LTC Bullet: Polishing Nursing Homes

Thursday, January 16, 2003


LTC Comment: How would you like to have the public relations job of convincing consumers that nursing homes aren't so bad after all? A new American Health Care Association brochure and the forthcoming National Nursing Home Week are trying to do just that. Details after the ***news***. Then read a short essay by LTCI specialist Barbara Hanson on the underlying cause of nursing homes' poor PR and why more private financing is the long-term solution.

*** This Bullet is sponsored by the National LTC Network, "Partners in Long-Term Care Insurance Coverage, Design, Education and Distribution." Visit the Network online at . Contact Allen Mansfield, Executive Director, at 800-996-6789 or for more information. Thanks so much to Network members 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 .***

*** Would you like some strong practical, logical and philosophical arguments why private insurance excels social insurance? Read Center President Steve Moses's latest article, titled "The Inherent Individualism of Insurance," published in the November-December 2002 issue of Navigator magazine. You can read the article online at: . Navigator is the monthly journal of The Objectivist Center (TOC); for a free copy, click here: or email . For more information on TOC, go to . To read the speech on which this article was based, titled "Insurance: Private vs. Social," go to . ***

*** Half price sale. To help raise financial support for the Center for Long-Term Care Financing, we are offering Center President Stephen Moses's appearances for half price. There is a catch, however. To get the usual flat fee for Steve's programs reduced from $5,000 to $2,500, you'll need to piggy-back on a trip he already has scheduled. So, check the following schedule, and if you can organize something in the same general locale and time frame, let Center Executive Director Amy McDougall know ( 1-425-377-9500, or ) . She'll help you arrange the event whether you decide on a speech, legislative testimony, press contacts, training and motivation for agents, an LTC Graduate Seminar, or whatever else you think will best convey your message and ours of responsible long-term care planning. How do these dates look?

January 24-29


January 30-February 3


February 4-12

New Mexico

February 13-17


February 18-20


March 7-12


March 24-28

New York and Northeast

All proceeds go to the Center for Long-Term Care Financing which is a 501(c)(3) charitable, non-profit, non-partisan think tank and public policy organization. ***

*** Latest donor-only zone content includes:

LTC Data Base #3-001--LTCI Tax Deductibility Update Plus Good Coverage News

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 donor zone content and the archives: . To Zone In, mail your tax-deductible contribution of $150 or more to the Center for Long-Term Care Financing, 2212 Queen Anne Avenue North, #110, Seattle, WA 98109. Then email your preferred user name and password (up to 10 characters each). You can also contribute online by credit card or direct withdrawal at . ***


LTC Comment: The guide described below can help remove the confusion and fear from selecting and moving into a nursing facility. This brochure, available in batches of 25 for $39.95 ($29.95 for members) from the American Health Care Association, might be a helpful handout for senior advisors to give their prospects and clients. (This is not an ad; we provide this information as a service to readers without remuneration to the Center.)

"AHCA Offers New LTC Consumer Guide. WASHINGTON, DC -- 12/10/2002 -- (Eli Digital) The American Health Care Association wants to help dispel misconceptions about life in long-term care facilities. The organization has published a booklet titled 'Living in a Nursing Facility: Myths and Realities.' The 9-page brochure aims to educate individuals about the move to a nursing facility and help them gain a comfort level with the future move. The guide is intended for facilities, doctor's offices, hospitals, offices on aging, or any other organization that works with families and the elderly. For more information, click here ."

Source: LTC Daily Analysis Briefs, December 10, 2002, prepared by for members of .


LTC Comment: National Nursing Home Week, described below, is another attempt to put a better shine on nursing homes.

"LTC Daily Analysis Briefs: Theme, Dates Announced for National Nursing Home Week WASHINGTON, DC -- 12/31/2002 -- (Eli Digital) Mark your calendars, nursing home providers. The American Health Care Association has announced the theme and dates for the 2003 National Nursing Home Week. The event will begin on Mother's Day, May 11, and continue through May 17. The theme is 'Reflections of a Lifetime.' 'National Nursing Home Week is an opportunity to bring forward into the limelight the celebration of this focus on quality with residents, staff, families, volunteers and members of our communities,' says Dr. Charles Roadman, AHCA's president and chief executive officer. AHCA will mail the event planning guide to members in mid-January. Others can print the guide and product catalog from in mid-January.

Source: LTC Daily Analysis Briefs, December 31, 2002, prepared by for members of


LTC Comment: The following article by a long-term care specialist with experience on both the provider and insurance sides of the business gives a perceptive perspective on the quality challenge facing nursing homes.

"Can the Quality of Care Be Improved in Nursing Homes?"
Barbara Hanson, California Long-Term Care Insurance Specialist

Contact the author at 831-335-4949, , or

". . . the Bush administration believes making nursing home quality information public and . . . subjecting homes to inspections and fines, will improve the quality of care." (Recent news article, 11/02)

I worked in nursing homes seven years. The story was the same twenty-five years ago as now. It has always been difficult for understaffed and underpaid nursing homes to get a perfect score in the inspections by well meaning government agencies. The main problem causing lack of quality care in nursing homes is the underpayment of nursing homes by the government.

MediCal, the welfare program in California, pays for about 70% of the residents of nursing homes at a reduced rate, usually less than the actual out of pocket cost to the facility. Any share of cost by the resident triggers the MediCal rate. More generous Medicare reimbursement which used to make up some of the short-fall has recently been cut to the bone as well. Also, with generous liability laws in CA, we have a lot of lawyers pouncing on nursing homes and driving the cost of liability insurance through the roof. Nursing homes are a money losing proposition already--a few more fines will put even more out of business. Twenty-five per cent of the nursing home industry declared bankruptcy a couple years ago and 8% are still bankrupt.

Look around. Have you seen any new skilled nursing homes popping up in your neighborhood? In Santa Cruz County, we have not seen a new one built in decades and some have closed. There are now 35 million people over 65 in the US, 75 million boomers on their heels. The historical rate is that 43% of us over 65 will need care at some point in a skilled nursing facility. Where will we all be staying?

The ideal place to convalesce is at home, and often a private-pay apartment in assisted living or a residential care facility will fill the bill. These options cost money. The government is not able or willing to spend $3000-$5000 a month to put us all up in a place we might like. The nursing home is the very last resort when health has deteriorated past home care, family and friends are exhausted, or all the money is gone. (MediCal Planning is another piece of the problem, whereby the middle class goes to the nursing home at taxpayer's expense by artificially impoverishing themselves. MediCal was designed to help the truly needy, not our heirs.)

The federal government began to encourage the purchase of long-term care insurance in 1996 with a tax deduction on the premiums (and a penalty for welfare planning). Currently, corporations get a 100% federal and California tax deduction for tax qualified LTC insurance as a "reasonable and necessary business expense" for a bona fide class of select corporate employees. Self-employed and sole proprietors are allowed tax deductions for LTC insurance as medical insurance based on their age before the close of the tax year, and LTC insurance is subject to the 7.5% AGI floor for individual taxpayers. More generous tax deductions are expected soon.

The California Partnership for Long Term Care is a state government/private insurer alliance designed to encourage middle class Californians to buy long term care insurance so they can pay for quality care both at home and in the facilities of their choice. This program also includes asset protection from welfare spend down. Every dollar paid out by the insurer is a dollar protected for your family or any other purpose. Information on the Partnership is at 800-CARE-445, and .

When most of us start paying what care actually costs, the competitive market will ensure quality care.