LTC Bullet:  Congressional Quarterly Nails the LTC Issue 

Monday, October 23, 2006 


LTC Comment:  Sloppy, ideologically biased reporting on the long-term care issue is endemic in the media.  A welcome exception follows the ***news.*** 

*** WSJ MISSES ON THE LTC ISSUE.  Speaking of misguided media, here's an example on the front page of today's Wall Street Journal:  "Olden Days:  Seniors in Vermont Are Finding They Can Go Home Again; In Shift From Nursing Homes, State Has Family Members Care for Elderly Relatives; Helping Gram at $9.25 an Hour," by Lucette Lagnado.  If you subscribe to the WSJ Online, read it at  Otherwise, pick up a hard copy.  You won't find a single mention of long-term care insurance or home equity conversion, the only hopes for saving long-term care financing.  Instead, read how Vermont is digging its LTC financing hole deeper than ever by diverting scarce public welfare dollars toward paying families to provide care they've been giving for free heretofore.  It won't save money, economists say, and it will further anesthetize the public to the real risk, cost and emotional strain of long-term care. *** 

*** ALZHEIMER'S DISEASE:  CAREGIVING IMPACT.  A recent MetLife study found that those caring for an individual with Alzheimer's disease or a similar dementia were 45% more likely than those caring for a loved one with a physical impairment to report that caregiving had caused their health to worsen.  Caring for someone with Alzheimer's disease added 13.5% to the caregiver's stress.  See "The MetLife Study of Alzheimer's Disease:  The Caregiving Experience"  by the MetLife Mature Market Institute in conjunction with LifePlans, Inc., August 2006, *** 

*** UCS SELECTS GOLDENCARE USA.  Unified Capital Solutions, a leading provider of employee-paid voluntary plans, has selected GoldenCare USA as provider of long-term care solutions for their clients.  GoldenCare USA, based in Plymouth, Minn., is widely known for its long-term care expertise and, together with its western affiliate (American Independent Marketing), operates in 50 states, has 11,000 agents, with over $500 million in written premium.  Contact:  Gerald O. Summers, 1-888-533-7503. *** 



LTC Comment:  We're very pleased to point you today to an excellent, 23-page report titled "Caring for the Elderly."  It was written by Marcia Clemmitt and published in CQ Researcher ( by CQ Press (, a division of Congressional Quarterly, Inc. (  Single copies of this and other CQ Researcher reports can be purchased for $15 each at or by calling 866-427-7737. 

Here's what we found on a website about CQ Researcher:  

"The award-winning CQ Researcher explores a single 'hot' issue in the news in depth each week.  Topics range from social and teen issues to environment, health, education and science and technology.  There are 44 reports produced each year including four expanded reports.  The CQ Researcher's hallmark is scrupulous objectivity and balance.  Every 12,000-word report is written by an experienced journalist and features comments from experts, lawmakers and citizens on all sides of every issue.  Numerous charts, graphs and sidebar articles -- plus a pro-con feature, a chronology, lengthy bibliographies and a list of contacts -- round out each report." 

Following are excerpts (a few of our favorite quotes) from CQ Researcher's "Caring for the Elderly," published October 13, 2006.   

Several LTC Bullets subscribers are also quoted in this paper including professor Richard Kaplan of the University of Illinois, Joshua Wiener of the Research Triangle Institute, Mark Meiners of George Mason University's Center for Health Policy, Research and Ethics, Jodi Anatole of MetLife, Professor Stephen Golant of the University of Florida, Bill Thomas of the Eden Alternative, and Medicaid planner Bernard Krooks.  We wanted to pull all their quotes for you but the result would have been much too long.  By all means, get a copy of this excellent article and read everyone's comments in context. 


"To see the futility of expanding the government's presence into LTC, 'you have to look 20 years ahead, when Medicare and Social Security will be in the last stages of collapse, and Medicaid will be history,' says Stephen A. Moses, president of the Seattle-based Center for Long-Term Care Reform, who advocates more private financing of LTC." (p. 846) 


“Some advocates of private LTC insurance doubt public programs can ever hold down spending.  ‘Has anyone run the numbers for the difference between promises made through Japan’s social-insurance programs . . . and the country’s ability to keep those promises?’ asks Stephen A. Moses, president of the Seattle-based Center for Long-Term Care Reform, which advocates private LTC. 

“‘In the absence of a private market for services in which supply and demand set prices and determine priorities, governments are hopelessly at a loss to decide the best services to offer and the proper prices to charge for them’ Moses says.” (p. 847)


“Medicaid’s rules allow adult children to routinely commit what Moses, of the Center for Long-Term Care Reform, calls ‘financial abuse’ on their elderly parents.  The children hire lawyers to deplete the parents’ estates of enough assets to make them eligible for Medicaid while preserving the children’s inheritance in financial trusts, he explains.  Moses advocates the voluntary purchase of private insurance, with the government’s role confined to helping the very poor pay for LTC.” (p. 854) 


"Should the federal government establish a mandatory long-term care insurance program? 

"Stephen A. Moses, President, Center for Long-Term Care Reform, from speech to insurers posted at, February 28, 2006 

“The personal tragedy of long-term care for individuals and families can be substantially relieved if people are able to pay privately for high-quality personal and respite care.  The social tragedy of long-term care for America’s aging population can be entirely averted by changing public policy so that fewer people end up dependent on underfinanced public welfare programs. 

“Friends and families provide most long-term care at no charge, but under enormous financial and emotional stress.  The vast majority of all formal, compensated long-term-care services are paid for by Medicaid (welfare) or Medicare (social insurance).  I believe that Medicaid routinely pays less than the cost of providing long-term care and that Medicare is slowly ratcheting down its reimbursement, while both programs impose heavier and heavier regulation on providers. 

“We’re in [this mess] because 40 years ago the government started paying for nursing-home care without limiting its free and subsidized services to people in financial need.  By making nursing-home care free, for all intents and purposes, the government impeded the development of a private market place for home- and community-based services.  By subsidizing long-term care for middle- and upper-class Americans, the government impeded the development of a private insurance market to help pay for the kinds of services people prefer. 

“By becoming a single buyer of long-term care, the government artificially increased the demand for and the price of care beyond its ability to pay adequately.  The resulting cost containment caused quality of care to decline and led directly to the overregulation that tied nursing homes and home-health agencies in bureaucratic knots.  

“If too much government financing has caused excessive dependency on inadequately financed institutional care, then the answer must lie in targeting scarce government resources to a smaller number of people truly in need. 

“When government programs have fewer people to serve, they will be better able to provide adequate reimbursement of higher quality.  If they cannot ignore the risk and cost of long-term care, most people will save, invest and insure and thus be able to purchase red-carpet access to care in the private marketplace.  When the government stops giving away what the long-term-care insurance industry and reverse-mortgage lenders are trying to sell, more people will buy those products.” (p. 857) 


“‘The DRA was the culmination of a decade of major work for me,’ says Moses, of the Center for Long-Term Care Reform.  He has been one of the strongest voices urging lawmakers to make it harder for people to qualify for Medicaid-funded LTC because it would spur development of a strong, private LTC insurance market.  ‘It’s a virtual miracle that we got as much as we did’ in the DRA, ‘though it doesn’t go far enough,’ he says.” (p. 858)  [David Rosenfeld, co-founder of the Center for Long-Term Care Reform, and later Chief Health Counsel to the House Energy and Commerce Committee played a critical role in the design and passage of the DRA.] 


“‘We have a lot of people on Medicaid for LTC who would have, could have and should have been able to pay, had they taken the steps to do so,’ says Moses.  

“He acknowledges that there is ‘little empirical research’ showing how many people illegitimately spend down money to qualify for Medicaid LTC.  The phenomenon is ‘driven by adult children’ of cognitively impaired parents who ‘hate to see their inheritance consumed’ paying for private LTC, so they transfer and conceal their parents’ assets so Medicaid will pay instead, Moses says.” (p. 858-859) 


“But home-based care is generally more expensive than assisted living, and HCBS programs will only be as large as states can afford, some warn. The initiative ‘isn’t going to go very far, because there isn’t enough money,’ predicts Moses.” (p. 859)