LTC Bullet:  LTC E-Alert and LTC Clippings Samples

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 ***news***

*** PODCAST of Steve Moses and Center member Maryglenn Boals interviewed August 22, 2014 by Bob Roth of
Cypress Homecare Solutions for his radio show:  Check out many more of our “media” links, including Steve’s Congressional testimony, here. ***

*** 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 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 here.

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  You can reach Steve Moses at or 425-891-3640.

Following are LTC Clippings covering the previous two weeks:


8/28/2014, “Thanks To The Courts, Medicare's Long-Term Care Program Has Become A Profound Fiscal Liability,” Forbes

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. 


8/28/2014, “Boomer Wealth Dented by Mortgages Poses U.S. Risk,” by Victoria Stilwell, Bloomberg

“A growing number of homeowners are reaching retirement age 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 analysis 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. . . .

Greg Frost, founder of Frost Mortgage Banking Group in Albuquerque, New Mexico, said baby boomers will probably be the first generation to take advantage of reverse mortgages on a large scale.”

LTC Comment Reverse mortgages could be the salvation of LTC financing when Medicaid implodes . . . if there is any home equity left to borrow.


8/27/2014, “The Prospect of 'Empowered Living' Could Motivate Millions to Plan for Long Term Care, ACSIA Partners Says,” InsuranceNewsNet 

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. 


8/27/2014, “Your 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 of him/her.


8/27/2014, “Looking Beyond Medicare's Nursing Home Ratings: What To Know Before Picking a Facility,” by Howard Gleckman, Forbes

Quote “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 website makes many of these same suggestions, but they are buried in a 56-page guidebook, so few will ever read them.”

LTC Comment Sound advice.


8/27/2014, “Hello, May I Help You Plan Your Final Months?,” by Elana Gordon, National Public Radio

Quote “Schleicher is one of 50 or so counselors working for a company founded in 2008 called Vital Decisions. The firm represents roughly a dozen insurance companies nationally that want to, when appropriate, start discussions with beneficiaries about end-of-life care.”

LTC Comment 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?


8/26/2014, “Minnesota 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. 


8/25/2014, “Is it any wonder this field has an identity crisis?,” by John O'Connor, McKnight's LTC News

Quote “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 trying to find Waldo.”

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.


8/25/2014, “Dementia: 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." 

LTC Comment:  Curiously, there is nothing in this article about planning to pay for long-term care.


8/24/2014, “Medicare 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. 


8/22/2014, “Help 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."

LTC Comment:  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. 


8/22/2014, “Regulators 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 kettle black.


8/22/2014, “Half 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?


8/22/2014, “Mid-life 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 dementia." 

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. 


8/21/2014, “World getting 'super-aged' at scary speed,” by Alanna Petroff, Money   

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.


8/21/2014, “Divorce 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 life." 

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 incentives. 


8/20/2014, “Long-term 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 it." 

LTC Comment:  Good idea.  How about Mother's Day, Father's Day, Silver or even Golden wedding anniversaries, Christmas or Hanukkah too? 


8/20/2014, “Genesis, Skilled Healthcare merger to create huge long-term care provider with more than 500 facilities,” by Tim Mullaney, McKnight's LTC News

Quote “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 aggressively pursuing an acquisition of home healthcare company Gentiva. Providers have forged deals largely in response to the Affordable Care Act.”

LTC Comment 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.


8/19/2014, “America 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 decade." 

LTC Comment:  This recognition of LTCI on the left-leaning Brookings Institution's website is significant. 


8/19/2014, “More 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." 


, “Your Next Sales Idea from LTCA:  ‘I Know What You Did Last Summer’,” by Stephen D. Forman, Long Term Care Associates

:  "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.”

LTC Comment:  Congratulations to Center-supporter Steve Forman and corporate member LTCA on the publication of this updated version of an excellent guide to LTC planning.


8/19/2014, “OIG: 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 General." 

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 non-Medicaid providers. 


8/18/2014, “36% 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 Recession.”

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.


8/18/2014, “Medicare Advantage Is More Expensive, but It May Be Worth It,” by Austin Frakt, New York Times 

Quote “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: They cost 6 percent more.  But they outperform traditional Medicare in another way: They offer higher quality.”

LTC Comment
And this in the New York Times, no less!


8/11/2014, “Stroke 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 (