LTC Bullet: LTC E-Alert and LTC
Friday, August 29, 2014--
LTC Comment: If you’re not a member of the Center for Long-Term Care
Reform, these are samples of some of what you’re missing, after the
*** PODCAST of Steve Moses and Center member Maryglenn Boals interviewed
August 22, 2014 by Bob Roth of
Cypress Homecare Solutions for his radio
Check out many more of our “media” links, including Steve’s Congressional
*** FREE VIDEO: Jesse Slome of
AALTCI announces availability of
presentation videos from the 2014 LTCI Sales Summit:
“You can now watch one of the 40 sessions recorded at the 2014 LTC Sales
Summit. Free. It will be available through Sept. 30th. The 30 minute
presentation features [Center for LTC Reform Regional Representative]
Romeo Raabe sharing how we deals with uninsurable prospects. Some great
selling ideas and tips. You'll see the speaker + his presentation. If you
like the presentation, you can watch all the Summit presentations (40 of
them) for just $64.50 (TOTAL) when you use the special 50% off code. Enter
aaltci50 when you check out. You'll have 24/7 access for a full year. You
can share this information with others. Just click the link below to
access the sign-in page now.
LTC BULLET: LTC E-ALERT AND LTC CLIPPINGS SAMPLES
LTC Comment: If you’re a Center for Long-Term Care Reform member, you see
LTC E-Alerts like the one below that we send you nearly every
Monday. We’re publishing today’s LTC E-Alert as a LTC Bullet
with wide distribution to our entire mailing list to make a point.
Please read through the following “clippings.” Note that they include a
title, source, link to the original, and Steve Moses’s trenchant “LTC
Comments” for each of the articles, reports or commentaries cited.
We gather and distribute this information so you don’t have to spend
precious professional hours searching the internet for data and analysis
you must know to be at the top of your professional game. It’s a smart
division of labor that saves you time and money.
By far the best way to receive this information is to subscribe to our
daily “LTC Clippings” service. We send an average of three clippings per
day so you can know breaking news affecting your business before your
prospects, clients or competition.
Get LTC Clippings for as little as $10 per month (non-members) or
join the Center for LTC Reform as a “Premium Member” for $225 per year or
$19/month (usually $250 and $21 respectively) and receive a clippings
subscription at no extra cost with full member benefits explained
here. Find our temporary special offer for clippings
subscriptions and join/subscribe
Regular Center members ($150 per year) receive a compendium of the
previous week’s LTC Clippings most Mondays. We call those LTC
E-Alerts and we archive them in The Zone, our password-protected
members-only website, for future reference. Members can search the LTC
E-Alerts or our weekly LTC Bullets or our Almanac of
Long-Term Care for vital information and statistics published any time
in the past 15 or more years.
Of course, Center president Steve Moses eagerly encourages queries from
Center members and responds (usually) with 24-hour turnaround. Quick
access to his vast LTC policy experience and expertise is another major
benefit of membership in the Center for Long-Term Care Reform.
To join the Center, subscribe to LTC Clippings, or ask any
questions, please contact Damon at 206-283-7036 or
firstname.lastname@example.org. You can reach Steve Moses at
email@example.com or 425-891-3640.
Following are LTC Clippings covering the previous two weeks:
To The Courts, Medicare's Long-Term Care Program Has Become A Profound
Quote: "Courtesy of a
recent court ruling, which clarified program eligibility, Medicare has an
untold, profound liability, which actuaries have yet to address in their
calculations. The ruling focused on the seemingly innocuous notion of
ability to improve, which it turns out has played a pivotal in determining
home health coverage. The court struck down consideration of improvement
potential as criterion for coverage, even informally. Medicare needs to
prepare for the dramatic increase in service demand the clarification will
bring and the roll-out, in essence, of its first long term care benefit."
LTC Comment: As we
pointed out when this court ruling was first announced, it has the effect
of moving Medicare into providing home-based long-term care in a major
way. Not only will Medicare expenditures rise, but Medicare will join
Medicaid as another major government program crowding out private LTC
planning and financing.
Wealth Dented by Mortgages Poses U.S. Risk,” by
Victoria Stilwell, Bloomberg
Quote: “A growing number of
homeowners are reaching
still owing money on their houses. The share of Americans 65 and older
with mortgage debt rose to 30 percent in 2011 from 22 percent in 2001,
according to a May
by the Consumer Financial Protection Bureau based on the latest available
figures. Loan balances also increased, with the median amount owed
climbing to $79,000 from $43,400 after adjusting for inflation, the data
showed. . . .
Frost, founder of
Frost Mortgage Banking Group in
will probably be the first generation to take advantage of reverse
mortgages on a large scale.”
Reverse mortgages could be the salvation of
LTC financing when Medicaid implodes . . . if there is any home equity
left to borrow.
Prospect of 'Empowered Living' Could Motivate Millions to Plan for Long
Term Care, ACSIA Partners Says,”
Quote: "Today ACSIA
Partners introduces the concept of 'empowered living' an idea they hope
will catch on to help solve a big national problem: lack of planning for
long term care."
LTC Comment: Certainly
has a nicer ring to it than long-term care, much less nursing home care
or, ugh, institutionalization.
Retirement Will Probably Start Earlier Than You Want,”
by Brian O'Connell, The Street
Quote: “According to
the Employee Benefit Research Institute, 63% of employees who leave the
workforce early do so because of a health problem or disability; 23%
depart over a downsizing issue or an employer shuttering its doors or
business closure; and 18% leave because they have to care
for a family member. . . .
“Look into long-term care insurance. You can save money by paying
for long-term care insurance now instead of paying more for it later. The
cost of services such as in-home health care rise annually, but if you buy
now, you can lock in a lower price for long-term care and save money for
down the road.”
LTC Comment: Good reason, if there’s time, to help that family
member get coverage so you don’t have to quit your job early to take care
Beyond Medicare's Nursing Home Ratings: What To Know Before Picking a
Facility,” by Howard Gleckman, Forbes
“Use Nursing Home Compare, by all means.
But don’t stop there. Visit facilities and look beyond the wood-paneled
lobby. Talk to residents and their families. Talk to nurses and,
especially, to aides, who provide nearly all of hands-on-care. Check the
local ombudsman office for complaints. To be fair, the Medicare.gov
website makes many of these same suggestions, but they are buried in a
so few will ever read them.”
May I Help You Plan Your Final Months?,” by
Elana Gordon, National Public Radio
“Schleicher is one of 50 or so counselors
working for a company founded in 2008 called
The firm represents roughly a dozen insurance companies nationally that
want to, when appropriate, start discussions with beneficiaries about
Is this a private “death panel” or good for
everyone, as in the terminally ill get counseling, the insurance company
may save money, and health insurance premiums could possibly decline?
Home-Care Workers Say Yes to Union SEIU Adds 27,000 Home-Health Aides to
600,000 Others in About 20 States,” by Kris
Maher, Wall Street Journal
Quote: "The Service
Employees International Union scored a victory Tuesday as home health-care
workers in Minnesota voted to be represented by the labor group, even as
it faces a legal challenge from opponents who say the 27,000 workers
involved shouldn't be forced to join a union. . . .
"In June, the U.S. Supreme Court ruled 5-4 that home-care workers in
Illinois aren't full-fledged public employees and can't be forced to pay
union dues. The court found that requiring mandatory union fees violated
the First Amendment rights of workers who didn't want to join."
LTC Comment: If not
reversed judicially, costs will likely increase putting pressure on
Medicaid, Medicare, and home care companies.
it any wonder this field has an identity crisis?,”
by John O'Connor, McKnight's LTC News
“Even back when I began reporting for
McKnight's in 1990, there was not a universally agreed-upon
description for this sector. At that time, many providers of skilled care
services simply identified themselves as ‘nursing homes.’ And even now,
the term continues to have currency among the general public. But locating
a facility that uses ‘nursing home’ in its title these days is a bit like
LTC Comment: Interesting,
but unmentioned in this article, is the fact that LTC name changes have
been driven by funding sources. “Assisted living” emerged as a private
pay alternative to nursing homes because of discontent with the perceived
poor quality of Medicaid-financed nursing homes. “Post-acute care”
derived from Medicare’s efforts to reduce costs by substituting skilled
nursing for hospitalization. And so on.
The Growing Retirement Risk,” by Margarida
Correia, Financial Planning
Quote: "No one wants
to talk about dementia, but it's a conversation many people-and their
advisors-need to have if they want to be fully prepared for the risks of
retirement. Individuals who haven't thought through what might await them
not only face the threat of throwing their families into chaos but also
risk putting their assets on the line by making themselves vulnerable to
con artists and other financial predators."
Curiously, there is nothing in this article about planning to pay for
Star Ratings Allow Nursing Homes to Game the System,”
by Katie Thomas, New York Times
Quote: "The Medicare
ratings, which have become the gold standard across the industry, are
based in large part on self-reported data by the nursing homes that the
government does not verify. Only one of the three criteria used to
determine the star ratings - the results of annual health inspections -
relies on assessments from independent reviewers. The other measures -
staff levels and quality statistics - are reported by the nursing homes
and accepted by Medicare, with limited exceptions, at face value."
LTC Comment: This
article, based on one nursing facility and speculation, is reminiscent of
the grey lady's hit pieces on LTC insurance a few years ago. The real
problem derives from heavy dependency on low reimbursement from Medicaid.
Wanted (a Lot): Home-Health Aides Fast-Growing Industry: Experiences High
Turnover Amid Low Pay and Demanding Duties,” by
Sarah Portlock, Wall Street Journal
Quote: "No major
segment of the workforce is expected to expand faster in coming years than
that of the paid caregivers who assist aging Americans at home. The jobs
typically don't require a high-school diploma, there is little required
training and the average workweek is 34 hours. . . .
"But the main problem isn't attracting new home-health aides, people in
the industry say. It is keeping caregivers in a profession that can be
emotionally and physically difficult, and often offers only part-time work
with limited pay and few benefits. . . .
"The bulk of funding for the home health-services industry-roughly 73%, or
$44.3 billion-comes from government programs, primarily Medicaid and
Medicare, according to the Paraprofessional Healthcare Institute, a
home-care advocacy organization."
Attracting, properly training, adequately compensating and somehow
retaining enough caregivers as boomer aging spikes is a huge problem. It
won't be solved without getting more private financing into the LTC
services business, but with nearly 3/4 of all home health funds coming
from government programs, private financing has been and continues to be
mostly crowded out.
consider fast LTCI rate review process,” by
Allison Bell, LifeHealthPRO
Quote: "Drafters say a
state insurance commissioner could let an issuer of LTCI policies written
in the past, under old rules and old, mistaken assumptions, have an
expedited rate review. The issuer could use the fast-track process if it
agreed to share the cost of experience deviations from the expected with
the policyholder; send the policyholder a clear, detailed notification
letter; refrain from filing for additional increases for at least five
years; and refrain from filing for any additional increases unless
experience is at least 15 percent worse than now expected."
LTC Comment: First,
let's apply comparably strict rules to Medicaid and Medicare which promise
benefits without any actuarial likelihood they'll be able to pay in the
future. Government criticizing private insurers is the pot calling the
of all New Mexicans now on Medicaid and Medicare,”
by Dennis Domrzalski, Albuquerque Business First
Quote: "Since October,
155,000 New Mexico residents have joined the state's Medicaid rolls,
pushing total enrollment to more than 630,000, or nearly a third of the
state's population. On top of that, 410,000 New Mexicans are enrolled in
Medicare, the federal health care program for the elderly. Together, total
enrollment in those two federal programs are more than 1 million, or half
of the state's 2.1 million population."
LTC Comment: Half the population dependent on the other half for
health care. How long can that go on?
obesity linked to risk of dementia,” by
Elizabeth Leis Newman, McKnight's LTC News
Quote: "University of
Oxford researchers looked at hospital admission records for people with
dementia and looked at when a diagnosis of obesity was recorded. They
found that obese people between the ages of 30 to 39 had a 3.5 times
higher chance of developing dementia. Those who received their diagnosis
between their 40s and 60s had a higher risk of developing vascular
LTC Comment: Is it
causation or only correlation? Does public financing of most long-term
care indirectly subsidize obesity? Are hard-working, hard-exercising,
health conscious people punished by having to pay (through taxes) the
medical costs of people who do the opposite? So many tough questions.
getting 'super-aged' at scary speed,” by Alanna
Quote: "By 2020, 13
countries will be 'super-aged' -- with more than 20% of the population
over 65 -- according to a report by Moody's Investor Service. That number
will rise to 34 nations by 2030. Only three qualify now: Germany, Italy
and Japan. . . . Canada, Spain and the U.K. will be 'super-aged' by 2025,
and the U.S. will follow by 2030."
LTC Comment: When it
comes to dealing with the challenge of super-aging, we at least have the
advantage of learning from most of the developed world before confronting
the problem ourselves.
Due To Medical Bills? Sometimes It Makes Sense,”
by Eve Kaplan, Forbes
Quote: "Divorce among
older couples is on the rise in our country due to spiraling medical and
long-term care costs. Soaring medical/nursing care expenses are aggravated
by longevity and uninsured risk (no long-term care insurance in place).
Although unappetizing, divorce - when compared with alternatives - may
inflict the least amount of damage. When Medicaid finally steps in to
cover an ill spouse, he or she will be guaranteed care to the end of
LTC Comment: Divorce
and many, many other Medicaid planning methods have the effect of negating
the financial liability of LTC after the insurable event occurs and thus
discourage responsible LTC planning by the next generation. Unintended
consequences of well-intentioned public policy create many such perverse
care insurance makes a great birthday gift,” by
Robert Klein, MarketWatch
Quote: "Looking for
something different to give to your mom or dad for their next birthday?
How about long-term care insurance? Don't laugh. If they don't have it
already, this will undoubtedly be the most meaningful and memorable gift
you give to your parents and you - even if your mom or dad never uses
LTC Comment: Good
idea. How about Mother's Day, Father's Day, Silver or even Golden wedding
anniversaries, Christmas or Hanukkah too?
Skilled Healthcare merger to create huge long-term care provider with more
than 500 facilities,” by Tim Mullaney,
McKnight's LTC News
“The all-stock deal is the latest instance
of consolidation in the sector. Less than a month ago, Brookdale Senior
Living and Emeritus Corp.
closed a $2.8 billion merger,
and Kindred Healthcare has been
an acquisition of home healthcare company Gentiva. Providers have forged
deals largely in response to the Affordable Care Act.”
Big changes are afoot in the LTC provider
industry: merging home and institutional care in giant companies with
economies of scale but maybe not the same personal touch.
Has a Retirement Spending Problem,” by Benjamin
H. Harris, Brookings
Quote: "[M]arkets for
insurance-like products can be a critical tool for achieving retirement
security. Without these markets, households either under-save and hence
risk retirement security or over-save to protect against various
retirement risks-not the least of which is living longer than expected-and
consequently enjoy less consumption and happiness over the course of a
lifetime. The problem for many retirees is that they simply don't have
access to or knowledge of insurance products that can help to provide
security. . . . Long-term care risk is a very real threat to older
Americans, but few households carry private insurance. In recent years,
only one-in-ten elderly people carried long-term care insurance, and the
annual growth rate of new premiums has been stagnant for at least a
LTC Comment: This recognition of LTCI on the left-leaning
Brookings Institution's website is significant.
evidence adult daycare eases stress on dementia caregivers,”
by Shereen Lehman, Reuters
Quote: "The stress of
caring for a family member with dementia may take a toll on health over
time, but a new study suggests that even one day off can shift caregivers'
stress levels back toward normal."
LTC Comment: "What a
difference a day makes; just 24 little hours."
Next Sales Idea from LTCA: ‘I Know What You Did Last Summer’,”
by Stephen D. Forman,
Long Term Care Associates
Quote: "This year [Steve Forman of
Long Term Care Associates] was
given the opportunity to . . . author the 2nd Edition of the Advisor's
Guide to Long-Term Care (1st Edition authored by Jeff Sadler, CLTC).
67% of Land This Plane respondents agree that the ‘long term care
problem should be a mainstream financial planning requirement’ and that's
the approach we take in the book. We argue passionately, in plain-English,
why long-term care solutions and alternatives should be part of every
retirement planning discussion.”
Congratulations to Center-supporter Steve Forman and corporate member LTCA
on the publication of this updated version of an excellent guide to LTC
Nursing homes correctly reported 53% of abuse or neglect allegations in
2012,” by Tim Mullaney, McKnight's LTC News
Quote: "Only about
half of nursing facilities correctly reported abuse or neglect allegations
in 2012, indicating that the government needs to provide more guidance and
oversight, according to a new report from the Office of Inspector
LTC Comment: When
private payers encounter abuse or neglect, they or their families can
change facilities or caregivers. People dependent on Medicaid have little
choice but to complain and hope for the best. As Medicaid pays less than
the cost of the care, it's hard to see why top quality care can be
expected no matter how much reporting and enforcement is required.
Compounding the problem is that Medicaid also drags down quality and
choices for private payers through cost shifting and a limited supply of
of adults lack retirement savings, including many 65 or older,”
by Jim Puzzanghera, Los Angeles Times
Quote: “More than a
third of American adults have no retirement savings, and 14% of those ages
65 and older also haven’t put money away yet, according to a new study. .
. . Overall, 36% of those 18 years or older have not started saving for
retirement, according to the survey of 1,003 adults. . . . Savers have
been hurt in recent years by historically low interest rates caused by the
Federal Reserve’s attempts to stimulate the economy after the Great
LTC Comment: Fiscal
and monetary policy of the U.S. government have discouraged savings. We
analyzed the significance of those policies in last Friday’s (8/15/14)
LTC Bullet: Keynes vs. Hayek on LTC Insurance.
Advantage Is More Expensive, but It May Be Worth It,”
by Austin Frakt, New York Times
“Medicare Advantage plans — private plans
that serve as alternatives to the traditional, public program for those
that qualify for it — underperform traditional Medicare in one respect:
6 percent more.
But they outperform traditional Medicare in another way: They offer higher
LTC Comment: And this in the
New York Times, no less!
risk spikes with declining cognition, researchers say,”
by Tim Mullaney, McKnight's LTC News
Quote: "Seniors who scored lower on cognitive tests administered
every three years had a 61% higher chance of having stroke, the
investigators determined. Cognitive decline increased stroke risk
five-fold in African Americans compared to European Americans. After
stroke, cognition began to decline about twice as fast in both groups, and
the risk of death increased."
LTC Comment: Causation or correlation?
"LTC E-Alerts" are a
feature offered by the Center for Long-Term Care Reform, Inc. to members
at the $150 per year level or higher. We'll track and report to you news
and analysis regarding long-term care financing, service delivery, and
research. We hope The LTC E-Alerts will help you attain and maintain a
high level of knowledge and competency in this complex field. The
Center for Long-Term Care Reform, Inc. is a private institute dedicated to
ensuring quality LTC for all Americans (www.centerltc.com).