LTC Bullet:  LTC Almanac Update

Friday, February 12, 2016


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. ***

*** 2016 ILTCI CONFERENCE:  The 16th Annual Intercompany LTCI Conference will convene at The Grand Hyatt in San Antonio, Texas March 13th to 16th, 2016.  Get the mobile app and be there if you can.  Professional meetings don’t get any better than this one.  Your Center for Long-Term Care Reform will be on hand and we hope to see you there. By the way, we hear that nearly all exhibit booth spots are taken, but there are some left. Click here for further information and reserve your spot while you can. ***

*** 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 / 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 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, February 19, 2016.  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

Heritage on Poverty 0915 URL:

9/16/2015, “Poverty and the Social Welfare State in the United States and Other Nations,” by Robert Rector, Heritage Foundation

Quote:  “When private-sector contributions to retirement, health care, and education are added to the count, social welfare spending in the U.S. dwarfs that of other nations. In fact, social welfare spending per capita in the U.S. rises to nearly twice the European average.[4] As Garfinkel, Rainwater, and Smeeding conclude, ‘For those who believe the absolute size of the US welfare state is small, the data presented...[in the book] are shocking and constitute a wake up call. Once health and education benefits are counted, real per capita social welfare in the United States is larger than in almost all other countries!’[5] Only one nation (Norway) spends more per person than the U.S. spends.[6] . . .  Compared against a uniform standard, the U.S. has a poverty rate that is similar to poverty rates in most other advanced nations. However, the U.S. should not seek to outspend other nations in its anti-poverty programs. Instead, the U.S. should seek to reduce poverty by promoting self-sufficiency: the ability to support one’s self and family above the poverty level without reliance on welfare aid.”

LTC Comment:  This is a fascinating article that blows up the stereotype of poverty in America.  The poverty rate is lower and the poor’s standard of living is higher that commonly understood.


Chapter 5:  Caregiving

Caregiver Stress,  Burnout and Costs

Health Affairs on Caregiving 1015 URL:

10/9/2015, “The Disproportionate Impact Of Dementia On Family And Unpaid Caregiving To Older Adults,” by Judith D. Kasper, Vicki Freedman, Brenda C. Spillman, and Jennifer L. Wolff, Health Affairs

Quote:  “Although 10 percent of older adults have dementia, their caregivers account for one third of all family and unpaid caregivers and for 41 percent of all hours these caregivers provide to older adults.

LTC Comment:  You can read the Abstract of this article for free here.  You can subscribe to Health Affairs or buy only this article here.
Northwestern Mutual 2015 Long Term Caregiving Study 1015 LINK


11/09/2015, “New C.A.R.E. Study from Northwestern Mutual Reveals the Caregiving Conundrum,” by Northwestern Mutual

Quote: “New research from Northwestern Mutual released today uncovers a number of surprising insights into the emotional and financial implications of delivering care to an elderly relative or friend. Drawn from the perspectives of both current and future caregivers, the C.A.R.E  (Costs, Accountabilities, Realities, Expectations) Study finds that Americans are often unprepared for the complex and unpredictable realities of longevity and caregiving. According to the C.A.R.E. Study, the cycle of care and dependency is a constant that extends beyond child rearing. Nearly 4 in 10 Americans (36%) either currently consider themselves a caregiver to someone aging, ill or with special needs (other than a child) or say they have performed this role in the past. Notably, the majority (59%) of Americans feel that taking care of two adults between the ages of 85 and 90 would be more difficult than managing two children, ages 3 and 5.

“The 35% of experienced caregivers who have incurred financial costs suggest there can be significant financial pressure. They estimate that on average more than a quarter (26%) of their monthly budget goes towards caring for an aging family member or friend. However, even though financial demands are a concern, people are not necessarily taking action. According to the research, among experienced caregivers who listed financial costs as their top concern about caregiving, more than a quarter (27%) say they know they need to do something but have not taken any steps while 22% have just completely avoided the issue.”

LTC Comment: This is a good reminder, especially during LTC Awareness Month, that while some people might be able to rely on family for caregiving, it’s not without cost. Of course, those costs are vast: emotional, physical, psychological, professional, financial and so on.


Chapter 6:  Long-Term Care Financing


NAHUWhitePaperLTC 0615 URL:

LTC Bullet:  NAHU on LTC Financing, Friday, September 18, 2015:

LTC Comment:  The National Association of Health Underwriters (NAHU) has published its analysis and recommendations regarding long-term care financing.  Some background, the executive summary and a link to the full report follow the ***news.***


Medicare LTC Financing

Institute on Medicare Age Increase Impact 0915 URL:  Here

9/17/2015, “The Effect on States of Increasing the Medicare Eligibility Age,” by Timothy A. Waidmann and Emily Lawton, Urban Institute

Quote:  “Proposals to raise the eligibility age for Medicare may have unintended consequences for state government finances. The medical care of persons who currently receive both Medicaid and Medicare benefits, also known as ‘dual eligibles,’ could become the sole responsibility of Medicaid. In this brief we estimate the number of such individuals in each state and the amount of current Medicare spending that could be shifted to state Medicaid programs. The actual cost impact of such a policy change for an individual state depends on both the demographic makeup of its population and its decision about Medicaid expansion under the ACA.”

LTC Comment:  Something has to be done about Medicare’s huge unfunded liabilities.  One of the commonest proposals is to raise Medicare’s age of eligibility.  But doing that could devastate Medicaid by shifting huge costs to the welfare program.


KFF on Income and Assets of Medicare Benes 091015 URL:  Here

9/10/2015, “Income and Assets of Medicare Beneficiaries, 2014 – 2030,” by Gretchen Jacobson, Christina Swoope, Tricia Neuman, and Karen Smith, Kaiser Family Foundation

Quote:  “While a small share of the Medicare population lives on relatively high incomes, most are of modest means, with half of people on Medicare living on less than $24,150 in 2014.  The typical beneficiary has some savings and home equity, but the range of asset values among beneficiaries is wide and varies greatly across demographic characteristics. Looking to the future, the income, assets and home equity values of Medicare beneficiaries overall are projected to be somewhat greater in 2030 than in 2014 after adjusting for inflation; yet, much of the growth is projected to be realized among those with relatively high incomes and assets.  As policymakers consider options for decreasing federal Medicare spending and addressing the federal debt and deficit, these findings raise questions about the extent to which the next generation of Medicare beneficiaries will be able to bear a larger share of costs.”  [Emphasis added.]

LTC Comment:  The correct take-away from this data showing how poor most Medicare beneficiaries are:  We should stop destroying the Medicaid backstop by stretching it to cover middle and upper-middle class people.

HCBS:  Cost-Effective or Not? (See also similar section under LTC Financing)


Chapter 9:  Long-Term Care Providers

HCBS:  Cost-Effective or Not?

KFF on Medicaid HCBS 0915 URL:

9/18/2015, “Serving Low-Income Seniors Where They Live: Medicaid's Role in Providing Community-Based Long-Term Services and Supports,” by Rachel Garfield, Katherine Young, MaryBeth Musumeci, Erica L. Reaves, and Judy Kasper, Kaiser Family Foundation

Quote:  “Looking ahead, state and federal policymakers and other stakeholders will be challenged to meet the growing need for LTSS to support seniors living in the community in a way that accommodates diverse needs, ensures care quality, and manages costs. Insight into the socio-demographic and health status characteristics of these seniors, especially dual eligible beneficiaries who rely on Medicaid for their LTSS needs and how they may be similar to or different from other seniors with LTSS needs, can lead to increased understanding about how to optimize policies to support these populations.”

LTC Comment:  Like the Health Affairs issue brief on “rebalancing” we sent your way yesterday, this disquisition on the long-term services and supports (LTSS, aka LTC) needs of seniors in the community is worth reading.  But keep in mind that the high need and poor care management it documents was caused by excessive dependency on public financing for long-term care.  In a free market, people would pay privately for care they prefer instead of relying on Medicaid with its institutional bias.  They would buy private insurance to avoid late-life catastrophic LTC costs.  If they did not buy insurance, they would use their home equity to pay for care.  With those incentives to plan responsibly in place, few would end up dependent on welfare which would be better able to serve fewer people in the most appropriate care setting. 


Health Affairs on Rebalancing Medicaid LTC 0915 URL:

9/17/2015, “Health Policy Brief: Rebalancing Medicaid Long-Term Services And Supports," Health Affairs, September 17, 2015.

Quote:  “Twenty-five years after the passage of the Americans with Disabilities Act (ADA), the Medicaid program is also marking an important milestone in system transformation in 2015. The national profile of Medicaid long-term services and supports (LTSS) expenditures has shifted away from primary dependence on institutional care. In 2013 the majority of Medicaid LTSS spending was for the first time focused on home and community-based settings instead of institutional care, and the Centers for Medicare and Medicaid Services (CMS) projects that community-based spending will reach 63 percent of all Medicaid LTSS spending by 2020. However, the fundamental structure of the Medicaid statute continues to promote an ‘institutional bias’ that strongly limits the potential for true balance for beneficiaries.”

LTC Comment:  This history of Medicaid’s rebalancing from principally institutional to mostly home and community-based care is worth reading, but take it with a grain of salt.  There is no reliable evidence that rebalancing saves Medicaid money and one thing is for sure, the more Medicaid pays for home care that people want instead of nursing home care they’d rather avoid, the more people will seek Medicaid and the more its cost for LTC will increase.  Be sure to note that while HCBS now consumes over half of Medicaid LTC expenditures overall, that’s not the case for elderly recipients for whom 71 percent of LTC expenditures still pay for institutional services.


Chapter 10:  Medicaid

Medicaid is the 800-pound gorilla of LTC

KFF on LTC and Medicaid 1215 URL:  PDF of report: 

Report online:  Here

12/15/2015, “Medicaid and Long-Term Services and Supports: A Primer,” by Erica L. Reaves and MaryBeth Musumeci, Kaiser Family Foundation

Quote:  “Private long-term care insurance is typically inaccessible to all with current or future care needs often due to high premium prices. . . .  Few individuals can afford to pay out-of-pocket for needed long-term services and supports, especially those living on fixed incomes with limited personal savings and assets. . . .  People with long-term services and supports needs may qualify for Medicaid based solely on their low incomes or they may qualify at slightly higher incomes if they also meet disability-related functional criteria.” (Emphasis in the original.)

LTC Comment:  This overview of Medicaid and long-term care is mostly accurate factually.  The problem is interpretation of the facts based on ideological bias.  That bias is revealed in the quotes above.  In a nutshell:  LTC is expensive so people can’t afford insurance for it and, therefore, government has to pay even for people with higher incomes.  Try this instead:  LTC is expensive so people would insure against its potentially catastrophic costs if it were not for government having co-opted the private insurance market by paying for most LTC for most people regardless of their financial wherewithal.  See how the otherwise puzzling pieces fit together if you just look at the facts objectively?