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."
LTC BULLET: LTC ALMANAC UPDATE
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
http://www.centerltc.com/members/index.htm 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
International
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
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:
http://www.centerltc.com/support/index.htm. Call or email Damon at
206-283-7036 or
damon@centerltc.com. 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
General
OECD on LTC Financing 2011 URL:
http://www.oecd.org/document/23/0,3746,en_2649_37407_47659479_1_1_1_37407,00.html
"Help Wanted? Providing and Paying for
Long-Term Care," OECD 2011
http://www.oecd.org/document/23/0,3746,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
General
Alliance Health Sourcebook, Ed. 6,
0511 URL:
http://www.allhealth.org/health-issues-sourcebook2011/covering-health-issues-2011.pdf
"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:
http://www.kff.org/medicare/upload/8150.pdf
"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:
http://www.cato.org/pubs/wtpapers/StateMedicaidSpendingWP.pdf
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:
http://www.metlife.com/assets/cao/contributions/foundation/alzheimers-2011.pdf
"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:
http://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf
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
General
MetLife on Caregiving Costs 0611 URL:
http://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-caregiving-costs-working-caregivers.pdf
"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:
http://www.lhc.ca.gov/reports/listall.html
"A LONG-TERM STRATEGY FOR LONG-TERM
CARE," LITTLE HOOVER COMMISSION April 2011
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:
http://thf_media.s3.amazonaws.com/2011/pdf/sr0091.pdf
"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:
http://www.urban.org/UploadedPDF/412324-Long-Term-Care-Insurance.pdf
"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"
The CLASS Act
Health Affairs on CLASS 0511 URL:
http://www.healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_46.pdf
"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
General
Reverse Mortgages Save Medicaid 0311
URL:
http://reversemortgagedaily.com/rmstudy.pdf
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
http://www.centerltc.com/members/ltccostsurveys.htm
Chapter 10: Medicaid
Medicaid Financing
NCPA on Federal Match Inequity 0511
URL:
http://www.ncpa.org/pdfs/ba744.pdf
"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:
http://assets.aarp.org/rgcenter/ppi/health-care/fs219-medicaid.pdf
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:
http://www.kff.org/medicaid/upload/8173.pdf
"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:
http://www.nsclc.org/about-us/nsclc-in-the-news/Issue%20Brief%20-%20Medicaid%20Block%20Grants%20April%202011.pdf
"Medicaid Block Grants: Attacking the
Safety Net for Low-Income Older Adults," Policy Issue Brief, APRIL
2011, National Senior Citizens Law Center, www.nsclc.org nsclc@nsclc.org
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:
http://assets.aarp.org/rgcenter/ppi/ltc/fs223_-medicaid.pdf
"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:
http://thf_media.s3.amazonaws.com/2011/pdf/bg2553.pdf
"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) |