LTC Bullet:  Long-Term Care News and Analysis

Friday, June 2, 2017


LTC Comment:  Center for Long-Term Care Reform Premium members have the option to receive our LTC Clipping Service and weekly LTC E-Alerts newsletters.  Today, we’d like to share a sample of these members-only services with a wider audience.  Our topic is the news this week, so we’ll skip our usual ***news*** section and get straight to the point.

LTC Bullet:  Long-Term Care News and Analysis

Many Center for Long-Term Care Reform Premium members are familiar with our LTC Clipping Service, and from what we hear, get great value from this benefit of Premium membership.

For those who don’t already know, our LTC Clipping Service is an excellent way to stay on top of current and critical long-term care news without having to spend hours a day researching on the internet.  We send our Clipping Service subscribers an average of 2-3 emails per workday with a must-read-article link, a pull quote and some brief analysis.  We’re sensitive to the fact that we all receive too many emails, so we’re very careful to send along only the most important LTC news items. 

As an added benefit and for convenient reference, we keep a running archive of the clippings we send in our new LTC Clippings Archive, dating back to January 2016.  This archive is organized by LTC-related subject and sub-category.  While CLTCR Premium members will continue to receive their LTC Clippings in real time, they and Individual members, have access to the Clippings Archive through our Members-Only Zone website.  Here’s a breakdown of the Archive’s subject categories: 

  • INSURANCE (Long-Term Care Insurance, Critical Illness Insurance, Hybrid and Miscellaneous [including alternative financing solutions])

  • LONG-TERM CARE (General, Cost, Assisted Living, Nursing Homes, Home Care, Caregiving, Veterans Affairs and Government Solutions)

  • MEDICAID (General and Medicaid Planning and Crowd-Out Effect)

  • MEDICARE (and Medi-Gap and Medicare Advantage)








If you’re reading this, chances are you play a valuable role in protecting people from the risk and cost of long-term care and to that end we think the Clipping Service allows our subscribers to be more effective doing so.  Based on their feedback, we think our subscribers feel the same.  For example:

Steve, you and Damon have been a valuable resource for me regarding all aspects of Long Term Care planning for my clients.  I believe there is not an article on the subject that you have missed.  Keep up the good work. -- Eric Rubin, CLTC, Cedar Brook Financial Partners

I love the clippings . . . very informative and I'm impressed with the amount of info you are consistently filtering through.  I really enjoy the LTC comments, as they boil it down perfectly for me! -- Jared Turner, Executive Chairman, Amada Franchise, Inc.

I LOVE receiving your clippings, because . . . I'm able to get the info quickly and can pass it on to my colleagues. Honestly, without your service, I probably wouldn't be aware of half of the things that you serve up to me, on a “silver platter" as the saying goes. Thanks for making my life so much easier! -- Susanne E. Howarth, Director of Long-Term Care, TBG West

Please find below a sample collection of clippings we’ve sent to our Clipping Service subscribers over the past two weeks.  Read through them and if you think that receiving news items like these in real time would be valuable to you, please consider subscribing at the Premium membership level.  By doing so, you can stay on the forefront of professional knowledge and help us fight for rational long-term care policy reform.  

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.


6/1/2017, “This is what Alzheimer’s looks like: ‘It looks like me’” by Judy Woodruff, PBS NewsHour

Quote: “Now to another in our Brief But Spectacular series, where we ask people to describe their passions. Five-and-a-half million Americans are living with Alzheimer’s disease, and another 15 million serve as their unpaid caregivers. Tonight, two individuals diagnosed with Alzheimer’s, Chris Hannafan and Pam Montana, share their experiences.”

LTC Comment: “Brief but spectacular,” indeed. Watch the short video or read the transcript.  


5/28/2017, “Municipalities Grapple With Whether Nursing Homes Should Be Taxpayer-Funded,” by Jennifer Levitz, Wall Street Journal

Quote:  “In these places, ‘residents want a nursing-home option for themselves in the future, and they're willing to pay taxes to support that,’ he said. But government-owned and -run facilities often have deficits and have outdated institutional styles that don't attract the wealthier private-pay customers that offset Medicaid patients, said Jeff Binder, managing director of Senior Living Investment Brokerage Inc. Medicaid payments also face uncertainty, with the new White House budget proposing heavy cuts to the federal-state health program for the poor.”

LTC Comment: Medicaid made nursing home care free in 1965 causing institutional bias and exploding budgets, the consequences of which are coming to bear now, but especially in 14 years when boomers start turning 85.


5/26/2017, “Retirement Savings Gap Seen Reaching $400 Trillion by 2050,” ThinkAdvisor

Quote:  “Longer life spans and disappointing investment returns will help create a $400 trillion retirement-savings shortfall in about three decades, a figure more than five times the size of the global economy, according to a World Economic Forum report. That includes a $224 trillion gap among six large pension-savings systems: the United States, the United Kingdom, Japan, Netherlands, Canada and Australia, according to the report issued Friday. China and India account for the rest.

LTC Comment: Need some help imagining how much $400 trillion is? Check this out and multiply by 400:


5/25/2017, “Home gaining on LTC as final residence for those with Alzheimer's,” by Lois A. Bowers, McKnight's Senior Living

Quote:  “Of those who died with Alzheimer's disease in 2014, the most recent year studied:

  • 54.1% died in a nursing home or other long-term care facility, compared with 67.5% in 1999
  • 24.9% died at home, compared with 13.9% in 1999
  • 6.6% died in a hospital, compared with 14.7% in 1999
  • 6.1% died in a hospice

These realities, wrote the authors of an article in the CDC's Morbidity and Mortality Weekly Report, have implications for the government and the healthcare system, because some states and counties operate publicly funded long-term care facilities and because payments for more than two-thirds of the anticipated $259 billion in healthcare and long-term care costs for people with Alzheimer's and other dementias in the United States in 2017 are expected to come from public sources such as Medicare and Medicaid.

LTC Comment: The tragedy that America’s WW-II “greatest generation” ended up dying in welfare-financed nursing home was entirely an artifact of Medicaid’s interference in the LTC market. Without the welfare program’s institutional bias and effective crowd out of the home care market and private financing alternatives like home equity conversion and LTC insurance, nursing homes would have served a critical, but limited purpose providing sub-acute care and most custodial care would have been delivered in people’s homes.


5/25/2017, “Survey: 75% of 40+ adults do not know how much assisted living costs,” by Lois A. Bowers, McKnight's Senior Living

Quote:  “Only 25% of adults queried by investigators at the Associated Press-NORC Center for Public Affairs Research correctly estimated costs, which the center said average $3,000 to $4,000 per month, whereas 44% underestimated them and 30% overestimated them. Underestimating has grown since the first surveys were conducted in 2013 and 2014, when it was 31%, according to center representatives.”

LTC Comment: Ignorance is bliss, until . . . 


5/25/2017, “Older Americans Want Medicare to Pay for Long-Term Care,” by Emily Swanson, U.S. News & World Report

Quote:  “More than half of older Americans — 56 percent — think the federal government should devote a great deal or a lot of effort to helping people with the costs of long-term care, and another 30 percent think it should make a moderate effort to do so. . . . Most also favor tax policies to encourage long-term care planning, including tax breaks to encourage saving for long-term care and the ability to use nontaxable accounts like 401(k)s and IRAs to pay for long-term care insurance premiums. . . . Fifty-seven percent plan to rely on Medicare quite a bit or completely for their own ongoing living assistance if and when they need it, even though Medicare does not cover most nursing care or home health aides. Just 25 percent plan to rely on Medicaid. Medicaid is much more likely to pay for long-term care, but is only available to lower income and disabled individuals and families.”

LTC Comment: What’s more predictable than “People want something for nothing” and “Politicians thrive by appearing to give it to them?”


5/24/2017, “How Medicaid Reforms Could Harm Even Middle-Class and Wealthy Americans,” by Christy Bieber, Motley Fool

Quote:  “When seniors need care they cannot afford, Medicaid picks up the tab, provided the senior has a low income -- with maximum income varying by state and program -- or functional limitations that necessitate care, such as the inability to bathe, get dressed, or use the bathroom without assistance. Seniors must also have countable financial assets below an allowable amount, which is usually $2,000 per person and $3,000 per family; however, not all assets are countable, and spouses who remain in the community are allowed to maintain some assets.

LTC Comment: If you have to be that poor to qualify, how could cutting Medicaid hurt the middle class and wealthy? Therein lies the fallacy in this argument. You don’t have to be that poor to qualify for Medicaid LTC benefits. Income rarely counts because medical and LTC expenses are deducted before counting it. Assets are easy to convert to exempt status. So, yes, Trumpcare cuts will impact the wealthy and middle class, but why should they be getting welfare for LTC instead of private insurance?


5/24/2017, “CDC: Those 85+ are six times as likely to need ADL help than those aged 65 to 74,” by Lois A. Bowers, McKnight's Senior Living

Quote: “U.S. adults aged 85 or more years are approximately three times as likely to need assistance with activities of daily living as are adults aged 75 to 84 and are six times as likely to require help as those aged 65 to 74, according to newly released data from the Centers for Disease Control and Prevention.

LTC Comment: Key takeaway: boomers start turning 85 in 2031, about the time Social Security and Medicare run out of IOUs in their “trust funds.” Our window of opportunity to prepare for the age wave is rapidly closing.


5/22/2017, “U.K. Conservatives Retreat After Backlash Over ‘Dementia Tax’,” by Stephen Castle, New York Times

Quote:  “Having called an early election in an attempt to expand her party's majority in Parliament, Prime Minister Theresa May is pitching her ‘strong and stable leadership’ at a time when Britain confronts the formidable challenge of leaving the European Union. But on Monday, Mrs. May found that carefully crafted image at risk, as she agreed to revisit a controversial proposal to put a hard cap on the assets that residents who receive long-term care at home may own. The proposal, widely derided as a ‘dementia tax,’ raised such an uproar that Mrs. May was forced to beat a hasty retreat.”

LTC Comment: Thanks to Center member and LTCI advocate Ross Schriftman for tipping us to this article. We analyzed the British proposal earlier:  Try British LTC Plan Here, May 26, 2017. So paying for your own long-term care is a “dementia tax” now?


5/22/2017, “Trump wants to cut $800 billion from Medicaid. Where does all the program’s money go?,” by Megan Thielking, STAT

Quote:  “President Trump is expected to release his new budget proposal this week, which is reported to include an $800 billion cut to the Medicaid budget over the next 10 years. That proposal assumes that the American Health Care Act — passed by the House earlier this month — will become law. That’s far from a sure thing, given big questions about the Senate’s plans for health care reform. But if Medicaid is going to be slashed, it’s worth taking a look at exactly how the program spends its money now. After all, Medicaid accounts for $1 out of every $6 spent on health care in the US. But there are major differences in what that spending looks like on a state-by-state level. And certain services cost Medicaid far more than others.”

LTC Comment: Expect a lot of articles like this one this week, but read them dubiously. This one, for example, compares Medicaid managed care (46% of costs) with acute care (26%) and long-term care (20%), but managed care provides both acute and long-term care. Apples and oranges. The right way to break down costs is between the aged, blind and disabled who are ¼ of the recipients but account for 2/3 of the costs, largely for long-term care, but also for acute care not provided by Medicare and for dual eligibles’ Medicare premiums, co-insurance and deductibles. Divert people from becoming expensive dual eligibles to reduce Medicaid expenditures hugely without hurting anyone. See How Much Could Medicaid Save?, May 12, 2017. We estimated the savings to Medicaid could be $16.7 billion per year, more than double the $800 billion proposed in the first Trump budget.


5/19/2017, “Planning to Age in Place? Find a Contractor Now,” by Paula Span, New York Times

Quote:  “Older people have the highest rate of homeownership in the country — about 80 percent, according to a 2016 report by the Joint Center for Housing Studies at Harvard. The great majority live in single-family homes, most of them poorly suited for the disabilities common in later life.

LTC Comment: How ironic that seniors have so much home equity that could help them age in place, but government policy, in the form of huge exemptions for home equity, divert them to nursing homes under-funded by Medicaid.


5/17/2017, “Congress May Open The Door To Some Medicare Long-Term Care,” by Howard Gleckman, Forbes

Quote:  “Congress is taking a small, but important, step towards expanding Medicare to include some long-term supports and services. A bipartisan (yes, bipartisan) measure before the Senate Finance Committee would give some Medicare providers additional flexibility in the way they care for people with chronic conditions, who are among the program’s highest need and highest cost beneficiaries.”

LTC Comment: Ironically, the long-term care problem is not too little government money but too much. Medicaid made nursing home care free, impaired the private home care market, crowded out private financing, and paid providers less than cost hurting care access and quality. Adding more Medicare funding will further desensitize the public to LTC risk and cost, hasten the program’s insolvency, and exacerbate the coming economic implosion when the current credit bubble bursts.


5/15/2017, “5 New Facts About Retirees’ Real Health Care Bills,” by Allison Bell, ThinkAdvisor

Quote:  “The authors of the new paper don't break catastrophic risk down by income level, but they note that Medicare enrollees in the top 5% in terms of out-of-pocket spending probably spent an average of $19,009 out of pocket in 2016. . . . In 2016, high-income Medicare enrollees spent an average of $564 on dental care, $820 on audiologists and other providers not paid by Medicare, and $913 on prescription drug co-payments and coinsurance bills. . . . The new out-of-pocket spending analysis shows that, for the 2016 Medicare enrollees in the top 5% in terms of out-of-pocketing spending, long-term care spending of all kinds accounted for more than $13,400 of the $19,009 in average out-of-pocket spending.

LTC Comment: It is unusual, but welcome, to see analysts focus on upper-income Medicare beneficiaries instead of claiming all older people are poor and desperately in need of more government largesse. Next they should analyze how easily upper-income Medicare beneficiaries qualify for Medicaid LTC benefits as we did in “LTC Bullet: Hoist with its Own Petard,” Friday, April 28, 2017.