LTC Bullet:  LTC Almanac Update (2)

Friday, July 15, 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.***

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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. 

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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 another week—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


An Aging World: 2015 International Population Reports
Issued March 2016, U.S. Census Bureau

3/28/2016, “Relatively low percentage of U.S. residents in long-term care: report,” by Lois A. Bowers, McKnight's Senior Living

Quote:  “The percent of the over-65 population living in skilled nursing facilities or other residential care settings or receiving care at home ranges from 0.8% in Poland to 22.1% in Israel, according to a new report from the U.S. Census Bureau. Of 26 countries ranked in 2013 by the Organization for Economic Cooperation and Development in research cited in the report, the United States ranked seventh lowest, with 6.4% of the 65+ population living in SNFs or other residential care settings or receiving home healthcare.  The bureau released “An Aging World: 2015” (PDF) on March 28.

LTC Comment:  If you think we have problems, explore the wide, wide world of long-term care in this report.

Boomer Generation Characteristics

IRI on boomer-expectations-for-retirement-April 2016 URL:

“Boomer Expectations for Retirement 2016 Sixth Annual Update on the Retirement Preparedness of the Boomer Generation,” Insured Retirement Institute (IRI)

4/12/2016, “Trouble Ahead! Baby Boomers’ Retirement Outlook on the Decline,” Advisor Magazine

Quote:  “The Insured Retirement Institute (IRI) today released a new research report that found less than a quarter of Baby Boomers, 24 percent, are confident they will have enough savings to last throughout their retirement years. This is the lowest level since IRI began this research study in 2011, when 37 percent of Boomers had this same level of confidence.    The entire report, “Boomer Expectations for Retirement 2016,” is available HERE.”

LTC Comment:  We are now beginning to see the unintended consequences of Social Security, Medicare and Medicaid convincing consumers for decades that they do not need to plan privately for retirement income security, health and long-term care.  Today this is just a worry; by the 2030s it will become a national catastrophe of incalculable proportions.

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

Unfunded Liability Estimates

Cato fiscal-imbalance-book 0416 URL:  

Jeffrey Miron, “U.S. Fiscal Imbalance,” Cato Institute

See also WSJ:  Inattention-to-the-Deficit Disorder:  By one estimate, the government will spend $117.9 trillion more than it takes in this century.” By George Melloan May 26, 2016 6:07 p.m. ET

4/6/2016, U.S. Fiscal Imbalance, by Jeffrey Miron, Cato Institute

Quote:  “The U.S. fiscal imbalance—the excess of what we expect to spend, including repayment of our debt, over what government expects to receive in revenue—is large and growing. And with politicians proposing large new expenditures, little is being done to rectify the country’s fiscal health.    As of 2014, the fiscal imbalance stands at $117.9 trillion, with few signs of future improvement even if GDP growth accelerates or tax revenues increase relative to historic norms. Thus the only viable way to restore fiscal balance is to scale back mandatory spending policies, particularly on large health care programs such as Medicare, Medicaid, and the Affordable Care Act (ACA).”

LTC Comment:  Our fiscal imbalance of $117.9 trillion is about 6.6 times the U.S. Gross Domestic Product and getting worse all the time.  Fiscal and monetary shenanigans can delay the reckoning, but not prevent it.  The economic vise is closing.  I don’t think the status quo can continue until, much less beyond, the 2030s when boomers start turning 85 (2031) and Social Security (2034) and Medicare (2030) become insolvent. 

Chapter 4:  Long-Term Care


CDC on Care Incidence 0216 URL:

Early Release of Selected Estimates Based on Data From the January–September 2015 National Health Interview Survey,” Centers for Disease Control

2/28/2016, “Number of seniors who need personal care help increasing, CDC says,” by Emily Mongan, McKnight's LTC News

Quote:  “The data, released last Tuesday by the CDC's National Center for Health Statistics, shows 7.2% of seniors required help with activities of daily living in 2015, compared to 6.6% in 1997. The report included eating, bathing, dressing and getting around as personal care needs.    Seniors over age 85 were twice as likely as adults between age 75 and 84 to require personal care help, and were five times as likely as adults age 65 to 74. The report also found 6.4% of white seniors required personal care help, compared to 9.6% of black and 11.3% of Hispanic seniors.  Click here to read the full report, which also includes data on other health issues like diabetes, influenza vaccinations and alcohol consumption.

LTC Comment:  We not only have more seniors, especially those over the critical age of 85, but their rate of needing care is increasing as well.  A dangerous combination!

Chapter 5:  Caregiving

Caregiver Shortages

DOL Mandates Minimum Wage for Home Care Workers 0316 URL:

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

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?

Chapter 9:  Long-Term Care Providers


CDC on Assisted Living Stats 0216 URL:
“Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014,” Centers for Disease Control

2/24/2016, “CDC report details characteristics of assisted living residents,” by Lois A. Bowers, McKnight's Senior Living

Quote:  “‘Findings on differences and similarities in supply, provision and use, and the characteristics of providers and users of long-term care services, can inform policy and planning to meet the needs of an aging population,’ according to the report, titled ‘Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014’ (PDF).

LTC Comment:  Valuable information well worth your time to review.

Chapter 10:  Medicaid

Medicaid Financing and Burwell Data

Blase-Medicaid-Provider-Taxes-v1 URL 021716 URL:
Medicaid Provider Taxes: The Gimmick That Exposes Flaws with Medicaid’s Financing,” Brian Blase, Mercatus Center, February 2016

2/16/2016, “Biden Was Right: Medicaid Provider Taxes A 'Scam' That Should Be Scrapped,” by Brian Blase, Forbes

Quote:  “In his book, The Price of Politics, renowned journalist Bob Woodward chronicled the 2011 negotiations between the Obama administration and Congress as the sides attempted to reach a deal to trim future budget deficits. One area of common ground between the administration and congressional Republicans centered on Medicaid provider taxes, which happens to be the subject of my most recent study, “Medicaid Provider Taxes: The Gimmick That Exposes Flaws with Medicaid’s Financing,” published today by the Mercatus Center at George Mason University.”

LTC Comment:  I’ve called Medicaid provider taxes “Medicaid planning writ large.”  They amount to states gaming the program in a manner similar to the way elder law attorneys artificially impoverish their affluent clients.  Brian Blase’s excellent critique of the practice is right on target with this proviso.  The extra federal revenue generated by provider taxes helps prevent Medicaid’s dismally low LTC provider reimbursement rates from getting even worse.  In the bigger picture, however, this fact is a further indictment of Medicaid LTC financing, which crowds out responsible private planning for long-term care, and not a justification for provider taxes.

Medicaid Services

Heartland on Welfare Report Card 2015 URL:

3/19/2016, “2015 Welfare Reform Report Card,” by Diane Bast, Matthew Glans, Logan Pike, and Gary MacDougal, Heartland Institute

Quote:  “Most state governments can improve the effectiveness of their efforts to help those in poverty. This 50-state report card offers policymakers and the public a roadmap for how it can be done.

LTC Comment:  Trillions spent on welfare have failed to improve the lot of the poor and arguably made it worse.  See which states have done relatively well in fighting poverty and which have fared worse.  This “report card” doesn’t address Medicaid or long-term care financing, but many of the same principles of good public policy apply.