LTC Bullet: LTC ViaRail

Wednesday, May 28, 2008

Lake Fairfax Park, Reston, Virginia (LTC Tour Mile 12,500, State #19)--

LTC Comment: LTC in Canada: on track or derailing? After the ***news.***

*** THE SECOND ANNUAL PARTNERSHIP SUMMIT: Charting the Future of Long-Term Care Insurance will be held July 8-9, 2008 at the Baltimore Marriott Inner Harbor at Camden Yards, 110 South Eutaw St., Baltimore MD 21201. Space will be limited so register early. Participation Fee: $375. Special rates for Federal and State participants. Questions? Contact Marcia Bearor, Project Coordinator at For details and to register: This was an excellent program last year. I'd attend again if I weren't already committed elsewhere. Go and send me your feedback on the program for publication. ***

*** DEAR MARCI'S mindless message about long-term care insurance roused several Center members to appeal to us for a rebuttal. Let's do better. Let Marci know what YOU think of her advice in yesterday's "Medicare Rights Center" e-letter. To wit: "First, be aware that while long-term care (LTC) insurance can limit health care costs for some people, it is not a good option for most. It is expensive and premiums can increase substantially as you age. A reason for purchasing long-term care insurance is that it may help you avoid depleting life savings if you need a prolonged nursing home stay and preserve savings and other assets. Another is that it may help offset the cost of long-term care if you and your spouse have limited assets but relatively high income (over $35,000 a year or $2,917 a month). There may, however, be other options that can help you pay for long-term care, such as Medicaid." I found grievous errors of fact and interpretation in every line of that blurb. Read the rest of the article here. Then, with patient professionalism and respect, explain the facts of long life to Marci so she can learn and stop luring her readers down the primrose path of impoverishment. ***

*** REFERRALS. Thank you for reading the Center for Long-Term Care Reform's latest "LTC Bullets" newsletter. If you know someone who would be interested in this publication, please recommend us by clicking here If you have received this edition as a forward, and would like your own subscription, you may subscribe here Thank you. ***



LTC Comment: Remember the joke about cruise ships and LTC? Why spend $250 per day for a nursing home when you can live in luxury with tender loving care on the high seas for less?

Riding the Canadian "ViaRail" system round trip from Toronto, Ontario to Vancouver, British Columbia I was reminded of that idea. The train is comfortable. The service is excellent. The food is good and plentiful. And the average age of the passengers, many of them frail or under-abled, must be 70 or more.

I took the opportunity at meals and relaxing in the dome car to ask my fellow travelers about long-term care in their countries. Bottom line, most people on the train, whether hailing from Europe, Australia, or Canada, were as unaware--and as much in denial-- about long-term care, especially its financing, as my compatriots from the USA.

My most important takeaway from these conversations is the following anecdote. Take what follows with a grain of salt as it is just a story, not documented research. Two unrelated Canadians told me nearly identical stories, however.

They said that in Canada financial help from the government for long-term care is based only on income. Assets, no matter how large, are disregarded, except that home equity must first be liquidated, which then of course increases interest income. So income over a certain amount, unspecified by my interlocutors, disqualifies Canadians from public assistance.

What happened in both of these cases was that my train companions' mothers qualified financially for publicly financed nursing home care, but their fathers, who needed assisted living, had too much income to qualify for government help. So, although there was publicly subsidized assisted living associated with the mothers' nursing homes, the fathers, ineligible for public assistance, could not live there. They had to reside in private-pay facilities many miles away from their wives. Two loving couples, each married for over 50 years, were broken up by Canadian LTC public policy.

My conversations with other passengers several times drifted into the area of asset transfers. It appears that giving away wealth to qualify for LTC assistance (by reducing interest income) is discouraged in Canada as it is in the United States. But as in the U.S., the rules governing asset transfers are enforced or unenforced at the whim of local authorities, often depending on whether and to what extent public funds are scarce.

Bottom line, my brief exposure to Canadian long-term care policy and the slightest familiarity gleaned from conversations with other nationalities, is that--as at home-- knowledge about LTC financing is rare except within families currently in crisis. Few people plan ahead. Private long-term care insurance is even less common in Canada and Europe than in the United States. And public LTC financing sources are inadequate already and doomed to fail in the future as the Age Wave crests and crashes across the world.

June 3 I'll meet in the Silver Bullet near Washington, DC with a delegation from the Prime Minister's office of the United Kingdom. They want to know why the private LTC insurance market has not taken off in the U.S. If private insurance isn't popular here, what chance would it have in a country with an even more socialized health care system than ours?

That's easy to explain. LTCI languishes here for the same reason it's even more uncommon elsewhere. Government financing has anesthetized the public to the risk and cost of LTC and distorted the service delivery system toward institutional care which most people would rather avoid.

How to fix the problem is equally easy once you understand and focus on the cause instead of the symptoms. Economize and improve the publicly financed long-term care safety net by making it available only to people truly in need. Require others to pay privately, including the use of home equity to fund their long-term care. More private financing will enhance access to and quality of care for everyone, rich and poor alike. And the need to pay privately will quickly increase responsible long-term care planning through private insurance and savings.

Gee, that sounds familiar. Responsible long-term care planning and rational LTC public policy! The very same simple message of this year's "National Long-Term Care Consciousness Tour." Just think what the market for long-term care insurance and home equity conversion could be in countries that are more stressed by aging demographics and more encumbered by unfunded entitlement programs than we are.

Maybe next year the LTC Tour should go international!