LTC Bullet:  LTC Almanac Update

Tuesday, July 05, 2011

Loomis, CA--

LTC Comment:  Our latest update to the "LTC Almanac" in The Zone follows, but first.  I'm underway, traveling again in the "Silver Bullet of Long-Term Care."  Having spent the Fourth with family near Sacramento, I'm off to Los Angeles this morning.  After a week at a conference in Anaheim, I'll head east toward Washington, DC and the best opportunity we've had to fix LTC financing since 2005 and the DRA.  I'll keep you posted from the road.  For details on our new project, see "LTC Bullet:  The LTC Opportunity."


Center members know and appreciate our "Almanac of Long-Term Care" in The Zone, our password-protected website. 

*** SPECIAL.  To celebrate the beginning of our new project, we are making access to The Zone, including the "Almanac of Long-Term Care" free for one week.  To access this introductory peek into The Zone, go to and use the following case-sensitive user name and password:  UN: IntrotoZone / PW: FreeTrial.  Like what you see?  Then join the Center for Long-Term Care Reform here. ***

The LTC Almanac is divided into 11 sections: 

Aging Demographics 
Unfunded Liabilities--Social Security, Medicare, and Budgets 
Long-Term Care 
Long-Term Care Financing 
Long-Term Care Insurance 
Reverse Mortgages 
Long-Term Care Providers 
Medicaid Planning   

Each section is divided into sub-sections and under each sub-section we provide a list by date of the most important reports and articles published on the topic, usually with a few highlights.

The Almanac of Long-Term Care is a great way to find statistics you need quickly or to get current on topics you need to know the latest information about.

The Zone and the LTC Almanac are for Center for Long-Term Care Reform members only, except during this week's free trial offer.  Join the Center here:  Call or email Damon at 206-283-7036 or  He can give you a user name and password to open up The Zone even before your annual dues payment arrives.  Individual annual memberships are $150 and corporate memberships with many extra benefits start at $1,000.  See our "Membership Levels and Benefits" schedule here.

Caveat:  With time, some hyperlinks go bad.  In a huge document like the "LTC Almanac," we can't keep all the links current all the time.  If you find a bad link, but want to get to the material, contact us.  We often have an electronic copy of the document and we can usually find a current live link.  We'll also fix the link in the LTC Almanac so it will be current again for others.

Suggestion:  Read through the following update to stay current on new resource materials.  Then browse through the "LTC Almanac" at your leisure.  Then, when you need a quick fact or the latest research on a particular topic, you'll know right where to go.  Enjoy.


LTC Almanac Update

Chapter 2:  International


OECD on LTC Financing 2011 URL:,3746,en_2649_37407_47659479_1_1_1_37407,00.html  

"Help Wanted? Providing and Paying for Long-Term Care," OECD 2011,3746,en_2649_37407_47659479_1_1_1_37407,00.html 

Quote:  "As life expectancy pushes into the late 70s for men and well into the 80s for women, ever more people want help in order to be able to live their lives to the full for as long as possible.  How will demographic and labour market trends affect the supply of family and friends available to care for us? Can we rely on family carers as the sole source of support for frail seniors? Should family carers and friends be better supported, and if so how? Can we attract and retain care workers -- is it just a matter of paying them better? Will public finances be threatened by the cost of providing care in the future? What should be the balance between private responsibility and public support in care-giving? Can we reduce costs by improving efficiency of long-term care services?"


Chapter 4:  Long-Term Care


Alliance Health Sourcebook, Ed. 6, 0511 URL:

"Covering Health Issues:  A Sourcebook for Journalists" with chapters on "Health Reform," "Medicare," "Medicaid," and "Long-Term Care" by the Alliance for Health Reform, an advocate for government financing of health care.


KFF on IPAB 0411 URL:

"The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending," Prepared by: Jack Ebeler Health Policy Alternatives, Inc. and Tricia Neuman and Juliette Cubanski, The Henry J. Kaiser Family Foundation, April 2011

Quote:  "The 2010 health reform law (the Patient Protection and Affordable Care Act, also referred to as the ACA) establishes a new Independent Payment Advisory Board (IPAB) with authority to issue recommendations to reduce the growth in Medicare spending, and provides for the Board's recommendations to be considered by Congress and implemented by the Administration on a fast-track basis. IPAB has been heralded by some as a cornerstone of efforts to slow the growth in health care spending, beginning with enforceable savings targets for Medicare to help limit the growth in program spending. Some, including the President's National Commission on Fiscal Responsibility and Reform, have advocated strengthening the role of IPAB. Yet others, including some in Congress, representatives of some aging organizations, and various health industry stakeholders, are opposed to IPAB and are pressing to block its implementation."  (p. 1)


Medicaid Costs and PPACA, Cato 0411 URL:

Jagadeesh Gokhale, "The New Health Care Law's Effect on State Medicaid Spending: A Study of the Five Most Populous States," Cato Institute, April 6, 2011.

Quote:  "Unless it is repealed, the Patient Protection and Affordable Care Act of 2010 promises to increase state government obligations for Med­icaid by expanding Medicaid eligibility and in­troducing an individual health insurance man­date for all U.S. citizens and legal permanent residents. Once PPACA becomes fully effective in 2014, the Medicaid benefits of those who become newly eligible and enroll into Medicaid will be almost fully covered by the federal government through 2019, with federal finan­cial support expected to be extended thereafter. But PPACA provides states with no additional federal financial support for new enrollees among those eligible for Medicaid under the old laws. That makes increased state Medicaid spending from higher enrollments by “old-eligibles” virtually certain as they enroll in Medicaid in response to the individual mandate to purchase health insurance."  (p. 1)


Alzheimer's Disease

MetLife on Alzheimers, 0211 URL:

"What America Thinks MetLife Foundation Alzheimer's Survey," February 2011

Study Conducted by Harris Interactive for MetLife Foundation

Quote:  "A new survey by MetLife Foundation finds that Alzheimer's disease is the second most feared disease among American adults, behind only cancer. When asked which of five major diseases they are most afraid, 31 % said Alzheimer's, while 41% said cancer. Heart disease and stroke were named by 8% each, while only 6% said they fear diabetes most.  A majority of those polled (62%) admit they know little or nothing about Alzheimer's disease, leading to the fact that few are planning for its possibility. Only 18%, fewer than one in five people, have developed any such plan, which may include care options, housing arrangements and/or financial planning.  Currently, more than five million people have Alzheimer's. That number is expected to rise sharply as the Baby Boom generation reaches retirement age. 44% of adults indicate they have family members or friends with Alzheimer's." (p. 1)


Elder Abuse

MetLife on Elder Abuse 0611 URL:

The MetLife Study of Elder Financial Abuse Crimes of Occasion, Desperation, and Predation Against America's Elders June 2011

Key Findings

• The annual financial loss by victims of elder financial abuse is estimated to be at least $2.9 billion dollars, a 12% increase from the $2.6 billion estimated in 2008.

• Instances of fraud perpetrated by strangers comprised 51% of the articles. Reports of elder financial abuse by family, friends, and neighbors came in second, with 34% of the news articles followed by reports of exploitation within the business sector (12%) and Medicare and Medicaid fraud (4%).

• Medicare and Medicaid fraud resulted in the highest average loss to victims ($38,263,136) followed by fraud by business and industry ($6,219,496), family, friends, and neighbors ($145,768), and fraud by strangers ($95,156).

• Women were nearly twice as likely to be victims of elder financial abuse as men. Most victims were between the ages of 80 and 89, lived alone, and required some level of help with either health care or home maintenance. In almost all of the cases, there existed a combination of tenuous, valued independence and observable vulnerability that merged in the lives of victims to optimize opportunities for abuse by every type of perpetrator - from the closest family members to professional criminals.

• Nearly 60% of perpetrators were males. Most male perpetrators were between the ages of 30 and 59, while most of the female perpetrators were between the ages of 30 and 49. Perpetrators who were strangers often targeted victims with visible vulnerabilities (e.g., limited mobility, displays of confusion, or living alone).

• The number of news articles increased and the character of elder financial abuse changed during the holidays. From November 2010 through January 2011, of the 1,128 articles on elder abuse identified through the newsfeeds, 354 (31%) concerned elder financial abuse. At least one-quarter (27%) of the cases reported were random, predominantly single-event crimes accounting for relatively small monetary rewards and characterized by a high level of brutality and disregard for human life. Reports of elder financial abuse perpetrated by strangers and by friends and families were very similar (47% vs. 45%, respectively).

• Dollar losses over the holidays due to family, friend, and neighbor perpetrators were overall higher than any other category, likely owing to sheer numbers of instances, although the average number of dollars lost per individual instance was highest from business perpetrators. It is remarkable that the number of stranger cases comprise nearly 50% of all the holiday cases, comparable to the 51% April to June incidence rate.

• In almost all instances reported in the newsfeeds, the goals of financial abuse perpetrators were achieved through deceit, threats, and emotional manipulation of the elder. In addition, physical and sexual violence frequently occurred within the vortex of elemental greed and disregard for the victim that surrounded financial abuse.

• New research indicates that the instances of elder financial abuse are far higher than previously reported. In particular, a national study of 5,776 older adults found that the one-year prevalence for financial abuse by a family member was 5%.1 Further, a recent prevalence study covering the state of New York revealed that the highest rate of any type of elder mistreatment was financial abuse, with a rate of 41 per 1,000 (4%).2

• Elder financial abuse appears to fall into three types of crimes: occasion, desperation, and predation. Crimes of occasion or opportunity are incidents of financial abuse or exploitation that occur because the victim is merely in the way of what the perpetrator wants. Crimes of desperation are typically those in which family members or friends become so desperate for money that they will do whatever it takes to get it. Many of these family members are dependent on the elder relative for housing and money. Finally, crimes of predation or occupation occur when trust is engendered for the specific intention of financial abuse later. A relationship is built, either through a bond of trust created though developing a relationship (romantic or otherwise) or as a trusted professional advisor, and then used to financially exploit the victim.


Chapter 5:  Caregiving


MetLife on Caregiving Costs 0611 URL:

"The MetLife Study of Caregiving Costs to Working Caregivers: Double Jeopardy for Baby Boomers Caring for Their Parents," MetLife Mature Market Institute, June 2011

Key Findings

• The percentage of adult children providing personal care and/or financial assistance to a parent has more than tripled over the past 15 years. Currently, a quarter of adult children, mainly Baby Boomers, provide these types of care  to a parent.

• The total estimated aggregate lost wages, pension, and Social Security  benefits of these caregivers of parents is nearly $3 trillion.

• For women, the total individual amount of lost wages due to leaving the labor force early because of caregiving responsibilities equals $142,693. The estimated impact of caregiving on lost Social Security benefits is $131,351.  A very conservative estimated impact on pensions is approximately $50,000.  Thus, in total, the cost impact of caregiving on the individual female caregiver in terms of lost wages and Social Security benefits equals $324,044.

• For men, the total individual amount of lost wages due to leaving the labor force early because of caregiving responsibilities equals $89,107. The estimated impact of caregiving on lost Social Security benefits is $144,609.  Adding in a conservative estimate of the impact on pensions at $50,000, the total impact equals $283,716 for men, or $303,880 for the average male or female caregiver 50+ who cares for a parent.  (p. 2)


Chapter 6:  Long-Term Care Financing

Who Will Pay for LTC? (includes "Not the VA")

Little Hoover on CA LTC 0411 URL:


Quote:  "The lack of information about the state's long-term care programs means that the state, at any given moment, cannot say how much money California spends on long-term care for the aged and the disabled. The most recent estimate is $7 billion for the state's share, from the 2005-06 budget year, a figure aggregated by the Legislative Analyst's Office.  With federal and state contributions, total spending was $13.7 billion for the period." (p. ii)


Don't Count on the Government

Heritage Debt Plan 0511 URL:

"Saving the American Dream: The Heritage Plan to Fix the Debt, Cut Spending, and Restore Prosperity," Edited by Stuart M. Butler, Ph.D., Alison Acosta Fraser, and William W. Beach

Quote:  "This plan substantially reduces the size and scope of the federal government, fundamentally increases the role of the states in choosing their own practices, and brings decision-making closer to the people rather than unelected administrators. These are crucial steps that will get our nation on a path of fiscal, political, and constitutional responsibility. It is part of our larger effort to get our country back on track, reclaim its truths, conserve its liberating principles, and build an America where freedom, opportunity, prosperity, and civil society flourish."


Chapter 7:  Long-Term Care Insurance

General and Data

Who Purchases Long-Term Care Insurance, UI, 0311 URL:

"Who Purchases Long-Term Care Insurance?," Richard W. Johnson and Janice S. Park, URBAN INSTITUTE, Number 29, March 2011  

Quote:  "Who Has Private Long-Term Care Insurance?

"In 2008, 7.6 million Americans age 55 and older had private  long-term care insurance coverage, accounting for 10.7  percent of adults in this age group (figure 1).4

  • Among adults age 65 and older, 12.4 percent (or 4.8  million adults) had coverage.
  • Only 3.0 percent of African Americans age 55 and older  and 2.4 percent of Hispanics were covered by private  long-term care insurance.
  • Coverage rates increased with income, reaching 19.3 percent  for those whose annual incomes exceeded $100,000.  Although coverage rates remain relatively low, they have  recently increased somewhat. In 2002, 9.1 percent of Americans  age 55 and older had private long-term care insurance  coverage, including 10.3 percent of those age 65 and older"



Health Affairs on CLASS 0511 URL:

"The CLASS Act. The long-term care insurance program created by the Affordable Care Act will be reshaped to address concerns about solvency."

Quote:  "The Obama administration has acknowledged the program's shortcomings and is developing modifications that it says will ensure the program will remain solvent and self-financing for at least 75 years, as the law requires. Regulations must be issued by the secretary of the US Department of Health and Human Services (HHS) no later than October 1, 2012. Some lawmakers, however, have questioned whether HHS has the legal authority to change certain CLASS provisions."


Chapter 8:  Reverse Mortgages


Reverse Mortgages Save Medicaid 0311 URL:

See also:  LTC E-Alert #11-016:  LTC News and Comment, Thursday, April 14, 2011


3/31/11, "Study Aims to Show Reverse Mortgages Offset Medicaid Spending," by Elizabeth Ecker, Reverse Mortgage Daily


Quote:  "By encouraging seniors to cash in on home equity before relying on entitlement programs for their health and long term care needs, the study asserts, the use of reverse mortgages can cut down substantially on government spending." 

LTC Comment:  Check out the full study here.  It recommends eliminating Medicaid's $500,000 to $750,000 home equity exemption in order to incentivize people to pay for their own long-term care with reverse mortgages before they become dependent on public welfare.  This proposal would obviously encourage the public to plan early and responsibly for long-term care through private insurance.


Chapter 9:  Long-Term Care Providers

Cost of Care

For links to the Genworth, MetLife, John Hancock, Northwestern Mutual, Prudential and Univita cost of care surveys, see "Long-Term Care Cost Surveys" in The Zone at


Chapter 10:  Medicaid

Medicaid Financing

NCPA on Federal Match Inequity 0511 URL:

"Update on Federal Medicaid Funding," Brief Analysis No. 744 by Pamela Villarreal and Michael Barba, May 10, 2011, National Center for Policy Analysis  

Quote:  "Medicaid is a joint federal-state health program, primarily for the poor. At the federal level, Medicaid is an entitlement. Each enrollee has a right to benefits. However, federal funds are not distributed equally. Each state determines its own Medicaid spending, but receives federal funds based on a matching formula. . . .

"States should have the flexibility to use their federal funds as they choose, and federal funds should be capped at a certain dollar amount. But now that the Affordable Care Act mandates coverage of new populations, states will have to deal with the disparity in the funding formula as well as the eventual burden of providing coverage out of their state budgets to additional enrollees."


AARP on Medicaid Block Grants 0411 URL:

Quote:  "This Fact Sheet discusses reasons why some state and federal policymakers prefer capping Medicaid funding and why this type of funding arrangement is not good for beneficiaries. According to an analysis by the Congressional Budget Office, if total funding for Medicaid (including funding for the Medicaid expansion under health reform) is converted into a block grant, states would be required to provide less extensive coverage or pay a larger share of program costs." (p. 1)

For the other side of the story, see "Block-Granting Medicaid Is a Long-Overdue Way of Restoring Federalism and Promoting Good Fiscal Policy," by Daniel J. Mitchell and "Paul Ryan's Medicaid Block Grants: Good for Maryland," by Michael F. Cannon.


KFF on Medicaid Block Grant 0411 URL:

"Implications of a Federal Block Grant for Medicaid, April 2011, Kaiser Family Foundation

Quote:  "As state and federal policymakers face budget shortfalls and recurrent budget deficits, proposals to lower Medicaid spending by converting the program into a block grant have re-emerged. The FY 2012 budget resolution released April 5, 2011 by the House Committee on the Budget includes an estimated savings of $1.4 trillion in Medicaid related to converting the program to a block grant and repealing health reform Such changes represent a fundamental change in the entitlement nature and financing structure of the program that would have major implications for beneficiaries, providers, states and localities. Such changes could also affect the ability of Medicaid to maintain its current roles in the health system."  (p. 1)


NSCLC on Medicaid Block Grants 0411 URL:

"Medicaid Block Grants: Attacking the Safety Net for Low-Income Older Adults,"   Policy Issue Brief, APRIL 2011,  National Senior Citizens Law Center,

Quote:  "If Medicaid or other safety-net programs are turned into block grants and the grants are less than their current share of Medicaid dollars, there is clear evidence that, given the opportunity, states will not provide an adequate safety net for low-income older adults or anyone else currently covered by the program. In the name of 'flexibility' and state's rights, America's safety net could be ripped to shreds."


Medicaid Eligibility

AARP on Medicaid LTC 0511 URL:

"Medicaid: A Program of Last Resort for People Who Need Long-Term Services and Supports" by Wendy Fox-Grage and Donald Redfoot, AARP Public Policy Institute. 

Quote:  "Medicaid provides a critical safety net not only for low-income people, but also for formerly middle-income people who have spent their life savings paying for long-term services and supports (LTSS). Most older people will need some LTSS during their lifetimes, and nearly a third of people turning age 65 will deplete their savings and will need to rely on Medicaid assistance."

LTC Comment:  Typical expression of the "Fallacy of Impoverishment," which assumes incorrectly that people must spend down savings to qualify for Medicaid LTC.


Medicaid Deficiencies

Heritage on Poor Medicaid Care 0511 URL:

"Medicaid Provides Poor Quality Care: What the Research Shows," Brian Blase, Backgrounder, No. 2553 May 5, 2011

"Abstract: While targeted public assistance can work, Medicaid has become far too large and unwieldy to serve those who truly need it. A variety of research shows that Americans enrolled in Medicaid have less access to health care, and when they do receive care, the quality is often inferior to the care provided to other similar patients. This Heritage Foundation paper lays out the research, and shows how Medicaid is failing current enrollees and taxpayers and must be fundamentally reformed. The Medicaid expansion contained in Obamacare will further weaken the program—hurting those who really need it, as well as unduly burdening the taxpayers who pay for it."

Quote:  "Medicaid has become too large to provide good services to those who genuinely need public assistance. Eligibility expansions have caused a substantial degree of crowd-out with the result that taxpayer money is spent on people who could afford private coverage." (p. 1)