LTC Bullet:  LTC Almanac Update (2)

Friday, February 19, 2016


LTC Comment:  We’ve updated the “Almanac of Long-Term Care” in The Zone.  The Almanac is not up to date.  More on the LTC Almanac and today’s update after the ***news.***

*** 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 26, 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 3:  Unfunded Liabilities--Social Security, Medicare, Pensions and Budgets

Unfunded Liability Estimates

TIA on State Finances 0915 URL:

9/2015, “Financial State of the States,” by Robert Rector, Truth in Accounting

Quote:  “For the sixth consecutive year, Truth in Accounting (TIA) has completed a comprehensive review of the financial reports of all 50 states to provide citizens with a clear picture of their governments’ financial conditions. Despite an improvement in the economy and financial markets, the amount of bills accumulated by the states has not significantly decreased. States still have almost $1.3 trillion of unfunded debt, accumulated despite balanced budget requirements in 49 of the 50 states. 39 states have dug financial holes, thus creating a “Taxpayer Burden,” which is the amount each taxpayer would have to send to their state’s treasury in order for the state to be debt-free. If state budgets had been truly balanced, no Taxpayer Burden would exist.”

LTC Comment:  Check out your personal debt or credit as a taxpayer in your state.


Chapter 5:  Caregiving

Caregiver Stress, Burnout and Costs

Genworth on Caregiving 1015 URL:

10/1/2015, “Beyond Dollars: Caregivers Face Career Crisis Resulting from Lack of Long Term Care Planning, According to Genworth Study,” Genworth press release, Market Watch

Quote:  “Providing care for loved ones has taken a toll on the careers of half of caregivers surveyed in Genworth's latest Beyond Dollars study, with 11 percent actually losing their jobs and another 10 percent having to change careers. That's in addition to the other financial, physical and emotional impacts of caregiving examined in the study. ”

LTC Comment:  It’s not just the money—a powerful message for prospects in denial.


Caregiver Shortages

NBER on LTCI 0815 URL:

8/2015, “Family Spillovers of Long-Term Care Insurance,” by Norma B. Coe, Gopi Shah Goda and Courtney Harold Van Houtven, National Bureau of Economic Research

Quote:  “LTCI coverage induces less informal caregiving, suggesting the presence of intra-family moral hazard. We also find that children are less likely to co-reside or live nearby parents with LTCI and more likely to work full-time, suggesting that significant economic gains from private LTCI could accrue to the younger generation.”

LTC Comment:  How much more would this finding apply to free Medicaid-financed HCBS than for expensive private long-term care insurance?  Easy access to Medicaid LTC crowds out free family care whereas private LTCI enables family members to keep their jobs and spend quality, less stressful time with chronically ill elders.


Value of Free Care

BLS on Free Caregiving 0915 URL:

9/23/2015, “Unpaid Eldercare in the United States —2013-14:  Data from the American Time Use Survey,” Bureau of Labor Statistics

Quote:  “Sixteen percent (40.4 million) of the civilian noninstitutional population age 15 and over provide unpaid eldercare, the U.S. Bureau of Labor Statistics reported today. Of the 40.4 million eldercare providers, a majority are employed (61 percent) and nearly one-half are employed full time (47 percent). These estimates are averages for the 2-year period of 2013-14; combining the 2 years of data facilitates a more in depth analysis of eldercare. ”

LTC Comment:  This BLS report contains extensive data on unpaid caregiving in the USA, but no estimate of its dollar value.  For that ($470 billion per year) see:  Susan C. Reinhard, et al., “Valuing the Invaluable: 2015 Update, Undeniable Progress, but Big Gaps Remain,” AARP Public Policy Institute, July 2015, p. 1;


Chapter 6:  Long-Term Care Financing

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

Bipartisan Policy Center’s “Initial Recommendations to Improve the Financing of Long-Term Care

2/2/2016, “Private Long Term Care Insurance Market Must Be Shored Up, Policy Center Argues,” by Bill Myers, Provider

Quote:  “Policymakers should act ‘to stabilize’ the long term care insurance market ‘and make it accessible to more Americans,’ a new report argues.  ...  The report also urges state policymakers to consider expanding Medicaid-even if only as part of a one-off ‘buy-in’ to help pay for long term care services and supports. Finally, the report urges lawmakers and policymakers to pursue concepts and elements for a public insurance program to: 1.) address uninsurable long term care costs; 2.) protect Americans from the catastrophic costs of long term care supports and services; and 3.) provide relief to states, which along with the federal government face significant Medicaid costs in the coming years as baby boomers begin to need their own long term care, the report says.”

LTC Comment:  This Friday’s LTC Bullet will summarize and analyze the new report.  Check it out here in the meantime.

Find our critique of the BPC proposals at LTC Bullet:  Three Cheers (But Two From the Bronx) for New BPC-LTC Recommendations, Friday, February 5, 2016
Health Affairs on LTC Article 1115 URL:


“Financing Long-Term Services And Supports: Options Reflect Trade- Offs For Older Americans And Federal Spending,” by Melissa M. Favreault, Howard Gleckman, and Richard W. Johnson

ABSTRACT About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance’s role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

Find our critique of this important article in “LTC Bullet:  The Arrogance of LTC Analysts’ Elitism,” Friday, December 4, 2015


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

Health Affairs on 2014 National Health Expenditures URL:

“National Health Spending In 2014: Faster Growth Driven By Coverage Expansion And Prescription Drug Spending,”  by Anne B. Martin, Micah Hartman, Joseph Benson, Aaron Catlin, and the National Health Expenditure Accounts Team

ABSTRACT US health care spending increased 5.3 percent to $3.0 trillion in 2014. On a per capita basis, health spending was $9,523 in 2014, an increase of 4.5 percent from 2013. The share of gross domestic product devoted to health care spending was 17.5 percent, up from 17.3 percent in 2013. The faster growth in 2014 that followed five consecutive years of historically low growth was primarily due to the major coverage expansions under the Affordable Care Act, particularly for Medicaid and private health insurance, which contributed to an increase in the insured share of the population. Additionally, the introduction of new hepatitis C drugs contributed to rapid growth in retail prescription drug expenditures, which increased by 12.2 percent in 2014. Spending by the federal government grew at a faster rate in 2014 than spending by other sponsors of health care, leading to a 2-percentage-point increase in its share of total health care spending between 2013 and 2014.


Chapter 7:  Long-Term Care Insurance


CRR on Lapse Rates 1015 LINK


“Why Do People Lapse Their Long-Term Care Insurance?,” by Wenliang Hou,Wei Sunand, Anthony Webb

The brief’s key findings are:

  • More than a third of those with long-term care insurance at age 65 will let their policies lapse at some point, forfeiting all benefits.
  • Lapses could be due to the burden of insurance premiums, a strategic calculation that care use is less likely, or poor decisions due to declining cognitive ability.
  • The analysis finds support for both the “financial burden” and “cognitive decline” explanations.
  • The consequences of lapsing are significant, as lapsers are actually more likely than non-lapsers to use care in the future, partly due to cognitive decline.
  • Thus, for some lapsers, having insurance could be counterproductive as they buy it to protect against risk but drop it just when the risk becomes more likely.

For our critique of this report, see LTC Bullet:  Another LTCI Hit Job?, Friday, October 9, 2015


Chapter 10:  Medicaid

Medicaid Spousal Impoverishment Tables

2016 SSI and Spousal Impoverishment Standards
2016-ssi-and-spousal-impoverishment-standards URL:

12/2/2015, CMS Confirms That Spousal Impoverishment Figures Will Remain the Same for 2016,” by, ElderLawAnswers

Quote“The Centers for Medicare and Medicaid Services (CMS) has announced that the spousal impoverishment and home equity limit figures will not change from 2015 levels next year.  This is because there was no increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). . . .  For CMS’s page on all the SSI and spousal impoverishment standards for 2016, click here.  For an informational bulletin that was attached to the figures, click here.

LTC Comment:  We’ll also update these numbers in The Zone where you can find the comparable annual amounts all the way back to 1991 for comparison.