LTC Bullet:  LTC Almanac Update

Friday, September 4, 2015


LTC Comment:  We’ve updated the “Almanac of Long-Term Care” in The Zone.  More on the LTC Almanac and today’s update after the ***news.***

*** TODAY'S LTC BULLET is sponsored by Claude Thau, a GA whose proprietary tools help advisors find clients and reduce the “Ping-Pong” in the LTCi sales process. Help clients make informed final decisions about buying LTCi in 15-20 minutes!  Gauge a client's true interest in a combo product immediately!  Change work-site LTCi sales from a series of proposal deliveries to a single interactive consultation!  Claude is the lead author of the Milliman Broker World LTCi Survey, one of Senior Market Advisor's 10 "Power People" in LTCi in 2007, a past Chair of the Center for Long-Term Care Financing. Test Claude by calling 800-999-3026, x2241 or email him at to ask questions or get references. ***

*** PHYLLIS SHELTON reports on her summer series of webinars here.  Her ninth and last program covered “So How Long DO Claims Last and What's the REAL Value of LTC Insurance?” with speakers Matt Morton of LTC Group and Jessica Miller of LifePlans.  Handouts and recordings for all nine sessions are available for purchase here. ***

*** OUR LTC CLIPPINGS service ensures you’ll see critical news, articles, reports and data before your clients do.  If you’re a member of the Center already, add the “Clippings” by becoming a “Premium Member” at only 27 cents a day more ($100 per year.)  Contact Damon at 206-283-7036 or to subscribe to “LTC Clippings.”  Here’s sample from this week. 

9/2/2015, “Long-Term Care in the United States: A Timeline,” Kaiser Family Foundation

Quote:  “Long-term care (LTC) in the United States has evolved over the course of the last century to better serve the needs of seniors and persons with disabilities. This timeline outlines the major milestones in LTC from the nursing home era, which created an institutional bias in LTC, to the era of home and community based services (HCBS) and integration, and into the era of health reform and beyond. These milestones include key legislation and court decisions that were instrumental in providing LTC funding; improving the quality of care and safety in nursing homes; and allowing people with LTC needs to stay in their communities. Despite these successes, proposals by commissions and legislators for broader and more comprehensive national LTC policies have not been fully realized; though efforts in this area continue. Download the PDF.”

LTC Comment:  To read this LTC timeline you’d think the only thing that matters about long-term care is government funding and intervention.  It contains hardly a word about private financing, especially long-term care insurance.  Unmentioned are efforts in federal statute after statute to target scarce, under-funded public benefits to the neediest and to divert the middle class and affluent to early LTC planning with better financing options.  We cover that story in detail in "The LTC Graduate Seminar Transcript" here (requires password, contact



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

*** SPECIAL:  We are making access to The Zone, including the "Almanac of Long-Term Care," free for one week—today through Friday, September 11, 2015.  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 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 the full LTC Almanac at your leisure.  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

Profile of Older Americans 2014 URL:

5/12/2015, “Profile of older Americans shows some states aging faster than others,” Administration for Community Living

Quote:  “Over the past 10 years, the U.S. population age 65 and over increased by approximately 25 percent, from roughly 36 million in 2003 to 45 million in 2013. An important aspect of this growth is that it is not equally distributed across states.  For example, the population age 65 and over increased by 30 percent or more in 20 states.  Nevada and Alaska experienced more than a 50 percent increase. Not only are more people reaching their 65th birthday, many are living well beyond age 65. Between 1980 and 2013, the population aged 100+ grew faster than the population over age 65.  The population of older Americans is experiencing dynamic changes. Monitoring these changes over time is an important part of understanding current needs and preparing for future growth.  Every year the Administration for Community Living (ACL) uses U.S. Census data to compile a profile of the U.S. population over age 65.  This year’s report is entitled ‘A Profile of Older Americans: 2014’ and is available here.” [Emphasis added]


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

CBO on Unfunded Liabilities

The 2015 Long-Term Budget Outlook,” Congressional Budget Office (CBO), 6/16/2015, LINK

Quote:  “If current law remained generally unchanged in the future, federal debt held by the public would decline slightly relative to GDP over the next few years, CBO projects. After that, however, growing budget deficits—caused mainly by the aging of the population and rising health care costs—would push debt back to, and then above, its current high level. The deficit would grow from less than 3 percent of GDP this year to more than 6 percent in 2040. At that point, 25 years from now, federal debt held by the public would exceed 100 percent of GDP.

Unfunded Liability Estimates

Social Security Bias (Spring, '15) URL:

“Systematic Bias and Nontransparency in US Social Security Administration Forecasts,” Konstantin Kashin, Gary King, and Samir Soneji, Journal of Economic Perspectives—Volume 29, Number 2—Spring 2015—Pages 239–258

5/13/2015, “Social Security forecasts ‘systemically biased’ to upside: study,” by Glenn Ruffenach, MarketWatch

Quote:  “A new report asserts that forecasting errors within the Social Security Administration, tied primarily to life-expectancy data, have significantly overstated the financial health of the benefits program.  . . .  The authors concluded that - since 2000 - the agency's forecasts have been ‘systematically biased’ and, as a result, are ‘misleading users of the forecasts to conclude that the Social Security Trust Funds are in better financial shape than turns out to be the case.’

LTC Comment:  What does this have to do with long-term care?  Medicaid pays for most LTC; most LTC recipients on Medicaid receive Social Security benefits; Medicaid LTC recipients are required to contribute most of their income including Social Security to offset Medicaid’s cost for their care; Social Security income reduces Medicaid LTC expenses by 10% to 15%.  Therefore, rosy financial scenarios by the Social Security Administration have the effect of making Medicaid’s LTC financial prospects look rosier too.  That’s very dangerous given the oncoming age wave and the public’s Medicaid-induced complacency about LTC planning.


Chapter 4:  Long-Term Care

Long-Term Care Awareness

AP-NORC Poll:  “Long-Term Care In America:  Americans’ Outlook and Planning For Future Care”:  Find it here.

7/16/2015, “Do Americans Understand Long-Term Care?,” by Lee-Lee Prina, Health Affairs:

Quote“Five Things You Should Know From The AP-NORC Center’s Long-Term Care Poll Among Adults Age 40 and Older

  • Nearly 1 in 10 are both supporting a child and providing ongoing living assistance for a loved one.
  • Only a third say they are very or extremely confident in their ability to pay for ongoing living assistance they may need in the future.
  • 54 percent report doing little or no planning for these needs.
  • 1 in 5 do not know if private health insurance plans cover ongoing care in a nursing home, and over a quarter do not know if Medicare does.
  • Majorities support a variety of policy options that would help Americans finance long‑term care.”

LTC Comment:  Old wine in the newest survey bottle.


Chapter 6:  Long-Term Care Financing

Cost of Care Surveys

Genworth 2015 Cost of Care Survey URL  

4/9/2015, “Genworth 2015 Cost of Care Survey,” Genworth:

Quote:  “2015 Cost of Care Overview.  Use the information below to find out and compare the cost of care in your region. Go mobile with the Cost of Care app from iTunes.

LTC Comment:  Click through to the link above to access a clickable map for state data.  Find the full report here.  National highlights (annual costs):

Homemaker Services:                        Up 2% to $44,616
Home Health Aide:                            Up 1% to $45,760
Adult Day Health Care:                     Up 3% to $17,904
Assisted Living Facility:                   Up 2% to $43,200
Nursing Home (Semi-Private):          Up 4% to $80,300
Nursing Home (Private):                   Up 4% to $91,250

Nursing Home and Home Care Expenditure Data from CMS and Health Affairs

Health Affairs on NHE 10 year projections 0715 URL:

“National Health Expenditure Projections, 2014-24: Spending Growth Faster Than Recent Trends,” by Sean P. Keehan, Gigi A. Cuckler, Andrea M. Sisko, Andrew J. Madison, Sheila D. Smith, Devin A. Stone, John A. Poisal, Christian J. Wolfe, and Joseph M. Lizonitz 

NO. 8 (2015): 1407-1417

"ABSTRACT Health spending growth in the United States is projected to average 5.8 percent for 2014-24, reflecting the Affordable Care Act's coverage expansions, faster economic growth, and population aging. Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase. However, in part because of the impact of continued cost-sharing increases that are anticipated among health plans, the acceleration of these growth rates is expected to be modest. The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024."  (p. 1407) 

Who Will Pay for LTC? (includes "Not the VA")

GAO on VA Benefits 0612:

“Improvements Needed to Ensure Only Qualified Veterans and Survivors Receive Benefits”

“The Department of Veterans Affairs’ (VA) pension program design and management do not adequately ensure that only veterans with financial need receive pension benefits. While the pension program is means tested, there is no prohibition on transferring assets prior to applying for benefits. Other means-tested programs, such as Medicaid, conduct a look-back review to determine if an individual has transferred assets at less than fair market value, and if so, may deny benefits for a period of time, known as the penalty period. This control helps ensure that only those in financial need receive benefits. In contrast, VA pension claimants can transfer assets for less than fair market value immediately prior to applying and be approved for benefits.”


Chapter 9:  Long-Term Care Providers


2/18/2015, “Long-Term Care Services in the United States: 2013 Overview,” National Center for Health Statistics (NCHS)

Quote:  “This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). . . . 

“Key Findings:  In 2012, about 58,500 paid, regulated long-term care services providers served about 8 million people in the United States.  . . .  Provider sectors differed in ownership, and average size and supply varied by region.  . . .  Provider sectors differed in their nursing staffing levels, use of social workers, and variety of services offered. Rates of use of long-term care services varied by sector and state.  . . .  Users of long-term care services varied by sector in their demographic and health characteristics and functional status. . . . 

“The NSLTCP findings in this report provide a current national picture of providers and users of five major sectors of paid, regulated long-term care services in the United States. These findings can inform policy and planning to meet the needs of an aging population. NCHS plans to conduct NSLTCP every 2 years to monitor trends. Future NSLTCP products will be available from the NSLTCP website:”

LTC Comment:  Finally, a closer statistical look at LTC providers in the USA.

Medicaid Reimbursement

2014 Eljay Medicaid Underfunding for Nursing Center Care FINAL URL 

“The majority of nursing center providers deliver Medicaid-covered services to residents at rates that are inadequate to cover their costs.  . . .  Unreimbursed allowable Medicaid costs for 2014 are projected to exceed $6.7 billion. Expressed as a shortfall in reimbursement per Medicaid patient day, the estimated average Medicaid shortfall for 2014 is projected to be $21.20,1 which is 12.6 percent lower than the preceding year’s projected shortfall of $24.26. The projected shortfall has declined due to Medicaid rates increasing slightly more than projected cost increases during the time period from the cost report years used in the study (2012 or 2013) to 2014. However, although Medicaid rate increases outpaced projected allowable cost increases during this period, significant shortfalls still exist.”


We will update the “Almanac of Long-Term Care” again soon to bring its content up to current.