LTC Bullet:  LTC Almanac Update (2)

Friday, September 11, 2015


LTC Comment:  Again this week, we’ve updated the “Almanac of Long-Term Care” in The Zone.  The Almanac is now current.  More on the LTC Almanac and today’s update after the ***news.***

*** SEPTEMBER 11:  Never forget!  We dedicate today’s LTC Bullet to remembrance.  Everyone cognizant at the time recalls that fateful late-summer day in 2001 when America came under attack on our own soil.  We recollect where we were, the shock we felt, and how the event impacted our lives even if we lost no one we knew personally.  Likewise, older readers will remember November 22, 1963, the day President Kennedy was killed, my 18th birthday as it happens.  But today, I want to bring back a different memory.  Two weeks after 9/11/2001, I lost a good friend and long-term care lost an inimitable analyst and advocate.  George Sherman, the curmudgeonly editor of LTC News & Comment, fell from his mountain bike at age 65, punctured his remaining lung and expired.  Now, here’s the connection with remembrance of important historical events.  At age six, George Sherman was in Hawaii and witnessed the Pearl Harbor invasion on December 7, 1941.  He claimed he looked up from his front yard and saw the face of an attacking Japanese aviator.  No one would agree more than George Sherman with Santayana’s admonition “Those who cannot remember the past are condemned to repeat it.”  So, remember. ***

*** DEADLINE APPROACHING:  2016 ILTCI CONFERENCE:  The 16th Annual Intercompany LTCI Conference will convene at The Grand Hyatt in San Antonio, Texas March 13th to 16th, 2016.  Mark your calendars and be there if you can.  Professional meetings don’t get any better than this one.  In case you’re considering sponsoring or exhibiting, conference organizers report “Please review the Promotional Opportunity Guide, Application and Exhibit Hall rules.  The conference is offering substantial discounts for signing up by Monday, September 14th.”  You can find an “Exhibitor & Sponsor Application” and “Exhibitor & Sponsor Options” at these links.***



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 18, 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 3:  Unfunded Liabilities--Social Security, Medicare, Pensions and Budgets

Unfunded Liability Estimates

2015 Social Security Trustees Report 0715 URL:

The Board of Trustees, Federal Old-Age And Survivors Insurance and Federal Disability Insurance Trust Funds transmitting “The 2015 Annual Report of The Board of Trustees of The Federal Old-Age And Survivors Insurance and Federal Disability Insurance Trust Funds”

“For the combined OASI and DI Trust Funds to remain solvent throughout the 75-year projection period: (1) revenues would have to increase by an amount equivalent to an immediate and permanent payroll tax rate increase of 2.62 percentage points1 (from its current level of 12.40 percent to 15.02 percent, a relative increase of 21.1 percent); (2) scheduled benefits during the period would have to be reduced by an amount equivalent to an immediate and permanent reduction of 16.4 percent applied to all current and future beneficiaries, or 19.6 percent if the reductions were applied only to those who become initially eligible for benefits in 2015 or later; or (3) some combination of these approaches would have to be adopted.”  (p. 6)   

Don’t Count on Social Security or Medicare

GAO on Retirement Savings 0615 URL:
“Retirement Security:  Most Households Approaching Retirement Have Low Savings”
GAO-15-419: Published: May 12, 2015. Publicly Released: Jun 2, 2015.

6/2/2015, “Most Households Approaching Retirement Have Low Savings,” Government Accountability Office

Quote:  “Many retirees and workers approaching retirement have limited financial resources. About half of households age 55 and older have no retirement savings (such as in a 401(k) plan or an IRA). According to GAO's analysis of the 2013 Survey of Consumer Finances, many older households without retirement savings have few other resources, such as a defined benefit (DB) plan or nonretirement savings, to draw on in retirement (see figure below). For example, among households age 55 and older, about 29 percent have neither retirement savings nor a DB plan, which typically provides a monthly payment for life. Households that have retirement savings generally have other resources to draw on, such as non-retirement savings and DB plans. Among those with some retirement savings, the median amount of those savings is about $104,000 for households age 55-64 and $148,000 for households age 65-74, equivalent to an inflation-protected annuity of $310 and $649 per month, respectively. Social Security provides most of the income for about half of households age 65 and older.

LTC Comment:  A sad state of affairs evoking the irony that people are less likely to save and plan these days because they think they can rely on Social Security, Medicare and other financially vulnerable public programs.

State Fiscal Responsibility

Fiscal Report Card, Cato 2014 URL

“Fiscal Policy Report Card on America's Governors:   2014”  by Nicole Kaeding and Chris Edwards

“Four governors were awarded an “A” on this report card: Pat McCrory of North Carolina, Sam Brownback of Kansas, Paul LePage of Maine, and Mike Pence of Indi­ana. Eight governors were awarded an “F”: Mark Dayton of Minnesota, John Kitzhaber of Oregon, Jack Markell of Delaware, Jay Inslee of Washington, Pat Quinn of Illinois, Deval Patrick of Massachusetts, John Hickenlooper of Colorado, and Jerry Brown of California.”  (p. 1)


Chapter 4:  Long-Term Care

Alzheimer's Disease

AA on Cost of Alzheimers URL:

“New Analysis Shows More Than 28 Million Baby Boomers Will Develop Alzheimer’s Disease; Will Consume Nearly 25% Of Medicare Spending”

7/20/2015, “Alzheimer's and Medicare spending to boom over next 25 years,” by Holly Petrovich, McKnight's LTC News

Quote:  “Over the next 25 years, more than 28 million baby boomers will develop Alzheimer's disease, and the cost of care will consume nearly 25% of Medicare spending, according to an analysis from the Alzheimer's Association released Monday. The association said that as more boomers develop the disease, more severe forms will develop, which will lead to greater Medicare costs. By 2020, caring for these patients will cost nearly $12 billion, and about 2.1% of total Medicare spending. By 2040, however, the baby boomers will be ages 76 to 94, and the projected Medicare costs will have increased to $328 billion, consuming nearly 24.2% of total Medicare spending.”

LTC Comment:  The financial impact on Medicaid will likely be even greater.


Chapter 5:  Caregiving

Value of Free Care

AARP on Valuing Caregiving 0715 URL

“Valuing the Invaluable 2015 Update: Undeniable Progress, but Big Gaps Remain,”
by Susan Reinhard, Lynn Friss Feinberg, Rita Choula, Ari Houser,
Public Policy Institute, July 16, 2015

7/16/2015, “Valuing the Invaluable 2015 Update: Undeniable Progress, but Big Gaps Remain,” by Susan Reinhard, et al., AARP

Quote:  “Family caregivers are an essential part of the social, health, and economic fabric of the U.S. But family caregiving often comes at substantial costs to the caregivers themselves, to their families, and to society.  Without family-provided help, the economic cost to the U.S. health and long-term services and supports (LTSS) systems would skyrocket.”

LTC Comment:  This latest update puts the value of unpaid caregiving at $470 billion as of 2013.


Chapter 6:  Long-Term Care Financing

LTC Costs and Risk

ASPE on LTC Risk and Cost URL:

“Long-Term Services and Supports for Older Americans:  Risks And Financing”

7/16/2015, “What Are the Chances You'll Need Long-Term Care And How Much Will It Cost?,” by Howard Gleckman, Forbes

Quote:  “What are the odds you’ll need assistance to help with personal activities such as bathing or dressing before you die? For those about to turn 65, it’s about 50/50, according to an important new study. On average, you can expect to need this high level of care for about two years. But one-in-five Americans will need such assistance for less than one year while about one in seven will need extensive help with daily living for five years or more.

“On average, this high level of long-term supports and services will cost about $140,000 (in 2015 dollars) from age 65 until you die. To think of it another way, if a 65-year-old wanted to have enough money to pay for this care for the rest of her life, she’d have to invest about $70,000.  But among those who use paid care (excluding those who use none), the average lifetime cost is more than $265,000. To afford that, you’d need to put aside about $134,000 at 65.”

LTC Comment:  I agree this new data on the risk and cost of long-term care from a just-published “ASPE Issue Brief” is important, but some of the claims for it may be dubious.  We’ll take a closer look and possibly publish a critique in next Friday’s LTC Bullet.

Quotes that Medicaid Requires Spendown from People Who Should Know Better

Feder on LTC 0615 URL:

“The Challenge of Financing Long-Term Care,” by Judith Feder, Saint Louis University Journal of Health Law & Policy, [Vol. 8:47]

“The federal-state Medicaid program does serve as a valuable last resort for people who need long-term care, but its protections (especially for care at home) vary considerably from state to state and become available only when people are, or have become, impoverished taking care of themselves.”  (p. 47)

LTC Comment:  Medicaid for LTC is hardly a “last resort.”  Anyone with income below the cost of a nursing home and virtually unlimited exempt assets qualifies easily.”


Chapter 10:  Medicaid

Medicaid Financing and Burwell Data

Burwell ltss-expenditures-2012 URL:  available at very long URL here.

“MEDICAID EXPENDITURES FOR LONG-TERM SERVICES AND SUPPORTS IN FFY 2012,” by Steve Eiken, Kate Sredl, Lisa Gold, Jessica Kasten, Brian Burwell, Paul Saucier, APRIL 28, 2014

“Managed care and new program authorities authorized by Congress in 2006 and 2010 had a greater role in LTSS expenditures in FFY 2012 than in previous years. Managed care accounted for 6.6 percent of LTSS expenditures in FFY 2012, compared to 3.8 percent in FFY 2008, the first year state-reported data for managed care programs were included. We expect the role of managed care to continue to increase as states implement Medicaid managed LTSS programs or include LTSS in financial alignment demonstration programs for people who are dually eligible for Medicaid and Medicare.” (p. 12)

Medicaid Deficiencies

Finkelstein on Medicaid 0615 URL  “The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment” by Amy Finkelstein, Nathaniel Hendren, Erzo F.P. Luttmer #21308 (AG HC PE)

Abstract:  “Our baseline estimates of Medicaid's welfare benefit to recipients per dollar of government spending range from about $0.2 to $0.4, depending on the framework, with at least two-fifths – and as much as four-fifths – of the value of Medicaid coming from a transfer component, as opposed to its ability to move resources across states of the world.”