LTC Bullet:  LTC Almanac Update

Friday, July 8, 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.***

*** Here are two news items we sent recently to our Clipping Service subscribers that deal with financing the many costs of long-term care:

1.)  07/03/2016, “How to get your kids to provide long-term care for you when you need it most,” by Sarah Anderson, Deseret News

Quote: “Are millennials as unwilling to help their parents and relatives as they age as popular conception would have you think? Not exactly. An opinion piece in Forbes discussed the recent results of the Fidelity Investments Family & Finance Study that interviewed 1,273 parents over the age of 55 and 221 of their adult children older than 25.”

LTC Comment: In many cases, it’s not about the willingness of an adult child to care for an aging parent or what generation they belong to. Ultimately, it’s about mitigating the costs associated with caregiving. Of course, those costs are many: financial, professional, physical, emotional, psychological, etc.

2.)  07/03/2016, “Warning: Healthcare Costs in Retirement May Be Higher Than We Thought,” by Maurie Backman, The Motley Fool  

Quote:  Many of us by now have been exposed to the dire reality of financing healthcare in retirement. For years, Fidelity has been releasing data on estimated retiree healthcare costs, and according to the most recent assessment, a 65-year-old couple retiring today can expect to spend $245,000 over the course of a 20-year retirement, not including nursing home or long-term care expenditures.”

LTC Comment:  We’ve often advised “save, invest or insure for long-term care” but with total healthcare costs in retirement on the rise, this article advocates for all of the above. In other words: save, invest and insure. On the upside, it does so in a way that eschews scare tactics and offers LTCi as a way to mitigate the risk of catastrophic healthcare costs in retirement.

Receive these LTC-relevant news items (with original analysis) in real time and stay on the forefront of professional knowledge by subscribing to our Clipping Service. Contact Damon at 206-283-7036 / to start your subscription immediately or go directly to our secure online subscription page and sign up for $250 per year or $21 per month. Already a Center member? Contact us to add the Clipping Service to your membership for only $100 per year or $8.25 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 two weeks—today through Friday, July 22, 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


Longevity+paper+-+ADA+-3-21-16 URL:

“A Silver LiningThe Investment Implications of an Aging World,” PGIM, Inc., March 2016

3/24/2016, “Aging population offers golden opportunities,” by Marlene Y. Satter, LifeHealthPRO

Quote:  “In its report “A Silver Lining: The Investment Implications of an Aging World,” PGIM presents the case that global aging will reshape consumer spending for decades to come. According to the report, these changes will not only impact developed markets but also have a far-reaching effect on emerging markets — where two-thirds of the world’s elderly live.  …  Within the three sectors to be most affected, specific opportunities exist in multifamily condos, senior housing, urban life sciences clusters, pharmaceuticals and biotech and technology-enabled medical services and devices.

LTC Comment:  Not to mention to mention LTCI and other financial products to save or invest for long-term housing and care costs.

Retirement Planning

NCOA-Older-Adult-Issue-Debt-Brief 0216 URL:

“Older Adults and Debt: Trends, Trade-offs, and Tools to Help,” National Council on the Aging, February 2016

2/17/2016, “Older Adults & Debt: Trends, Trade-offs, and Tools to Help,” National Council on the Aging (NCOA)

Quote:  “Numerous public and private benefits programs can help low-income older adults pay for health care, housing, food, transportation, and other expenses, thereby freeing up income that can be used to pay down debt.  …  These programs remain undersubscribed by older adults, and yet collectively are estimated to offer savings worth more than $12,000 (in 2014), an amount that would double the income of a person living at the federal poverty level.  …  NCOA’s BenefitsCheckUp® is the nation’s most comprehensive free, online service to screen seniors with limited income for benefits. It includes more than 2,000 public and private benefits programs from all 50 states and the District of Columbia.”  (p. 3)

LTC Comment:  The epidemic of senior debt clearly described in this report is a serious problem, but government benefit programs are the problem not the solution.  After 80 years of Social Security followed by 50 years of Medicare and Medicaid, aging Americans depend too much on public benefits and too little on personal responsibility and planning.  When the public programs they depend on become insolvent, the current crisis will become a genuine national tragedy.

Chapter 2:  International


LTC Financing in Europe URL:

“Long-Term Care Coverage in Europe,” by Edith Bocquaire

6/15/2016, “Some European countries seek private long-term care help,” by Allison Bell, LifeHealthPRO

Quote:  “Some European countries are hoping use of private annuities and insurance policies can help their residents hold down long-term care costs.  Edith Bocquaire, a French insurance industry analyst, has described how some European countries build private-sector arrangements into long-term care planning efforts in a paper posted on the website of the Schaumburg, Illinois-based Society of Actuaries.”

LTC Comment:  Check this paper out if you’re interested in how European countries handle long-term care financing.

Chapter 6:  Long-Term Care Financing


Leading Age Pathways 0216 URL

“Perspectives on the Challenges of Financing Long-Term Services and Supports,” Leading Age, February 2016

2/17/2016, “Current LTSS financing methods 'irrational, unfair' LeadingAge report claims,” by Emily Mongan, McKnight's LTC News

Quote:  “’Perspectives on the Challenges of Financing Long-Term Services and Supports’ builds on research from LeadingAge, AARP and the SCAN Foundation first released in late 2015.  …  Click here to read the full LeadingAge Pathways report.

LTC Comment:  More of the same old, same old that we’ve refuted repeatedly.  Don’t bother.  The last thing we need is a “mandatory, universal insurance option” which is what Leading Age advocates.

Chapter 10:  Medicaid

Medicaid is the 800-pound gorilla of LTC

June-2016-Report-to-Congress-on-Medicaid-and-CHIP URL:

“Report to Congress on Medicaid and CHIP,” Medicaid and CHIP Payment and Access Commission (MACPAC), June 2016

6/15/2016, “MACPAC: Medicaid spending for long-term care 'disproportionate',” by Emily Mongan, McKnight's LTC News

Quote:  “Medicaid is the largest payer of high-cost services like long-term care, MACPAC noted in its June 2016 Report to Congress. The program finances one-third of the country's nursing facilities; and spent $169 billion on long-term supports and services in fiscal year 2012.  That amount added up to roughly 43% of Medicaid's total expenditures for FY 2012, despite just 6.2% of Medicaid beneficiaries needing LTSS, the report found.  …  MACPAC's Report to Congress also covers financing reforms and trends in Medicaid spending. Click here to read the full report.

LTC Comment:  Critically important data:  long-term care touches only 6.2% of Medicaid recipients, but accounts for 43% of costs.  Yet far more political and policy attention is directed toward the other 93.8% of recipients who account for the only 57% of costs.  Whatever happened to the admonition “Follow the money?”

Medicaid Eligibility

KFF on Medicaid Financial Eligibility 0316 URL:

“Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015,” Kaiser Commission on Medicaid and the Uninsured, March 2016,


Medicaid Deficiencies

NCOA on Stigma 0616 URL:

“An End to Stigma: Challenging the Stigmatization of Public Assistance Among Older Adults and People with Disabilities,” National Council on the Aging, June 2016

6//2016, “Report: How to get more benefits to seniors,” by Lois A. Bowers, McKnight's Senior Living

Quote:  “So what's keeping older adults from applying?  Stigma, for one. Medicaid and Supplemental Nutrition Assistance Program benefits carry much more stigma that Medicare and Social Security benefits, according to the survey …  ‘Concerns about estate recovery and states placing liens on homes affect applicants' willingness to apply as well,’ the report authors state, noting that such concerns can be legitimate for families applying for Medicaid coverage for long-term services and supports.

LTC Comment:  More stigma for Medicaid than Medicare?  Well, yeah, Medicaid is welfare (for which others pay taxes) and Medicare is social insurance (for which everyone pays “premiums,” actually payroll taxes.  The irony is that Medicaid has become a de facto entitlement for LTC because of easy and elastic eligibility rules, whereas Medicare is moving toward welfare status due to means-testing, i.e. charging higher income people more.  Do some people object to paying back the cost of their care from their estates (estate recovery)?  Well, yes, and other people (taxpayers) object to paying for their own care and the care of people who transfer the cost of their care to Medicaid.  This new report is a good example of the moral decay we described in “Losing Principles.”