LTC Bullet: LTC Almanac Update

Friday, December 1, 2017

Seattle—

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.***

*** TODAY'S LTC BULLET is sponsored by Claude Thau, a GA whose proprietary tools help advisors find and educate clients, reducing the “Ping-Pong” in the LTCi sales process. Help clients project their exposure to LTC risk, compare Combo vs. Stand-Alone LTCi easily, and make informed final decisions about buying LTCi in 15-20 minutes!  Change work-site LTCi sales from a series of proposal deliveries to a single interactive consultation!  Claude is the lead author of the Milliman Broker World LTCi Survey, one of Senior Market Advisor's 10 "Power People" in LTCi in 2007, & a past Chair of the Center for Long-Term Care Financing. Contact Claude at 800-999-3026, x2241 or claudet@targetins.com to ask questions or get references. ***

*** 11/28/2017, “Retirees Still Have 80% of Savings After Nearly Two Decades,” by Lee Barney, PlanAdvisor

Quote:  “Research conducted by the BlackRock Retirement Institute and the Employee Benefit Research Institute (EBRI) found that after nearly two decades of being retired, the average retiree still has 80% of their nest egg intact. The researchers say this finding challenges long-held fears about retirees spending down their savings too fast. They also discovered that more than one-third of retirees continue to grow their assets late into life, ‘leaving considerable potential consumption on the table.’ And for all of the talk about long-term care insurance, the researchers found that burdensome late in life out-of-pocket medical expenses are faced by only a small portion of retirees.

LTC Comment: These people are financial advisors? Hmmm. Don’t buy LTCI because you’ll still have most of your nest egg at 85? That’s precisely when LTC costs spike if you have them. High LTC costs only hit a small portion of retirees? That’s why insurance works. If high costs hit most people, saving would be the only way to plan. Financial journalism like this is part of the reason we’re in such a mess. ***

*** LTC CLIPPING: 11/2017, “Issue Brief: Use of Paid and Unpaid Personal Help by Medicare Beneficiaries Needing Long-Term Services and Supports,” by Amber Willink, Karen Davis, John Mulcahy, Jennifer L. Wolff, Commonwealth Fund

Quote: “This analysis shows that the amount of unpaid care provided varies little between those who receive both paid and unpaid support and those who receive unpaid support only, suggesting that paid care does not replace unpaid care, but supplements it. Addressing and supporting the need for LTSS can result in savings to individuals and the government through delayed nursing home and Medicaid entry. A public LTSS financing solution, like Medicare Help at Home, that supports individuals and family caregivers would improve the supply of long-term services and supports and allow for their quality to be monitored to ensure older adults can live safely in the community.”

LTC Comment: This report displays a lack of understanding about what causes LTC dysfunction in the USA. Funding LTC through Medicaid created nursing home bias, put the public asleep about LTC risk and cost and nearly eliminated private LTC financing. Trying to solve these problems by adding more of the same with a Medicare LTC benefit would be like trying to put out a fire by dowsing it with gasoline. The best way to prepare families to deal with LTC risk is to wean the public off dependency on unsustainable public programs like Medicaid and Medicare. ***

*** SUBSCRIBE TO LTC CLIPPINGS: We scan the news searching for data, articles and reports you need to know about. Then we send you a brief email (like the ones above) with title, author, source link, a representative quote, and our brief analysis. LTC Clippings help you stay at the forefront of professional knowledge. To subscribe, contact Damon at 206-283-7036 or damon@centerltc.com. ***

 

LTC BULLET: LTC ALMANAC UPDATE

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, December 15, 2017. To access this introductory peek into The Zone, go to http://www.centerltc.com/members/index.htm 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 damon@centerltc.com. ***

The LTC Almanac is divided into 11 sections: 

Aging Demographics
International
Unfunded Liabilities--Social Security, Medicare, and Budgets
Long-Term Care
Caregiving
Long-Term Care Financing
Long-Term Care Insurance
Reverse Mortgages
Long-Term Care Providers
Medicaid
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: http://www.centerltc.com/support/index.htm. Call or email Damon at 206-283-7036 or damon@centerltc.com. 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.

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Chapter 1: Aging Demographics

United States

General Stats

A Profile of Older Americans 2016 0317 URL: https://aoa.acl.gov/Aging_Statistics/Profile/index.aspx

3/15/2017, “Subject: Profile of Older Americans: 2016,” Administration for Community Living

Quote: “The annual summary of the latest statistics on the older population, A Profile of Older Americans: 2016, is now available. This profile covers 15 topical areas including population, income and poverty, living arrangements, education, health, and caregiving. A description of the highlights of this document is below and the full document is attached. The profile has proven to be a very useful statistical summary in a user friendly format. It is a web based publication and is posted on the following website: http://www.aoa.acl.gov/Aging_Statistics/Profile/index.aspx

LTC Comment: This is one of the most comprehensive compendia of data on aging Americans.

Life Expectancy

United States Life Tables, 2014 URL: http://media.thinkadvisor.com/thinkadvisor/article/2017/08/16/cdc-life-tables-nvsr6604.pdf

8/16/2017, “Life Expectancy for a 65-Year-Old Increases 1.6 years,” by Allison Bell, ThinkAdvisor

Quote: “A U.S. resident who turned 65 in 2014 could expect to live an average of 19.4 more years. The average life expectancy at age 65 was 9.2% higher than the average life expectancy of a 65-year-old around 2000. Analysts at the U.S. Centers for Disease Control and Prevention have published data on shifts in U.S. life expectancy averages since 1900 in a new U.S. life tables report.

LTC Comment: Maybe LTCI producers should reach out to prospects and clients about extending their coverage for that extra 1.6 years.

Chapter 5: Caregiving

General

Transamerica Institute on Caregivers 0917 URL: https://www.transamericainstitute.org/docs/default-source/caregivers-research/the-many-faces-of-caregivers-research-report-2017.pdf

9/2017, “The Many Faces of Caregivers: A Close-Up Look at Caregiving and Its Impacts,” Transamerica Institute

Quote: “Key Highlights:
*Three in Four Caregivers Provide Care for One Person. . . .
*Most Caregivers Do So Out of Love. . . .
*Four Out of Five Caregivers Came to it Voluntarily. . . .
*Most Caregivers Have Provided Care for Years. . . .
*Family Members Often Work Together to Provide Care. . . .
*Caregivers Tend to Live in Close Proximity to the Care Recipient.”

LTC Comment: Click through to the report for the details behind these highlights. Thanks to Stephen D. Forman of Center-corporate-member LTCA for tipping us to this comprehensive, 300-page report from the Transamerica Institute.

Caregiver Stress, Burnout and Costs

Age Wave on Caregiving 1117 URL: https://mlaem.fs.ml.com/content/dam/ML/Registration/family-and-retirement/ML_Caregiving_WP_v02g.pdf

11/12/2017, “The Surprising Benefits and Costs of Family Caregiving,” by Maddy Dychtwald, Wall Street Journal

Quote: “Already, 40 million Americans are providing care to an adult family member or friend, most often to an aging parent or spouse. As the massive baby-boomer generation hits their 70s, the demand for family caregiving will skyrocket—and it’s poised to become America’s biggest off-the-books industry. In order to better understand the caregiving crunch, my firm, Age Wave, in partnership with Merrill Lynch, just completed a study, The Journey of Caregiving: Honor, Responsibility and Financial Complexity, that uncovers the rewards and sacrifices of this complex lifestage.”

LTC Comment: This article and the study it describes offers some interesting insights, some counterintuitive, about caregiving. It’s no surprise caregiving is complicated, challenging, multi-faceted and rewarding in surprising ways. But I don’t recall having seen percentages associated with those aspects before.

Caregiver Shortages

KFF on Medicaid Budget Survey 1017 URL: http://files.kff.org/attachment/Report-Results-from-a-50-State-Medicaid-Budget-Survey-for-State-Fiscal-Years-2017-and-2018

10/20/2017, “11 more states working on wage increases for direct care workforce,” by Emily Mongan, McKnight's LTC News

Quote: “The Kaiser Family Foundation's 50-state Medicaid budget survey for fiscal years 2017 and 2018, released Thursday, listed shortages and turnover among the long-term services and supports workforce as an issue to watch in coming years. The report cited low wages, meager benefits, limited opportunities for advancement, insufficient training and high injury rates as reasons why workers may be leaving or avoiding the sector.

LTC Comment: This problem is endemic to a long-term care system dependent on Medicaid and worst when the economy improves and people have other employment options.

 

Hiding_in_Plain_Sight_FNL 1017 LINK

10/3/2017, “Caregiving for Alzheimer's patients at risk in coming years, report says,” by Karen Weintraub, USA Today

Quote: “American families are having fewer children and are more likely to be divorced or estranged and have fewer financial resources, Nick Eberstadt, an economist, wrote in a report being released Wednesday [“Hiding in Plain Sight: Social and Demographic Trends That Will Exacerbate the Impact of Alzheimer's”] by advocacy group UsAgainstAlzheimer’s. . . . These families simply won’t be able to afford to care for aging loved ones, and the burden will necessarily shift to the government — a costly trend the government hasn’t planned for, said Eberstadt, who also works for the American Enterprise Institute, a conservative leaning think-tank.

LTC Comment: Belaboring the obvious is a public service when the powers-that-be, who should be addressing this problem, have their heads in the sand.

Chapter 6: Long-Term Care Financing

General

LTCA's summary of LTC financing proposals 1017 URL: https://ltc-associates.com/media/1323/ltc-financing_where-common-sense-finds-common-ground_ltca-100517.pdf

10/19/2017, “LTCA to Washington: Most Agree on These LTC Financing Reforms,” by Stephen D. Forman, PR/Web

Quote: “Long Term Care Associates, Inc. (‘LTCA’), accompanied by representatives from the nation's leading long-term care insurance carriers, traveled to Washington, DC this October to deliver a report addressing our country's pressing LTC financing crisis. In the report, LTCA finds common ground among competing solutions, and advocates for those which will appeal to a broad cross-section of Americans.”

LTC Comment: Congratulations to Center-corporate-member LTCA for taking a proactive stance toward the real problem facing long-term care insurance—poor public policy. Check out “LTC Financing: Where Common Sense Finds Common Ground,” their concise, highly readable report. It summarizes major recent proposals to reform LTC financing, including the Center for Long-Term Care Reform’s “How to Fix Long-Term Care Financing.” Well done!

 

LeadingAge on LTC Financing 0817 URL: http://www.leadingage.org/sites/default/files/A%20New%20Vision%20for%20Long-Term%20Services%20and%20Supports_FINAL.pdf

8/9/2017, “New report details way to finance LTSS,” by Lois A. Bowers, McKnight's Senior Living

Quote: “A universal, catastrophic insurance program sufficiently could finance the needs of those who need long-term services and supports, and a ‘managed cash’ benefit design might best pay for service delivery, LeadingAge concluded in a report issued Wednesday. The report is titled 'A New Vision for Long-Term Services and Supports.'

LTC Comment: The key word missing in this summary and in the report itself is “compulsory.” LeadingAge (formerly the American Association of Homes and Services for the Aging) is the trade association for nonprofit nursing homes. This report updates that organization’s earlier call for a government-enforced system to compel people to fund a new entitlement for long-term care. We refuted the arguments for such an approach and offered a better solution in How to Fix Long-Term Care Financing (2017).

 

Bipartisan Policy Center on LTC Financing 0717 URL: https://cdn.bipartisanpolicy.org/wp-content/uploads/2017/07/BPC-Health-Financing-Long-Term-Services-and-Supports.pdf

LTC Comment: Latest in a series of BPC reports that misdiagnose and therefore misprescribe for LTC problems and solutions.

Executive Summary and Recommendations

For more than a quarter-century, policymakers have sought solutions to improve the financing and delivery of long-term services and supports (LTSS). Recent analyses suggest that roughly 52 percent of individuals turning age 65 will require LTSS at some point in their life.1 In 2016, driven by recommendations from private sector policy experts, a general consensus formed around a multi-track approach that included:

1. Private Long-Term Care Insurance Improvements

  • Standardize and simplify private long-term care insurance (LTCI) to achieve an appropriate balance between coverage and affordability, which we called “retirement long-term care insurance”;

  • Incentivize employers to offer retirement LTCI and to auto-enroll certain employees (age 45 and older with minimum retirement savings), with an opt-out like many employer-sponsored retirement savings accounts; and

  • Permit penalty-free withdrawal from retirement savings accounts to pay retirement LTCI insurance premiums, recognizing that LTSS is a significant drain on retirement savings.

2. Medicaid
Simplify state plan options and waivers under Medicaid to provide additional flexibility to states to offer home and community-based LTSS, as well as an “LTSS-only buy-in” as a supplement to private health insurance for working individuals with disabilities.

3. Catastrophic Coverage
Recognize that for the 15 percent of the population that will have significant LTSS expenses, the private market, and personal savings are not adequate to cover LTSS needs. Further, states will not be able to sustain spending for LTSS under Medicaid as baby boomers begin to need these services and supports. While BPC’s leaders stopped short of endorsing a public catastrophic program financed through an additional Medicare payroll tax on individuals, proposals to limit the federal share of Medicaid reimbursement could further stress state budgets, and limit the availability of Medicaid-covered LTSS.

Since the release the February 2016 report, Initial Recommendations to Improve the Financing of Long-Term Care, which outlines these recommendations in detail, BPC has also issued two reports that have implications for LTSS financing and coordination of care for high-cost, high-need Medicare beneficiaries. These two reports, Delivery System Reform: Improving Care for Individuals Dually Eligible for Medicare and Medicaid and Improving Care for High-Need, High-Cost Medicare Patients, recommend providing additional flexibility to better integrate health and social services and supports for the highest-cost Medicare beneficiaries.

Medicare LTC Financing

Commonwealth on Medicare for LTC 1117 URL: http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/nov/willink_medicare_ltss_needs_ib_v2.pdf

11/2017, “Issue Brief: Use of Paid and Unpaid Personal Help by Medicare Beneficiaries Needing Long-Term Services and Supports,” by Amber Willink, Karen Davis, John Mulcahy, Jennifer L. Wolff, Commonwealth Fund

Quote: “This analysis shows that the amount of unpaid care provided varies little between those who receive both paid and unpaid support and those who receive unpaid support only, suggesting that paid care does not replace unpaid care, but supplements it. Addressing and supporting the need for LTSS can result in savings to individuals and the government through delayed nursing home and Medicaid entry. A public LTSS financing solution, like Medicare Help at Home, that supports individuals and family caregivers would improve the supply of long-term services and supports and allow for their quality to be monitored to ensure older adults can live safely in the community.”

LTC Comment: This report displays a lack of understanding about what causes LTC dysfunction in the USA. Funding LTC through Medicaid created nursing home bias, put the public asleep about LTC risk and cost and nearly eliminated private LTC financing. Trying to solve these problems by adding more of the same with a Medicare LTC benefit would be like trying to put out a fire by dowsing it with gasoline. The best way to prepare families to deal with LTC risk is to wean the public off dependency on unsustainable public programs like Medicaid and Medicare.

  

KFF on Income-and-Assets-of-Medicare-Beneficiaries-2016-2035 URL: http://files.kff.org/attachment/Issue-Brief-Income-and-Assets-of-Medicare-Beneficiaries-2016-2035
Update of the immediately below to April 2017. I used this data in “How to Fix Long-Term Care Financing
Gretchen Jacobson, Shannon Griffin, Tricia Neuman, and Karen Smith

KFF on Income and Assets of Medicare Benes 091015 URL: Here

9/10/2015, “Income and Assets of Medicare Beneficiaries, 2014 – 2030,” by Gretchen Jacobson, Christina Swoope, Tricia Neuman, and Karen Smith, Kaiser Family Foundation

Quote: “While a small share of the Medicare population lives on relatively high incomes, most are of modest means, with half of people on Medicare living on less than $24,150 in 2014. The typical beneficiary has some savings and home equity, but the range of asset values among beneficiaries is wide and varies greatly across demographic characteristics. Looking to the future, the income, assets and home equity values of Medicare beneficiaries overall are projected to be somewhat greater in 2030 than in 2014 after adjusting for inflation; yet, much of the growth is projected to be realized among those with relatively high incomes and assets. As policymakers consider options for decreasing federal Medicare spending and addressing the federal debt and deficit, these findings raise questions about the extent to which the next generation of Medicare beneficiaries will be able to bear a larger share of costs.” [Emphasis added.]

LTC Comment: The correct take-away from this data showing how poor most Medicare beneficiaries are: We should stop destroying the Medicaid backstop by stretching it to cover middle and upper-middle class people.

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

Swiss Re on Who Pays for Aging 0517 URL: http://www.swissre.com/library/expertise-publication/who_pays_for_ageing.html

5/5/2017, “Who Pays For Aging?,” by Swiss Re, Advisor Magazine

Quote: “There’s no doubt that our growing aging population could represent a major market opportunity for financial services. Of all the sources that help fund a longer life, insurance has only a single-digit share. If insurers want to increase their aging business, they will need to find new ways to provide relevant and attractive new paths to financial security for older people, rather than purely fight for market share among traditional competitors. The aging wallet analysis shows the starting point for insurers to win the hearts and minds of older consumers and their families, and become a larger part of the funding solution. . . . Read the entire report, Who Pays For Aging?, here.”

LTC Comment: Well worth a read. The thesis is that society covers most of the cost of aging now, but its share will have to decline as the age wave crests, meaning the share of private insurance, only 5% now, can, should and will grow, but only if the industry responds creatively to the opportunity.

Chapter 10: Medicaid

Medicaid Financing and Burwell Data

KFF on Strategies to Reduce Medicaid Spending 0617 URL: http://files.kff.org/attachment/Issue-Brief-Strategies-to-Reduce-Medicaid-Spending-Findings-from-a-Literature-Review

We analyzed this report in “LTC Bullet: Is it Really Hopeless to Reduce Medicaid LTC Costs?,” Friday, June 23, 2017: Control-Click to go to our analysis.

 

KFF on Medicaids-Role-in-Nursing-Home-Care 0617 URL: Infographic-Medicaids-Role-in-Nursing-Home-Care

June 2017, “Medicaid’s Role in Nursing Home Care,” Kaiser Family Foundation  

Quote: “Nursing homes are key providers of long-term care in the US, supplying medical, skilled nursing, and rehabilitative services on an inpatient basis to individuals who need help with self-care, such as bathing and dressing. As of 2015, there were 1.4 million people, primarily seniors, served in nearly 16,000 nursing homes.
Medicaid is the primary payer for nursing home care, providing needed long-term care services not offered by Medicare that would otherwise be unaffordable for seniors with low incomes and relieving the care burden from families.
Medicaid currently provides federal matching funds with no pre-set limit that help states cover nursing home care. Medicaid restructuring and cuts in federal funds as proposed in the American Health Care Act could limit states’ ability to provide these services.”

LTC Comment: This is advocacy masquerading as scholarship. The point should not be how much the country depends on Medicaid for nursing home care, but rather how we can reduce that dependency. The key to the solution is to re-direct Medicaid to the needy and get others to plan, save, invest and insure so they have options other than nursing homes underfinanced by public welfare.