LTC Bullet: LTC Parallels in Britain

Tuesday, August 3, 2010


LTC Comment: Caring for Mom and Dad is as big a problem for "Mother England" as it is for USA. Details after the ***news.***

*** LETTING GO. Author, speaker, friend Liz Taylor, founder of Aging Well Consortium and editor of the "Aging Deliberately" e-letter shared this tip with me: "This is one of the most intelligent, caring, informative, thought-provoking and poignant discussions about end-of-life decisions I've ever read. You'll probably want to put off reading it (as I did), but you'll be glad you did." I did put it off, but read it this morning, and I am glad I did. You will be too, especially if you care for, or council people who care for, terminally ill patients. Read "Letting Go" by Atul Gawande in the August 3, 2010 New Yorker here. ***

*** CENTER FOR LONG TERM CARE REFORM is co-sponsoring "The Intercompany Long-Term Care Insurance Conference again this year. The 11th annual convocation of this important meeting will take place in Atlanta, Georgia, March 6th to 9th, 2011. The conference is full of experts, leaders and top executives from companies in the long term care industry. It is a wonderful opportunity to network, market, and learn from many different areas of the industry. Watch this space for details as they become available. ***

*** WHAT HAPPENS IN VEGAS, STAYS IN VEGAS unless it's what you learn at the 9th National Long-Term Care Insurance Producers Summit organized by the American Association for Long-Term Care Insurance (AALTCI). The Summit will take place April 3-5, 2011 at the Tropicana Hotel in Las Vegas, NV. The National LTCi Producers Summit is the national conference for insurance and financial professionals who sell and market long-term care solutions. For further information, call AALTCI at (818) 597-3227 and watch here for more details as they become available. ***



LTC Comment: With all the talk of Don Berwick's (he's the new CMS recess appointee) fondness for the Brit's National Health Service, it's easy to assume England has financing health and long-term care covered.

Think again! They're in just as big a mess as we are, or bigger.

On the acute health care side, this just came out:

"Britain plans to decentralize health care. By Sarah Lyall, New York Times. July 24, 2010 In its most radical move yet, Great Britain's new coalition government has announced a plan to completely reorganize the country's National Health Service by removing layers of bureaucracy and putting the control in the hands of doctors at the local level. The doctors would use funds given to them by the government to purchase services from hospitals and other providers. A white paper issued by the government said the plan would 'cause significant disruption and loss of jobs,' but went on to explain its move, saying, 'The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.'"

Source: AHCA / NCAL Gazette - Monday, July 26, 2010

For more on this, see Grace-Marie Turner's piece in National Review Online titled "Britain Moves toward More Doctor-Patient Control" which begins: "Britain's new coalition government is proposing a major transformation of its socialized health-care system to give doctors much more authority over decisions involving their patients' care."

Hmmm. Am I missing something, or are we in the good ole USA headed in exactly the opposite direction . . . toward more bureaucracy, increasing central control and less involvement for patients and doctors?

On the long-term care side too, the Brits are struggling with the same problems we are. They've studied the issue to death and still can't decide what to do. Their quandary sounds so much like ours, it's worth looking at these recent quotes, if for no other reason than "misery loves company."


According to "Government unveils team tasked with finding ways to fund long-term care" in the July 20, 2010 Guardian:

"Ministers have unveiled the membership of the commission tasked with producing a formula for reform of long-term adult care funding, but have made clear that a compulsory insurance system would be off limits. . . .

"The commission has been told to consider 'a range of funding ideas including both voluntary insurance and partnership schemes', but its remit [i.e., instruction or guidance] leaves little doubt that compulsory insurance would be unacceptable after the Conservative campaign against Labour's so-called 'death taxes'. . . .

"The remit specifies that the commission should look at 'how people should choose to protect their homes against the cost of care.'" [Emphasis added.]

LTC Comment: Advocates trying to save the CLASS program from the scrap heap of actuarial non-starters claim making it compulsory would improve its chances. Lesson learned from abroad: even the socialized health care system of the U.K. isn't going to try that.


Or consider this in "Long-term care: get the best deal now," from the July 21, 2010 Telegraph.

"But regardless of what the commission recommends when it reports a year from now, it won't answer one key question: what help is available for those who need care now? . . .

"Financial help for those needing long-term care is limited, as local authorities assess not only an individual's health needs but also their ability to pay. With councils short of cash, help is often restricted to those on the lowest incomes with the most severe health needs.

"In what has been described as 'the meanest of means tests', those with assets - which in most cases will include the value of their home - of more than 23,500 [equals 35,400 dollars] are given no help at all with care costs. . . .

"It is not surprising that many thousands of elderly people are forced to sell the family home to meet these care costs." [Emphasis added.]

LTC Comment: Interesting. To receive LTC help from their government, the English must have low incomes and no more than 23,500 British pounds (around $35,400 at today's exchange rate) including the home! Compare that with our allegedly dog-eat-dog capitalist system in which anyone with income below the cost of a nursing home ($6,000 month on average) plus a home worth from $500,000 to $750,000 and many other exempt assets qualifies easily for Medicaid-financed LTC.

And get this, practices very like our "Medicaid planning" are routine in Britain too. The article continues thus:

"One of the main problems facing families caught in this position is where to get proper advice on the options and help available.

"For most people the first port of call is the local authority or NHS [National Health Service] Trust. Neither has a particularly good record of providing clear information on the complex and labyrinthine care system. To make matters worse, many families find they are trying to wade through a financial and legal quagmire at the same time as dealing with a serious family illness and emotional upheaval. As a result, many fail to claim the help to which they are entitled.

"But there are steps that many families can take to protect their assets and secure the best care for a loved one. The following information should provide a good starting point."

LTC Comment: The article concludes with a list of ways to game the British LTC welfare system including . . . "keep your home out of the council's clutches;" "request a deferred payment plan;" "buy an immediate needs annuity;" "invest in a life insurance bond."

Oh how familiar this is! Complex rules make it hard for the poor to get help, but the financially savvy affluent walk right around the rules and get public benefits easily. The parallels with Medicaid in the USA are striking.


Finally this from "Who cares as baby boomers become 'silver shufflers'?" in the July 21, 2010 Daily Telegraph.

"Who cares about the old and infirm? More to the point, who will fill the 6bn deficit [equals 9.5 billion dollars] in long term care funding forecast to open up over the next decade as an additional 1.7m older people become unable to look after themselves?"

"All three major parties promised to end the need for pensioners to sell their homes to pay for the cost of care. Under plans drawn up by the previous government [Labour], the elderly faced a fee of up to 20,000 [equals 31,800 dollars]- to be paid in advance or taken from their estate when they died - whether they ended up needing care or not.

"In opposition, the Conservatives favoured a voluntary insurance scheme which would involve a one-off payment of 8,000 [equals $12,700] on retirement. The Liberal Democrats proposed a partnership scheme to which both the state and individuals contributed. But the Coalition agreement talked only about 'a range of ideas, including both a voluntary insurance scheme ... and a partnership scheme.'

"A market-led solution which allows individual choice and rewards individuals for saving and insuring in a responsible manner must be better than the bureaucratic cop-out of creating another tax. Three in four older people never need long term care. So it ought to be possible for the majority to share the cost of insurance to fund the needs of the minority who do need to claim - just as most of us already do as householders and motorists.

"Earlier attempts to market long term care insurance failed due to lack of demand. People entering retirement simply did not buy these policies because they preferred not to think about the risks. But that is likely to change, as the extent of the problem becomes clearer and doing nothing ceases to be an option. The government must help insurers explain the value of the service they are offering, just as it already does with the wider problem of pensions."

LTC Comment: As our cousins across the pond contemplate a big death tax or voluntary insurance to fund LTC, we dither with unenforced "estate recovery" and private LTC insurance too few buy. But the Brits are right about this: "as the extent of the problem becomes clearer and doing nothing ceases to be an option," the public's denial about LTC risk and cost will disappear.

Sounds to me like the British are stepping back from the brink of socialized long-term care even as we're rushing towards it. In the words of the omnipresent London underground warning: "Mind the gap" between wishful thinking and affordable publicly financed care.


Or as "Paying for long-term care will cost 'second' NHS" in the July 27, 2010 Financial Times Adviser warned: "Free personal care for the elderly, funded out of general taxation, could cost the government the equivalent of a second NHS, claimed think tank Policy Exchange."

LTC Comment: Won't happen there any more than CLASS will solve our problems here.