LTC Bullet:  LTC Services:  Thousand Bullets Retrospective

Friday, September 6, 2013

Seattle—

LTC Comment:  Your Center for Long-Term Care Reform continues to celebrate its publication of over 1,000 LTC Bullets with this overview of 15 years of “LTC Services” Bullets.  Please enjoy this retrospective after these messages:

*** ANNOUNCING:  CLTCR Premium Membership  --  Center for Long-Term Care Reform premium members receive our full suite of individual membership benefits including:  our LTC Bullets and E-Alerts; access to our Members-Only Zone website and Almanac of Long-Term Care; subscription to our Clipping Service; and email/phone access to Steve Moses for 24-hour turnaround queries.  Our Premium Membership is designed to give you a competitive advantage in your long-term care profession. Your increased knowledge of the critical issues and challenges we face in the field of long-term care service delivery and financing equals improved professional success for you and better LTC services for your clients and for those who have no choice but to rely on scarce public resources.  Premium Membership is $250 per year, paid up front or monthly by automatically recurring credit card payments.  Contact Damon at 206-283-7036 / damon@centerltc.com to start your Premium Membership immediately or go directly to our secure online subscription page and sign up for as little as $21 per month. ***

LTC BULLET: LTC Services:  THOUSAND BULLETS RETROSPECTIVE

LTC Comment:  Once a week, usually on Fridays, we publish our latest LTC Bullet.  The Bullets are often policy pieces, sort of like op-eds.  You can always find the latest Bullets here and archives of the rest of the 1,000 Bullets (so far), by date here and by topic here.  These 1,000+ articles are a valuable historical resource.  Please make use of them.  Search for key terms using Control-F on your keyboard.

This year, in celebration of the thousandth LTC Bullet (published last May) and the Center’s 15th anniversary (April 1), we are releasing a retrospective of the most interesting and dramatic LTC Bullets that we’ve published since the Center’s founding in 1998.  We’ll highlight one Bullet per year in each of seven major topics:  “The LTC Problem and Solutions”; “Reality Check:  The Facts on LTCI”; “Medicaid Planning”; “LTC Services”; “Politics and Legislation”; “Demographics and Other Data”; and “CLTCR News.” 

Today’s Bullet is our “Thousand Bullets Retrospective” Number 4 covering “LTC Services.”  These “LTC Services” Bullets highlight the link between private financing and quality services.  Read our summary and check out the original at the link provided.  Enjoy this walk down memory lane.

------------------

July 22, 1998:  Can NHs Make Gold Out of Straw?.  “Evidence continues to mount that anyone who expects quality long-term care must be able to pay privately and avoid government financing. The New York Times reported today that President Clinton will offer legislation to improve the quality of care in nursing homes. The legislation calls for new criminal background checks, a national abuse registry, improved nutrition and hydration training, and reauthorization of the Nursing Home Ombudsman program.

“Unfortunately, quality care is not something nursing homes can wish into existence. Quality costs money. Medicaid pays for 70 percent of all nursing home patient days, but reimbursement rates are typically 80 percent of private-pay rates and often less than the cost of providing the care. How can the government expect Medicaid dependent facilities to deliver high quality care when the government won't pay for it? It can't. The Administration should focus on encouraging private financing alternatives to Medicaid if improving quality is the real goal.”

------------------

February 3, 1999:  Perils of Medicaid.  “A reporter from a prestigious financial planning publication contacted the Center for Long-Term Care Financing yesterday. She asked us to provide evidence that Medicaid nursing home care can be risky for consumers. Some Medicaid planning attorneys had told her that clients they artificially impoverish to qualify for the welfare program do not experience access and quality problems. We thought our readers would appreciate seeing the same evidence of potential Medicaid-related deficiencies gleaned from the gerontological literature that we provided to the reporter. That information follows [in this LTC Bullet].”

------------------

June 14, 2000:  Shedding Tiers.  “The following article was originally published in the March 1992 issue of LTC News & Comment. Since then, some conditions of the long-term care marketplace have changed. For example, private-pay assisted living facilities have co-opted nursing homes' light care residents. Most factors covered in the article, however, have stayed the same or gotten worse. Medicare cut-backs and Medicaid's parsimony have driven one in ten nursing home beds into bankruptcy. Nevertheless, public expenditures for nursing home care have increased ten percent in the past ten years, while out-of-pocket expenditures are down ten percent. In the meantime, the public's perception of nursing home quality has plummeted while litigation against nursing homes has skyrocketed. In other words, everything is playing out just as predicted in the article. That's why we think its argument needs to be re-stated. The secret to universal access to top-quality long-term care at the most appropriate level is to maximize private financing and target public financing to the genuinely needy. The result will be better care for rich and poor alike.”

------------------

January 11, 2001:  Triathlon Report Findings Resonate.  “Based on interviews with 119 of the leading private financiers, providers and insurers of long-term care, The LTC Triathlon study is a penetrating analysis and critique of long-term care public policy.  (See the full press release announcing publication of the report at www.centerltc.org/triathlon_release.htm.)  Don't assume, however, the opinions and insights of the largest LTC players covered in the report are necessarily related to the scale of their organizations.  Smaller players are facing some of the very same challenges!”

------------------

July 24, 2002:  New CLTCF Speech: "Insurance: Private vs. Social."  “Life is full of uncertainties. Usually, that's a good thing. Who doesn't like a pleasant surprise? But some uncertain events are very bad indeed. Heart attacks, auto accidents, and house fires come to mind. Although unpredictable individually, life's terrible shocks are thankfully rare and highly predictable collectively. We cannot eliminate risk, but we can mitigate its impact on our lives. Insurance prices, transfers, and softens risk so we can relax and enjoy life. It replaces the small risk of a catastrophic financial loss with the certainty of an affordable payment or premium. Unfortunately, however, the many benefits of insurance are highly susceptible to corruption and destruction by public officials with altruistic, but counterproductive motives. This talk will explain how private insurance empowers individuals to protect themselves and how you can recognize and resist the damaging trends of community rating, welfarization and ‘social insurance.’"

------------------

October 7, 2003:  Medicaid, Nursing Homes, Quality Problems and Insurance: How to Connect the Dots.  “Fire killed ten people last week in a nursing home that was ‘self-insured’ for liability. What's the connection between long-term care reimbursement, quality of care, and private insurance?”  Find out in this LTC Bullet.

------------------

March 10, 2004:  LTCi Professional Liability for Financial Advisors.  “What are the professional liabilities for financial advisors who fail to advise clients about long-term care risk, cost and solutions?”  Read this critical LTC Bullet and find out.

------------------

September 13, 2005:  Who Should Pay for Long-Term Care?  “Here is a succinct explanation of America's long-term care crisis:  how it came to be, where it's headed, and how to mitigate the damage.”     

------------------

March 7, 2006:  What I Believe About Long-Term Care.  “[W]hat follows is my [Steve Moses] address to a session at the meeting called ‘Shaking the Money Tree’ which was organized by LTCi veteran and MedAmerica Business Development Vice President Gail Holubinka.  Gail's idea was to have four speakers representing different perspectives on the LTC financing issue describe their vision of the topic.  She asked us to explain our underlying beliefs and to build from that foundation logically toward a description of our proposed solutions to the LTC financing crisis.” 

------------------

June 27, 2007:  The Brave New World of Long-Term Care.  “On November 9, 2006, I [Steve Moses] spoke at an ‘Aging America Symposium’ sponsored by the Notre Dame Law School.  My remarks, titled ‘The Brave New World of Long-Term Care,’ were published in the latest issue of the Notre Dame Journal of Law, Ethics & Public Policy.  To read the whole article, go to http://www.centerltc.com/pubs/Articles/Brave_New_World_of_LTC.pdf.”    

------------------

February 1, 2008:  LTC Tour Touches LTC Providers.  “Nursing homes are heavily dependent on Medicaid which pays them too little to ensure quality care.  Home health care providers are heavily dependent on Medicare which has whipsawed them between generous and penurious coverage.  Assisted living facilities are 90 percent private pay, but they're hurt by government subsidies of nursing home care and tempted by Medicaid's low reimbursements for beds that would otherwise remain empty.  In a nutshell, the entire LTC provider profession needs responsible LTC planning and rational long-term care policy.” 

------------------

October 6, 2009:  Medicare/Medicaid Meltdown Means More LTCI.  “Following are recent developments that suggest the end is near for near-universal government financed long-term care. As you read these tales of woe, consider this take-away:  IT IS TRUE TODAY AND WILL BE MORE TRUE IN THE FUTURE THAT TO ENSURE ACCESS TO QUALITY LONG-TERM CARE AT THE MOST APPROPRIATE LEVEL OF CARE, CONSUMERS MUST BE ABLE TO PAY PRIVATELY.  That simple truth, backed up by abundant evidence, trumps every excuse for failing to plan for long-term care.”

------------------

April 27, 2010:  Private LTC Insurance Vindicated.  “The national media and ideologically driven analysts love to bash LTCI based on anecdotes but solid longitudinal data belie their criticism.  New evidence [in this LTC Bullet].”   

------------------

June 21, 2011:  LTC Mixed Messages.  “LTC financing wouldn't have to be complicated except for the muddle public policy has made of it.  Markets will prevail in the end.”

------------------

April 20, 2012:  How RCFs and Duals Impact Medicaid and LTCI.  “Vital new information about residential care facilities and Medicaid/Medicare dual eligibles [and what it means for the quality of LTC services in this LTC Bullet].”

------------------

January 18, 2013, So What If the Government Pays for Most LTC?, 2011 Data Update, “Ever wonder why LTC insurance sales and market penetration are so discouraging?  Or why reverse mortgages are rarely used to pay for long-term care?  Or why LTC service providers are always struggling to survive financially and still provide quality care?”  Steve Moses explains in this LTC Bullet.

------------------