writes with clarity and verve. She intersperses the text with personal anecdotes, and boxed inserts designed to crystallize key points, i.e. "wisdom of the aged," "truth and consequences," "LTC lowdown," and "Marilee's memo."

The book contains six parts described in the introduction:

"Part 1, 'The Truth About LTC,' introduces you to long-term care choices, and how your method of payment can influence our choices when you need care . . . .

"Part 2, 'Paying with Your Own Money,' explains what assets you can use to pay long-term care, including some assets that you never thought could be used in this way. . . .

"Part 3, 'Government Programs,' introduces . . . Veteran's Administration and Medicare that pay for some long-term care for some people. . . .

"Part 4, 'The Truth About LTC Insurance,' helps you find the long-term care insurance that's right for you. . . .

"Part 5, 'A Buyer's Guide to LTC Insurance,' explains what you need to know to choose a good policy that is properly designed.

"Part 6, 'The Truth About Medicaid,' covers the limitations of the system. Medicaid planning could be a great move for you, or the biggest mistake that you'll make for the rest of your life."

Look for good chapters with fresh content on key and current topics, such as creative financing for long-term care, as in home equity conversion, annuities, and life insurance; group vs. individual LTCI coverage; government incentives to buy LTCI including tax treatment and the TQ vs. NTQ debate; pros and cons of LTC insurance and Medicaid planning; the new federal LTC insurance program; and how to take apart an LTCI policy and put it back together to fit an individual's needs.

OK, so buy the book, but recognize its faults too. Author Driscoll bends over backwards to be fair to lawyers who practice Medicaid planning even as she warns frequently about the severe access and quality deficiencies of Medicaid-financed LTC. She repeatedly urges readers to consult "elder law attorneys" even though in her experience "they disagreed almost as often as they agreed." She states no fewer than ten times that Medicaid requires impoverishment while including a whole chapter on "Medicaid Planning Techniques" that evade the program's income and asset limits. This book is schizophrenic on Medicaid, warning of its problems even as it promotes the program's availability to pay for LTC after the insurable event occurs for the well-heeled, not just the poor. Such advice and the people who take advantage of it are destroying Medicaid as a safety net for the poor and impeding the market for private financing solutions such as long-term care insurance and home equity conversion.

So, let's get a few things straight once and for all. Medicaid is a means-tested public assistance program, i.e. welfare. It is supposed to be a safety net to ensure access to quality long-term care for the poor. It has evolved into the biggest payor of long-term care in America dragging down 80 percent of all nursing home patient days with low reimbursement rates which are often below the cost of providing care. Medicaid does not require poverty, only a cash flow problem. Income is rarely an obstacle to eligibility and unlimited assets can be kept as home equity, a business and in many other exempt forms. Mandatory Medicaid estate recovery remains largely unenforced and easy to evade. Elder law attorneys who practice Medicaid planning (artificial impoverishment) do neither their clients nor society any good. Clients divested of their assets can no longer choose their LTC providers or their level of care. Once their heirs have their wealth, the infirm elders must depend on nursing home care paid by a financially collapsing welfare system. By overloading Medicaid with their upper-middle class clients, Medicaid planners line their own pockets at the expense of taxpayers. They condemn the poor--who lack "key" money to buy their way into the better nursing homes--to "low cost care of uncertain quality" in whatever financially struggling nursing homes are willing to take them.

America and Americans have the financial wherewithal to ensure access to quality long-term care for everyone, rich and poor alike. It won't happen, however, until perverse incentives in current public policy which discourage early planning for LTC are removed and replaced with positive incentives to encourage LTC insurance and home equity conversion. Although there is much good material in the "The Complete Idiot's Guide to Long-Term Care Planning," you will not find any solutions to the long-term public policy problem there. But, keep reading these LTC Bullets and explore the Center for Long-Term Care Financing's website at and you will find the answers here and there.