LTC Bullet:  Nursing Home Pot Calling LTCi Kettle Black? 

Wednesday, August 8, 2007 


LTC Comment:  LTC providers and insurers need to understand each other's challenges and opportunities better and cooperate more.  A case in point, after the ***news.*** 

*** INTERNATIONAL PRAISE for the Center's "Almanac of Long-Term Care":  Canadian Patty Randall, the highly regarded author and speaker on long-term care planning, wrote us about yesterday's "LTC Almanac" update:  "Stephen:  Just want to say that today's LTC E-Alert #7-101--outlining the newly published reports and articles is worth the membership fee alone!!!  Thanks once again for doing such an amazing job of updating your readers.  Kindest Regards, Patty Randall, National Consultant/Author."  And thank you, Patty, for many years of support for the Center and for your advocacy on behalf of rational LTC public policy in Canada. *** 

*** LTC ALMANAC.  Want to know more?  The "Long-Term Care Almanac" is a compendium of data, abstracts, quotes and citations about long-term care service delivery and financing listed chronologically by topic and ranging back as early as the 1980s.  The "Almanac" is available exclusively to dues-paying members of the Center for Long-Term Care Reform and to affiliates of our corporate members.  Find it in The Zone at  Topics covered are:  Aging Demographics; International LTC; Unfunded Liabilities--Social Security, Medicare, and Budgets; Long-Term Care; Caregiving; Long-Term Care Financing; Long-Term Care Insurance; Reverse Mortgages; Long-Term Care Providers; Medicaid; and Medicaid Planning.  Periodically, we add material to the "Almanac of Long-Term Care" based on newly published reports and journal articles.  We update Center members on all new additions to the "LTC Almanac" in our daily "LTC E-Alerts" for members. ***  

*** JOIN TODAY.  If you are not yet a member of the Center but would like to learn more about the "Almanac" and all the other features in our content-rich public and private websites, check out the webinar at  Then join the Center by contacting Damon at 206-283-7036 or  He'll have you in "The Zone" today with access to everything, including the Almanac and our daily publications, the "one-a-day mental vitamins" for anyone and everyone in the field of long-term care. *** 



LTC Comment:  One of the Center for Long-Term Care Reform's favorite themes is that private sector LTC stakeholders (providers, insurers and financiers) should stick together. 

Our "LTC Triathlon" study of a few years ago documented the counterproductive misunderstanding and lack of cooperation between those three groups and recommended solutions.  

Read "The LTC Triathlon:  Long-Term Care's Race for Survival" at

I compared competing LTC interest groups to the blind men of the elephant allegory in "The Elephant, The Blind Men and LTC," National Underwriter LTC E-Wire, Vol. 2, No. 3, February 2003.  Read that one at:    

Understanding why LTC service delivery and financing in the U.S.A. is so fouled up by comparing the competing interests of government, senior advocates, the public, providers, insurers and financiers is the primary goal of our "Long-Term Care Graduate Seminar." 
That understanding is a prerequisite to fixing LTC public policy AND selling more private insurance in the meantime.  Details at   

So when a leading nursing home/LTC provider trade magazine reported uncritically on that March 26 New York Times broadside at the LTC insurance industry, I responded. 

I reminded LTC providers how unfair national media coverage has been toward their own profession and urged them to consider this key point: 

Both LTC providers and insurers get a bad rap.  The real culprit is excessive public financing of long-term care.  Medicaid especially has undercut access and quality of LTC with low reimbursements and crowded out private financing by exempting huge home equities and subsidizing welfare-financed care after the insurable event occurs. 

To its credit, McKnight's Long-Term Care News ( published my letter.  It follows.  But first, let me strongly encourage all readers of this newsletter and our "LTC Blog" at to subscribe to McKnight's and other LTC provider trade journals.  The more you understand what providers, especially nursing homes, are up against, the more you'll appreciate their industry's good guys' heroic efforts to give compassionate, high-quality care under extremely difficult conditions.  They're comparable I assure you to the thankless labors of the AMGs (altruistic, masochistic geniuses) who sell LTCi. 


Stephen A. Moses, "Advocate Rips Newspaper About LTC Insurance Story," McKnight's Long-Term Care News, July 2007, pps. 40-41. 

The recent New York Times article (as reported on in McKnight's: "Analysis rips LTC insurers," May 2007, p. 12) is on a par with the attacks in USA Today and Consumer Reports on nursing homes - i.e., some real problems exist, but the criticism is out of all proportion and directed at the victims of the real problem: too much reliance on public financing, which undercuts nursing homes and crowds out private insurance. 

Scrutiny of long-term care insurance is good. I'll let people in that business defend their product. But to be fair, what happens if people don't have private LTC insurance? Most likely, they end up on Medicaid, which is a means-tested public assistance program. Although it is welfare, Medicaid for LTC is easy to get. Income is rarely an obstacle and most assets are protected, a home (up to $500,000) plus a business, car, home furnishings, personal belongings, term life insurance and prepaid burials of unlimited value. 

Free long-term care? What's not to like? First of all, it isn't free. You'll have to contribute all but a pittance of your income toward your cost of care. Then consider that Medicaid is tax-payer-financed. It's always short of funds. Medicaid pays nursing homes $13.10 per bed-day less than their cost of providing the care. So what? 

Medicaid has a dismal reputation for problems of access, quality, reimbursement, discrimination and institutional bias. Depend on Medicaid and you'll probably end up in an under-financed nursing home, if you can find one at all that will accept low reimbursement. The main reason to have private LTC insurance is so you can keep control of your life and receive red-carpet access to top quality long-term care at the most appropriate level: home care or assisted living and a top-notch nursing home, but only if you need it. 

If Medicaid-financed long-term care is problematical now, just wait a couple decades when baby boomers need LTC. By then, Social Security and Medicare will be in big trouble. By the time most boomers need LTC, those supports will be long gone. 

Wise consumers should use caution when selecting a private LTC insurance policy, but they should also apply similar scrutiny toward Medicaid. Because, without private insurance, that's where they'll likely end up. 

Stephen A. Moses
Center for Long-Term Care Reform, Inc.
Seattle, WA