LTC Bullet:  LTC Almanac Update (1)

Friday, June 29, 2012


LTC Comment:  This week and next we’re updating the “Almanac of Long-Term Care” in The Zone.  More on the LTC Almanac and today’s update after the ***news.***

*** SCOTUS HOCUS POCUS:  The Supreme Court’s monumental decision upholding the constitutionality of the Affordable Care Act, AKA “ObamaCare,” means health insurance reform will be at the top of the political hit parade from now through the national election on November 6.  We’ll follow the commentary and analyze the decision as it affects Medicaid specifically and LTC financing in general, but only after the dust settles.  For now, check out this morning’s Cato Institute briefing which concluded, contrary to conventional wisdom, that after yesterday’s ruling (a) the Constitution is stronger and (b) ObamaCare is weaker.  This Cato “E-Briefing” should be available in the Institute’s archives here within 24 to 48 hours. ***

*** MORE CATO ON SCOTUS:  If you can’t get to Cato’s newly remodeled headquarters in person, watch this program Monday online here:  “The Supreme Court's Obamacare Ruling: What Does It All Mean?,” POLICY FORUM, Monday, July 2, 2012 1:00 PM - 4:45 PM (Reception To Follow):  Featuring Randy Barnett, Georgetown University Law Center; Ilya Shapiro, Cato Institute; David Rivkin, Baker Hostetler LLP; Michael F. Cannon, Cato Institute; Avik Roy, Manhattan Institute; Grace-Marie Turner, Galen Institute; moderated by Michael Tanner, Cato Institute and Roger Pilon, Cato Institute. *** 

*** LTCI PRODUCERS SUMMIT:  The program for the 2012 National Long Term Care Insurance Producers Summit, a 3-day conference organized by the American Association for Long-Term Care Insurance has been announced. The Summit which takes place November 10-12, 2012 at the Tropicana Hotel in Las Vegas is the nation's largest conference focused exclusively on the marketing and sale of long term care insurance solutions. This marks the 10th conference for the Association." ***

*** 3IN4 NEED MORE:  Check out the campaign’s latest news and videos here. ***



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

*** SPECIAL.  To celebrate Independence Day and completing half of calendar year 2012, we are making access to The Zone, including the "Almanac of Long-Term Care" free for 10 days—today through Sunday, July 8, 2012.  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.  Or contact Damon at 206-283-7036 or  ***

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 and sometimes with analysis.

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 the current 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.  Premium memberships with access to our “Clipping Service” start at $250.  Premium Elite and “Regional Representative” membership (if you qualify professionally) are $500.  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.


Chapter 1:  Aging Demographics

United States

General Stats

American Housing Survey 0311 URL:  “This report presents data from the American Housing Survey (AHS). The survey is sponsored by the Department of Housing and Urban Development (HUD) and conducted by the U.S. Census Bureau. The AHS is the most comprehensive national housing survey in the United States. It provides data on a wide range of housing subjects, including single-family homes, apartments, manufactured housing, vacant units, family composition, income, housing and neighborhood quality, housing costs, equipment, fuel type, and recent moves.”  

Search for "Elderly" to find Table 2-9. Household Composition-Occupied Units, p. 28 and Table 3-15  Mortgage Characteristics-Owner-Occupied Units, p. 65


Census, The Older Population, 2010 URL:  “The Next Four Decades: The Older Population in the United States: 2010 to 2050: Population Estimates and Projections,” Issued May 2010

Excerpt:  “Between 2010 and 2050, the United States is projected to experience rapid growth in its older population. In 2050, the number of Americans aged 65 and older is projected to be 88.5 million, more than double its projected population of 40.2 million in 2010. The baby boomers are largely responsible for this increase in the older population, as they will begin crossing into this category in 2011.”


Boomer Generation Characteristics 

MetLife on Boomers 0412 URL:  “Transitioning into Retirement: TheMetLife Study of Baby Boomers at 65,” April 2012

“In 2011, the oldest Boomers reached a new milestone — turning age 65 — an age that traditionally defined retirement. This study examines the attitudes and behaviors of this leading-edge Boomer segment as they transition into their next life stage. . . .  The results indicate that much can change in three years, with major changes in employment and retirement status specifically. Despite the conventional wisdom that Boomers are ready to ‘work forever’ and significantly extend their formal working career, many of the oldest Boomers are already well into the retirement phase. Almost twice as many 65-year-olds in 2011 stated that they were fully retired as were working full-time at age 65 (45% versus 24% respectively). The average age at retirement for these Boomers was 59.7 for men and 57.2 for women. A large majority of those who have transitioned into their retirement also report that they are well satisfied with this new stage of their lives.”


Income of the Aged

Census Poverty Report 0911 URL:  “Income, Poverty, and Health Insurance Coverage in the United States: 2010, Current Population Reports, Issued September 2011

Excerpt:  “The percentage of the elderly with income below 50 percent of their poverty threshold was 2.5 percent, less than one-half the percent of the total population at this poverty level (6.7 percent). On the other hand, the percentage of the elderly with income below 200 percent of their poverty threshold was 34.6 percent, not statistically different from the percent of the total population with income below this level . . ..  The elderly represented 12.8 percent of the overall population, 13.1 percent of those with income below 200 percent of their poverty threshold, but 4.8 percent of the people with income below 50 percent of their poverty threshold . . ..”


Assets of the Aged

See LTC E-Alert #12-021:  LTC News and Comment, Monday, June 25, 2012:

6/2012, “Changes in U.S. Family Finances from 2007 to 2010:  Evidence from the Survey of Consumer Finances,” June 2012, Vol 98, No 2 

Quote:  “The Federal Reserve Board's Survey of Consumer Finances (SCF) for 2010 provides insights into changes in family income and net worth since the 2007 survey.  The survey shows that, over the 2007-10 period, the median value of real (inflation-adjusted) family income before taxes fell 7.7 percent; median income had also fallen slightly in the preceding three-year period (figure 1).  The decline in median income was widespread across demographic groups, with only a few groups experiencing stable or rising incomes.  Most noticeably, median incomes moved higher for retirees and other nonworking families.  . . .  The decreases in family income over the 2007-10 period were substantially smaller than the declines in both median and mean net worth; overall, median net worth fell 38.8 percent . . ..”

LTC Comment:  This is the source document for the many articles that have appeared recently lamenting the collapse of Americans’ financial status since the “Great Recession.”  Noteworthy, however, is the finding that bucking the trend, “median incomes moved higher for retirees.”  Hmmm.  So retirees’ incomes went up even as their net worths went down.  Sounds like retirees may have both more income to afford LTCI premiums and greater need than ever to protect what remains of their savings.  Just another angle on these findings. 


Chapter 2:  International


In England, "Elderly care reforms may have to wait until 2025," The Telegraph, by Tim Ross, Political Correspondent 6:15AM GMT 14 Dec 2011

"An estimated 20,000 people a year are forced to sell their homes to pay fees for nursing and residential care, which can reach hundreds of thousands of pounds.  Spending cuts have driven some care home companies out of business, while inspectors have warned that elderly people are being neglected and even abused by poorly trained helpers in their own homes."


Chapter 3:  Unfunded Liabilities--Social Security, Medicare, and Budgets

National Health Expenditures

NHE for 2010 URL:  By Anne B. Martin, David Lassman, Benjamin Washington, Aaron Catlin, and the National Health Expenditure Accounts Team, “Growth In US Health Spending Remained Slow In 2010; Health Share Of Gross Domestic Product Was Unchanged From 2009”

ABSTRACT Medical goods and services are generally viewed as necessities. Even so, the latest recession had a dramatic effect on their utilization. US health spending grew more slowly in 2009 and 2010—at rates of 3.8 percent and 3.9 percent, respectively—than in any other years during the fifty-one-year history of the National Health Expenditure Accounts. In 2010 extraordinarily slow growth in the use and intensity of services led to slower growth in spending for personal health care. The rates of growth in overall US gross domestic product (GDP) and in health spending began to converge in 2010. As a result, the health spending share of GDP stabilized at 17.9 percent.


Unfunded Liability Estimates

2011 Medicare Trustees Report URL:

LTC Comment:  This year’s report presented a relatively rosy scenario for Medicare.  To wit:  “The financial outlook for the Medicare program is substantially improved as a result of the changes in the Affordable Care Act. In the long range, however, much of this improvement depends on the feasibility of the ACA's downward adjustments to future increases in Medicare prices for most categories of health care providers.”

Any optimism, however, depends entirely on the success of the ACA, AKA “ObamaCare,” which looks highly and increasingly doubtful.  For example, no one really expects Medicare physicians’ reimbursement rates to be cut my a third, but that’s what the 2011 Medicare Trustees Report assumes will occur.  Of course, the Supreme Court has its say too.


Chapter 4:  Long-Term Care

Home and Community-Based Services

NCHS on RCFs 0412 URL:
“Residents Living in Residential Care Facilities: United States, 2010,”
Christine Caffrey, Ph.D.; Manisha Sengupta, Ph.D.; Eunice Park-Lee, Ph.D.; Abigail Moss; Emily Rosenoff, M.P.A.; and Lauren Harris-Kojetin, Ph.D.

NCHS Data Brief ■ No. 91 ■ April 2012 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

“Persons living in state-regulated residential care facilities (RCFs)—such as residents of assisted living communities—receive housing and supportive services because they cannot live independently but generally do not require the skilled level of care provided by nursing homes. The ability to provide a comprehensive picture of the long-term care industry has been hampered by a lack of data on RCFs (1–4). Previous estimates of the number of residents in RCFs vary depending on how RCFs are defined (5–7). A recent NCHS data brief (5) reported that for each day in 2010, 733,300 persons were residents of RCFs nationwide. Using data from the first nationally representative survey of RCFs with four or more beds, this report presents national estimates of these RCF residents by selected resident characteristics.”


RCFs Data 1211 URL:  “Residential Care Facilities: A Key Sector in the Spectrum of Long-term Care Providers in the United States,” Eunice Park-Lee, Ph.D.; Christine Caffrey, Ph.D.; Manisha Sengupta, Ph.D.; Abigail J. Moss; Emily Rosenoff, M.P.A.; and Lauren D. Harris-Kojetin, Ph.D. ; NCHS Data Brief ■ No. 78 ■ December 2011; U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

“Key findings: Data from the 2010 National Survey of Residential Care Facilities • In 2010, residential care facilities (RCFs) totaled 31,100, with 971,900 beds nationwide. • About one-half of RCFs were small facilities with 4–10 beds. The remainder comprised medium facilities with 11–25 beds (16%), large facilities with 26–100 beds (28%), and extra large facilities with more than 100 beds (7%). • One-tenth of all RCF residents lived in small RCFs and about that percentage (9%) lived in medium facilities, while the majority resided in large (52%) or extra large (29%) RCFs. • About 4 in 10 RCFs had one or more residents who had some or all of their long-term care services paid by Medicaid. • Larger RCFs were more likely than small RCFs to be chain-affiliated and to provide occupational therapy, physical therapy, social services counseling, and case management.”


Chapter 5:  Caregiving

Caregiver Stress and Burnout

Following is from LTC E-Alert #12-021:  LTC News and Comment and Waiting for SCOTUS  Monday, June 25, 2012

5/20/2012, “A Life Worth Ending: The era of medical miracles has created a new phase of aging, as far from living as it is from dying. A son's plea to let his mother go,” by Michael Wolff, New York Magazine 

Quote:  “Anyway, after due consideration, I decided on my own that I plainly would never want what LTC insurance buys, and, too, that this would be a bad deal.  My bet is that, even in America, even as screwed up as our health care is, we baby-boomers watching our parents' long and agonizing deaths won't do this to ourselves.  We will surely, we must surely, find a better, cheaper, quicker, kinder way out.  Meanwhile, since, like my mother, I can't count on someone putting a pillow over my head, I'll be trying to work out the timing and details of a do-it-yourself exit strategy.  As should we all.”

LTC Comment:  This emotionally wrenching article is not kind to LTC insurance, but it undoubtedly reflects what’s on many boomers’ minds.  So, it’s worth reading.  Boiled down to its essence, however, there’s not much here but the old objection “I’ll shoot myself first” and the same answer applies:  “By the time you need long-term care, you won’t remember why you bought the gun.”  In other words, planning to end it all before you become hopelessly dependent is no plan and leaves your loved ones with all the problems you’d like to spare them.


Value of Free Care

“In 2009, about 42.1 million family caregivers in the United States provided care to an adult with limitations in daily activities at any given point in time, and about 61.6 million provided care at some time during the year. The estimated economic value of their unpaid contributions was approximately $450 billion in 2009, up from an estimated $375 billion in 2007.”

Source:  AARP on Caregiving 0711 URL:


Chapter 6:  Long-Term Care Financing

Medicare LTC Financing

Cannon on IPAB 0612.txt URL:  “IPAB, Obamacare's Super-Legislature” 

“The individual mandate isn't Obamacare's only unconstitutional provision, or even its most unconstitutional provision. That distinction belongs to the

Independent Payment Advisory Board. A heretofore unreported feature of this super-legislature makes it even more authoritarian and dangerous than anyone knew.  IPAB consists of up to 15 unelected government ‘experts.’ Its stated purpose is to restrain Medicare spending. If projected spending exceeds certain targets, Obamacare requires IPAB to issue ‘legislative proposals’ to reduce future spending. Those proposals could include drastic cuts that jeopardize seniors' access to care, leading some critics to label IPAB a ‘death panel.’  But the really dangerous part is that these are not mere ‘proposals.’ Obamacare requires the secretary of Health and Human Services to implement them — which means they become law automatically — unless Congress takes certain steps to head them off.”


Chapter 7:  Long-Term Care Insurance


SOA on LTCI 0112 URL:  Society of Actuaries, “Taking the Long-Term Care Journey,” Managing Retirement Decisions Series, 2012, Schaumburg, IL,

For our critique of this report, see:  “LTC E-Alert #12-004:  SOA Report Plus LTC News and Comment,” Monday, January 30, 2012


Medicaid: This is a public assistance program for those who meet functional and financial eligibility criteria. People who have used up their personal assets for long-term care often turn to Medicaid for subsequent care. Medicaid is mostly a nursing home benefit and varies greatly from state to state. Future prospects for Medicaid are uncertain because state budgets are getting stretched and long-term care benefits are being reduced. This trend is expected to continue.”  (p. 4)

“Deciding Whether to Buy Long-Term Care Insurance

“The most basic function of long-term care insurance is to protect against catastrophic costs that can cut into retirement security or bequest amounts left for heirs.

“A common rule of thumb has been that purchasing this insurance is not worth it for those with low amounts of savings—for example, less than $250,000.That is because of the very real likelihood that they will need to turn to Medicaid in event of a significant care need.

“Rules of thumb can mislead, however. It’s necessary first to look at a person’s full financial picture—assets, income, and expenses—not just assets. Second, people need to be aware that Medicaid benefits are getting more restricted and will continue to do so. Finally, the availability of partnership programs, mentioned earlier, may provide a means of preserving assets so that the purchase of long-term care insurance may make sense for the less wealthy.

“Those with very significant wealth—for example, over $2 million—may be comfortable with creating a set-aside account to cover their future care costs.  However, even wealthy people may want to purchase long-term care insurance to reduce the uncertainty about the impact that care costs may have on bequest values.

“Those with ‘in-between’ levels of wealth will see the clearest benefit from purchasing long-term care insurance.

“Decisions made with regard to long-term care will require a great deal of research and analysis.  In the end, however, the physical, emotional and financial well-being of all concerned will be worth the effort spent.”  (pps. 7-8)



CLASS' UNTOLD STORY:  Taxpayers, Employers, and States On the Hook For Flawed Entitlement Program 0911 URL:

Congressional working group’s report on the CLASS Act.  For quotes and analysis see:  “LTC Bullet:  LTC Action  (LTC Embed Report #5),” Friday, September 16, 2011.

Excerpt:  “‘It is no secret that the CLASS program is fiscally unsound and was used as a budget gimmick in the health care law. However, 'CLASS' Untold Story' reveals that during the program's development, high-level officials within HHS were already aware the program was likely to collapse and privately expressed their own doubts, but continued to publicly tout the program's benefits and savings,’ said Rep. Fred Upton (Mich.-06), co-chair of the Working Group. ‘The CLASS Act is an ocean liner that was put to sea with a giant hole in the hull,’ said Rep. Joe Pitts (Pa.-16), co-chair of the Working Group. ‘This report clearly shows that the authors of last year's health care bill were aware of the flaws, and launched the program anyway. What we see here is legislative malpractice. When the CLASS program fails, the taxpayer will be left to foot the bill. The time to terminate this program is now, before it begins enrolling participants and taking premiums. The government has to stop making promises that it can't keep.’”