LTC Bullet:  Fuel for LTC Change

Friday, April 8, 2016


LTC Comment:  Why doesn’t somebody do something about long-term care services and financing?  Well, somebody did.  Details after the ***news.***

*** LTC CLIPPINGS:  Following is an example of an LTC Clipping we sent to our LTC Clippings subscribers this week.  We try with the clippings to keep our readership abreast in real time of important news, reports and statistics that they need to know in order to stay at the forefront of professional knowledge.  To join the Center or subscribe to our LTC Clippings, contact Damon at 206-283-7036 or

3/2016, “Paying Minimum Wage and Overtime to Home Care Workers:  A Guide for Consumers and their Families to the Fair Labor Standards Act,” by U.S. Department of Labor

Quote:  “Most home care workers must be paid at least the federal minimum wage and overtime. The relevant question is often who is responsible for making sure these workers are paid according to these FLSA requirements. Whether you are responsible for the worker being paid federal minimum wage and overtime depends on whether you are an ‘employer’ as defined by the FLSA.”

LTC Comment:  Double whammy for LTC financing:  first the Labor Department mandates home care workers receive at least the minimum wage (January 2015).  Then California and New York, and probably more states, increase the minimum wage to $15 per hour.  As economic gravity prevails, jobs for home care workers (and hence their availability) will decline and/or they’ll be increasingly replaced by technology such as robots and other assistive devices.  This is a classic case of good intentions with unanticipated consequences, though how can intentions be good when bad consequences are inevitable and recognized by most economists? ***

*** BETTER BURGERS THAN BEDPANS:  Thanks to longtime Center friend and supporter Ric Schafer for tipping us to this story “Nurses Quit Texas Nursing Homes to Work at McDonald's.”  The article says “Roughly 85 percent of Texans living in nursing homes depend on Medicaid or Medicare, and [Director of Government Relations for the Texas Health Care Association] Kibbe said each Medicaid patient is underfunded by 14 percent.”  According to a LTC patient “You can make more money flipping hamburgers than you can helping another person,” Lopez said, and she understands why the turnover rate is so high.  The pay is especially low for Certified Nurse Assistants and attendants who offer at-home care. According to Lopez, her attendant makes $8 an hour [and] she only requires one to two hours of assistance a day.”  Expect more stories like this one, especially if the economy takes a turn for the worse bringing even greater pressure on state budgets and Medicaid LTC reimbursements. ***



LTC Comment:  The delivery and financing of long-term care has received some much-needed attention lately.  We had our say over the past few weeks regarding the recent reports and recommendations coming from a provider trade association, a policy center, and an ad hoc “collaborative”—LTC Bullet:  LTCI Defeatism; LTC Bullet:  No Single Solution?; LTC Bullet:  Three Cheers (But Two From the Bronx) for New BPC-LTC Recommendations; and LTC Bullet:  The Arrogance of LTC Analysts’ Elitism.  Let’s look this week at some ideas coming from the people who see long-term care from the insurance side.

What follows are excerpts from “Long Term Care Think Tank:  Exploring the Possibilities for Helping the American Public Manage the Financial Burden of Long Term Care,” a report and recommendations by Maddock Douglas, Inc. for the Society of Actuaries, February 22, 2016.  Find the complete report here for free:  For $149 you can buy a very good webinar titled Fuel for Change: Three Angles on LTC Innovation which describes the process that generated the report and its results.

Special thanks to Think Tank Chair Vince Bodnar of LTCG, Inc. and Maria Ferrante-Schepis of Maddock Douglas for bringing this material to our attention and for taking the time to explain and discuss the process and results with us. 


Excerpts from the Society of Actuaries’ Long-Term Care Think Tank Report

“On October 19 and 20, 2015, the [Society of Actuaries] Long Term Care Think Tank met in Rosemont, Illinois, for a collaborative workshop. During this two-day facilitated session, participants from across the LTC industry reviewed previous Think Tank work and other industry research and participated in facilitated brainstorming exercises to:

  • Hypothesize and describe how consumers’ needs may be changing

  • Brainstorm how the LTC industry could evolve their offerings to meet these need in innovative new ways

“‘Fair Game’ for the workshop included ideas that would potentially impact the following areas:

  • Helping people pay for their care differently

  • Making care more accessible to everyone

  • Helping reduce the costs of care

  • Mitigating the need for care in the first place”  (p. 4)

The structured exercise, developed and led by staff of the innovation consulting firm Maddock Douglas, broke the long-term care challenge into three “Platforms of Influence” for each of which the participants generated ideas, two of which were highlighted in the report.

Read the report for its methodology and process.  We’ll focus here on the end result, the two creative ideas in each of the primary areas of focus.  Consult the full report for all the details.

Platform of Influence #1 

“Data-Driven Decision Support:  This category addresses how data is used to drive more evidence-based decision-making.  Ideas in this category aim to educate caregivers and care recipients, keep them informed of best practices, guide them in making decisions, improve the coordination of care, and obtain longitudinal data required to improve pricing and recommendations.” (p. 11)


Healthy Longevity App:  “App to encourage LTC insurance policyholders to lead healthier, more engaged and fulfilled lives. Focus on emotional, psychological and social engagement factors. App could act as coach/companion.” (p. 19)

The Care Portal:  “This is a curated portal accessible via the Web that aggregates vetted products and services (such as, and points people in need of care to relevant products and services.” (p. 24)

Platform of Influence #2

“Service Evolution and Expansion:  This category addresses consumer needs that relate to where, how or when claims dollars can be spent and how this impacts access to care. Ideas in this category aim to increase the number of caregivers in the system, more efficiently distribute available care to match care recipient needs, more efficiently deploy care-related resources, improve access to quality care, and delay the need for care in the first place.” (p. 12)


Uberfication:  “Technology can lower service prices. The Think Tank will encourage and promote these trends.” (p. 30)

Health Care Look-a-Like:  “Design a LTC insurance policy that ‘looks like’ a health insurance policy.”  (p. 34)

Platform of Influence #3

Paying for Care (“Pay-fors”):  “This category addresses how long term care costs are funded. Ideas in this category aim to help the industry and consumers to find additional ways of financing long term care, more effectively pool their resources, and make receiving financial reimbursement more familiar.  Use the ideas in this category to recognize potential partnerships and/or support changes to legislation that give consumers access to new financing options and make paying for LTC easier/more affordable.” (p. 13)


Flex 401(k):  “Individuals/families should have more options to use DC [defined contribution] plan/IRA funds to pay for LTSS (Long Term Services and Supports) directly and/or LTC insurance.” (p. 40)

The Family Long-Term Care Account:  “The Family Long Term Care Account is a product designed to help an individual or a family save responsibly for long term care needs of multiple family members with a benefit that lasts beyond their savings, thanks to an insurance element added to it.”  (p. 45)

Starting on page 55, the report covers “recommended next steps” for the Think Tank to pursue.

The report contains an Appendix starting on page 70 that enumerates all 85 of the ideas generated by the Think Tank.

LTC Comment:  We commend the SOA LTC Think Tank for a valuable contribution to the national discussion concerning what to do about long-term care services and financing.  While the report does not tackle the bigger, politically sensitive challenges which also eluded the Congressionally mandated LTC Commission, it does offer some good, systematically thought through ideas.