LTC Bullet: Could You Lift Your Husband From the Floor?

Wednesday, June 9, 2004


LTC Comment: Once in awhile, we should set aside public policy analysis and reconsider what it's all about. More after the ***news.***

*** This Bullet is sponsored by LTCi Decision Systems, creators of the "LTC Economic Impact Planning Model" (TM)--software which "estimates the economic impact of a care event over the client's and survivors' lifetimes, illustrates the value of insurance versus self-funding a care event, and helps the advisor and client determine optimum LTCi benefit design, resulting in lowest lifetime cost of the care event." For more information, contact Ralph Leisle ( or call toll-free at 1-800-360-9853) or visit LTCi Decision Systems online at Thanks so much to LTCi Decision Systems for its 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 the Center's Executive Director Amy Marohn-McDougall at 425-377-9500 or ***

*** CLTC MASTER CLASS SCHEDULE. The Center for Long-Term Care Financing does not endorse specific companies or professional designations, but we are acutely aware of the need for education and certification of LTC insurance agents. We've often found that LTCi agents with the "CLTC" certification rank high in professional knowledge and expertise. We also appreciate the support provided to the Center for Long-Term Care Financing by the Corporation for Long-Term Care Certification. As a public service, we will provide each month a schedule of forthcoming CLTC classes with a link to further information. The Corporation for Long-Term Care Certification offers the "Certified in Long-Term Care" (CLTC) program in a class-room setting referred to as a Master Class on June 17 & 18 in Syracuse, NY; June 22 & 23 in Philadelphia, PA; June 23 & 24 in Parma, OH; June 24 & 25 in Virginia Beach, VA; June 28 & 29 in St. Louis Park, MN; and June 29 & 30 in Walnut Creek, CA. For more information, call 877-771-2582 or go to .***

*** JOHN ENGLER will address the 17th Private Long-Term Care Insurance Conference in Washington, DC later this month. Today is the last day to register for a discounted room at the conference hotel. For more information, go to or call Diane Fulton at 703-968-8863. ***

*** LATEST DONOR-ONLY ZONE CONTENT: Here's the latest Zone content followed by instructions on how to subscribe so you can receive these critical epistles daily by email.

The LTC Reader #4-022--Understanding Aging (Brief review of the new "Merck Manual of Health and Aging" with a link to where to order it.)

LTC E-Alert #4-031--The LTCi Act of 2004 (Congressman Lee Terry [R-NE] has introduced legislation to permit tax- and penalty-free withdrawals from 401(k)-type plans to buy LTCi.)

The LTC Reader #4-023--Lawyers Prosper as Medicaid, the Poor and Nursing Homes Suffer (Exploding tort liability settlements and malpractice insurance premiums cause havoc.)

The LTC Data Update #4-027--More Staff Provide Better Care? Well, Duh! (New study belabors the obvious but ignores the cause [public financing of LTC] and the solution [LTCi and HEC])

Don't miss our "virtual visits" to major LTC industry conferences in The Zone. You'll find our comparison of the conferences, session summaries, interviews and pictures at .

Individual donors of $150 or more and corporate donors to the Center for Long-Term Care Financing receive our daily email LTC Bullets, LTC E-Alerts, LTC Readers, and LTC Data Updates for a full year. You'll also get access to the donor-only zone where these publications are archived along with other donor-only features. 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 archives: . If you do not already qualify for The Zone, 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 following article by Center supporter and long-term care advocate Caren Litt Horensten speaks for itself. Take a moment to reflect on the title question and the issues and challenges it raises.


"Could You Lift Your Husband From the Floor?"
Caren L. Horensten, CSA

Well, could you??

I recently married and moved to beautiful Morro Bay, California. My husband's only sibling, his sister, Barbara, and her husband who live on the East coast, were unable to join us for our wedding. I have yet to meet them.

Why? Because her husband has been in and out of care facilities for the last 16 months and she could not leave his side. Admission to several hospitals, rehabilitation facilities, two nursing homes (one of which was over an hour's drive from their home), back home for a week or so, then on to a hospital for yet another surgical procedure.

Not to mention the difficulties she has encountered due to distant and inadequate facilities, inattentive staff, malnutrition, mismanagement of medications, her husband falling out of bed in a care facility, and having to hire an attorney due to poor quality of care and neglect of her husband. The bedsores and bruises spoke for themselves. The saga continues.

Of course, not all care facilities are like those my sister-in-law encountered. Should the need arise for you, be diligent in your research. Consult Nursing Home Compare, . This is a federal site providing detailed information about past performance of every Medicare and Medicaid-certified nursing home in the country. Also, The American Association of Homes and Services for the Aging, , is an association representing over 5,000 not-for-profit nursing homes, continuing care retirement communities, assisted living and senior housing facilities, and community service organizations.

Locally [in California, but similar programs exist in most states], services are provided by HICAP (Health Insurance Counseling and Advocacy Program) which offers assistance with among many things, understanding Medicare benefits and other senior planning issues at .

I have always done my best to educate clients on the issues of long-term care insurance. The saying for real estate is "location, location, location;" with long-term care planning it is "education, education, education."

Oftentimes people look at an annual premium of $2,000 or more and say they cannot afford it without realizing that one month of home care could cost more than this depending on the level of care required. An assisted living facility could cost $2,500 or more per month. How would this impact your entire financial plan?

Medicare is the primary health care system for those 65 and older (or for those on disability). It is designed to pay for skilled and/or rehabilitative care. Medicare does not pay one cent for assisted living and fully pays for nursing facilities only if skilled care is needed and then only for the first twenty days. From the 21st through the 100th day, Medicare pays all but a daily co-insurance amount, which exceeds $100 per day and is adjusted annually. From the 100th day on, you are on your own. The numbers continue to change and they are not going lower. You do the math.

Barbara just received a $30,000 hospital bill because Medicare had been exhausted. Her husband was well enough to be discharged to return home but not ill enough to require skilled nursing care. The fact that he was unable to walk or care for himself had nothing to do with it. He went home!

She now faced the reality that she was going to have to care for him at home and this meant feeding and bathing him and taking care of his other personal needs. What about his personal dignity? When will she rest? Who will take care of her?

Many people say their children or other family members will care for them. Yes, of course your children will do what they can. But they can't do it 24/7 and not everyone is cut out for caregiving. What you want to do is make sure you have a plan that helps your children have the life they want to lead also.

This is real life. This is what could happen without proper planning and I don't mean giving assets away to qualify for Medicaid. (Medi-Cal in California.) Medicaid is welfare and there is loss of choice when one opts for this. The state determines where you receive care, the level and quality of care and the person(s) with whom you will be sharing space for the length of your stay! It is good for those who truly need it but if you don't have to use it, you will be in a position of having choices should you need to receive care. Having choices as to where to go for care as a "private pay" resident makes a huge difference when you or a loved one is facing a similar situation. Good decisions are never made in a crisis. Protect yourself from the tragic circumstances that befell my new family.

I am not an attorney and am not qualified to provide legal advice. However, if you have been told that Medicaid will pay for it all so you don't have to do anything but artificially impoverish yourself to qualify for it, seek a second opinion. After considering all you have to give away to qualify, it becomes the most expensive "deductible" you will ever pay in your life.

Understand that long-term care is a continuum of care which encompasses the services we require as well as our housing needs as we age and are less able to care for ourselves. This occurs either due to our loss of physical or cognitive abilities or a combination of both, and requires primarily custodial care, not skilled care, which is medical in nature.

You can help soften the emotional, psychological, physical and financial impact of either you or someone you love needing extended care for an acute or chronic medical condition. There is a fifty percent chance of this happening to us after the age of fifty. I am there. How about you? Know what your plan is for taking care of your long-term care costs.

The time has come to realize we are all responsible for our own "Frailty Planning," as it is but another phase of life that lies ahead for most of us. The only time to do this is before the time of need, while you are still young enough and healthy enough to medically qualify for the coverage because not everyone can get it!

If you are single, you need to be concerned about trusting that the care will be there should you require it.

For those of you who are going to be married, before you say "I Do," agree that you and your spouse (or care partner) will consider purchasing a long-term care insurance policy to protect your financial plan and quality of life should the need for care arise. We did. I couldn't lift 175 pounds.

Can you?


Caren L. Horensten is a California resident and a Certified Senior Advisor (CSA), specializing in long-term care insurance. Please direct questions or comments about this column to her at (805) 772-2455, 800-965-3750, or email them to