LTC Bullet:  Long-Term Care News and Analysis

Friday, March 9, 2018


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 keep our ***news*** section brief then dive straight in.

*** Some CLTCR staff will be attending the upcoming 18th Annual Intercompany Long-Term Care Insurance Conference in Las Vegas. In preparation for this vital and not-to-be-missed annual affair, we’ll skip next week’s LTC Bullet, but don’t fret: There’s over 1,200 LTC Bullets dating back to 1998 and archived by date and subject here. In lieu of anticipating and reading your Friday Bullet, why not have a look at our archive? If you need some direction, start by reading our LTC Bullets rebutting some of the unbalanced and negative treatment of LTCi in the popular press recently. To that end, we offer: Don’t Buy LTCI?!, LTCI Under Fire, LTCI Expert Fights Back and last week’s piece from Phyllis Shelton, It’s Time to Stop Bashing Long-Term Care. If that’s not enough, try our Reality Check: The Facts on LTCI section which compiles LTC Bullets dating back to 1998 that combat inaccurate media coverage of LTCi with facts and sound analysis. Enjoy. ***

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, Medicaid Planning and Crowd-Out Effect)

  • MEDICARE (including 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:

I depend on the clipping service to keep me abreast of all LTC breaking news. It is a huge time-saver and contributes to my overall sense of confidence and knowledge as a LTCi specialist. I really think the service gives me an “edge,” and helps keep me one step ahead of my competitors. Conveying the insights I gain from the clipping service often enables me to more easily and relevantly educate my clients on the importance of LTCi ownership. -- Honey Leveen

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.


3/7/2018, “What influences older adults' preferences for care?,” MedicalPress

Quote: “The researchers found that support from family was the most important influence on care preferences for older adults. But people also usually formed their preferences based on a variety of factors. They also discovered that it was unusual for older adults to know their care preferences or to have a clear understanding of how they formed their preferences.

“The key findings of this study were:

  • The level of support from families was the most important influence on care preferences. Often, older adults changed their preferences based on the concerns of family members or a wish to avoid ‘being a burden’ to others. This was especially true for preferences regarding the places where people wished to receive care (for example, at home versus in a healthcare facility).

  • Older adults' experiences of previous illness and of caring for others also influenced preferences about their own future care.

  • Being more seriously ill strongly influenced care preferences, especially for older adults who were aware that they were unwell.”

LTC Comment: Interesting that not being a burden on others and prior care-giving experience influence type-of-care preferences. Having LTCI would ameliorate both concerns and keep all options open.


3/7/2018, “Using a Health Savings Account to Pay for Long-Term-Care Insurance,” by Kimberly Lankford, Kiplinger

Quote: “Q: Can I withdraw money tax-free from my health savings account to pay my long-term-care insurance premiums? If I can, is there a limit to the amount I can use? Does it have to be for a stand-alone long-term-care policy, or can it be for a life insurance policy with long-term-care benefits, too?

LTC Comment: Click through to the article for the answers.


3/7/2018, “Why Long-Term Care Insurance Is a Bad Investment,” by Jason Notte, TheStreet

Quote: “‘Mathematics work against [long-term care insurance] because most people will need long-term care eventually,’ Kibler says. ‘For insurance to make economic sense, the risk must be spread across a pool of participants.’”

“With other types of insurance, only a portion of the population collects, while the others continue to pay their premiums. That covers expenses paid out and keeps premiums manageable. However, since most buyers of long-term care insurance will eventually collect, Kibler notes that insurers will have to raise premiums. That will cause the healthier portion of the population to opt out, leaving a pool of less-healthy participants who all believe they will need to collect their insurance in the immediate future.”

LTC Comment: The argument here is specious and the nuance the author misses is that through LTCi some people will be spared catastrophic loss, others will be glad they never needed it and many people will fall somewhere in-between and have protection.


3/7/2018, “Letting an LTC insurance policy lapse,” by Karin Price Mueller,

Quote: “Q, My husband and I are 84 and 85 and we have had long-term care insurance for 17 years. The premiums are going up too much and we are on a fixed income, earning a little over $30,000 a year. We have a good amount of other assets, and we're trying to decide if we should keep the insurance or cancel it.
-- Tough decision

A. As you know, long-term care insurance can be a very important part of your financial plan.

You shouldn't let the policy lapse without serious consideration.

LTC Comment: Some welcome good advice.


3/5/2018, “The Long-Term Care Insurance Market Evolves,” by Mark Miller, Morningstar

Quote: “It's a paradox: More Americans are worried about the risk that long-term care expenses can pose for their retirement plans, but few take action to protect themselves. The commercial long-term care insurance industry has never achieved mass market penetration levels, and sales have been falling steadily over the past five years. Chalk it up, in part, to consumer resistance. People are reluctant to spend thousands of dollars annually on insurance premiums for a long-term care need that might come far down the road, or not at all.”

LTC Comment: Some paradox! Medicaid has paid for the vast majority of all expensive long-term care since 1965. There’s no mystery why most Americans don’t worry about LTC costs until they need care after which it’s too late to do anything responsible like buy private insurance.


3/2018, “How Many Seniors Are Living in Poverty? National and State Estimates Under the Official and Supplemental Poverty Measures in 2016,” by Juliette Cubanski, Kendal Orgera, Anthony Damico, and Tricia Neuman, Kaiser Family Foundation

Quote: “Payments from Social Security and Supplemental Security Income have played a critical role in enhancing economic security and reducing poverty rates among people ages 65 and older. Yet many older adults live on limited incomes and have modest savings. In 2016, half of all people on Medicare had incomes less than $26,200. This analysis provides current data on poverty rates among the 49.3 million seniors in the U.S. in 2016, as context for understanding the implications of potential changes to federal and state programs that help to bolster financial security among older adults.

LTC Comment: We don’t know that SS and SSI have enhanced economic security and reduced poverty rates compared to what would have happened if those programs had not undercut the public’s sense of personal responsibility to save, invest and insure privately against the risk and costs of aging and retirement. Further, what matters is not that half of all Medicare recipients have incomes below $26,500. We have them covered with a wide range of government programs. What matters is how many people are getting those same programs, including Medicaid long-term care benefits, who have incomes far in excess of the median. KFF’s ideological bias is to over-estimate poverty in order to promote ever more government spending on the very programs that have created the problems it is claiming to fix.


3/5/2018, “These 5 defensive moves can protect your money and wealth,” by Liz Miller, MarketWatch

Quote: “Every well-considered wealth-management plan includes an assessment of personal, property, and financial risk. Investments have risks that can’t readily be insured, so other risks must be managed in order to minimize threats to overall wealth goals. Fortunately, many of the personal risks that can threaten one’s wealth can be managed with proper insurance. Consider these five ways to reduce your exposure to risk:

“2. Consider long-term care insurance:

Studies indicate that at least one member of every couple living today is likely to need some kind of long-term medical assistance. Many people have the means to pay these expenses out of their wealth savings, but for many others, a long-term stay in a luxury care facility — due to dementia or some other debilitating condition — can derail their lifestyle or legacy goals. If you have any medical conditions or family history that make you particularly vulnerable to health risks, or you do not have the means to cover these costs, consider long-term care insurance options. This is relatively inexpensive insurance to add prior to age 50, but it can get pricey later in life.”

LTC Comment: A pretty good concept offering LTCi as a type of lifestyle insurance or even “portfolio insurance.”    


3/2/2018, “Why the daunting economics of elder care are about to get much worse,” by Patricia Smith, The Conversation

Quote: “When no relative steps up to serve as an unpaid caregiver when the need arises, families hire paid caregivers or move their loved one into a nursing home, where a private room may cost $100,000 or more per year. Medicare rarely covers nursing home stays, and eligibility for Medicaid coverage is limited, so institutional care like that is generally out of reach for all but the wealthiest Americans or those with long-term care insurance – which also costs a lot. … In the meantime, Medicaid and Medicare can make caregiving more financially rewarding by increasing the rates they pay for elder care, spurring the kind of salary growth for home health aides required to make the profession more attractive. And to ease the financial burden of caregiving all around, Medicaid and Medicare could ramp up benefits for care delivered in the home and in institutions and extend coverage to more people.

LTC Comment: Typical balderdash: fix the LTC problem by spending more on what caused it in the first place.


3/2/2018, Good data source referenced by Stephen D. Forman in the “LTCA Weekly Reader”

Quote: “RBC Wealth Management did a bang-up job on their new report, "Taking Control of Healthcare in Retirement." It's a readable mix of text, graphs and well-sourced information that points frequently toward long-term care. Pre-retirees reading its 20-pages will not only get a better handle on the magnitude of the challenges they face, but also an encouraging tour of the manageable steps they can take.”

LTC Comment: We thank Center friend and Corporate member Steve Forman of Long-Term Care Associates for this resource tip.


2/27/2018, “Aerobic exercise slows cognitive decline in Alzheimer’s disease,” by Mary Gillis, Reuters

Quote: “Researchers assessed data from 19 studies conducted between 2002 and 2015 that examined the effects of exercise on cognitive ability in 1,145 people at risk of or diagnosed with Alzheimer’s disease. Nearly 90 percent were randomized controlled trials, which are the most reliable type of study.

“Results indicated that exercise - specifically, cardiovascular exercise - had a strong favorable impact, researchers reported in the Journal of the American Geriatrics Society.

“This study is the first to suggest that aerobic exercise may be more effective than other types of exercise when the goal is to preserve the cognitive health of older adults at risk of or with Alzheimer’s disease, Panza said.”

LTC Comment: It’s pretty gloomy here in Seattle, but I think I’ll go for a run later.


2/27/2018, “Here’s a surprise source you can tap for long-term care services,” by Darla Mercado, CNBC

Quote: “It isn't every day that an older client might consult experts to help him become impoverished as he prepares for long-term care. Enter Medicaid planning, a corner of personal finance that brings together elder law attorneys, accountants and financial advisors to help seniors pay for nursing home care while protecting their family members.

“Those who participate in Medicaid planning work with attorneys, accountants and advisors to shift their wealth to trusts or annuities in order to qualify.”

LTC Comment: We hesitate to forward articles such as this that are basically advertisements for Medicaid planning and contribute to the overall desensitization to the need for responsible long-term care planning. However, people read articles like this when researching options for financing long-term care and it’s better to know when there’s a new one out there. For some balance, see also our recent LTC Bullet: The Medicaid Prevention Business, which features Ron Hagelman’s column from the latest Broker World.


2/23/2018, “HSA use increasing among those under 65,” by Allison Bell, ThinkAdvisor

Quote: “U.S. residents’ use of public and private health coverage stayed about the same between 2016 and the first three quarters of 2017, but use of health savings accounts (HSAs) may have climbed 15 percent. The number of U.S. residents under the age of 65 who had HSAs increased to 17.9 million in 2017, from 15.5 million in 2016, according to new National Health Interview Survey (NHIS) data.

LTC Comment: Many will use the HSAs to fund the next generation of LTCI after Medicaid stops subsidizing the middle class and affluent.


2/26/2018, “Are You Prepared To Live To Be 100?,” by Alexander Koury, Forbes

Quote: “Today, we are living healthier lives, which has increased our life expectancy and changed the way in which we should prepare to live well beyond our expectations. We are living in an age when medicine and technology are being designed to keep us living longer, and future developments will continue to push life expectancies higher. This is the new reality, and unless you choose to solve the problem now, you could outlive your money. Ask yourself, ‘How long will my money last?’ If you do not know, now is the time to figure out how you will get on track.

“Last, consider buying long-term care, and shop for a plan that fits your budget and your goals. If we go back to the example I presented earlier, long-term care may end up costing you as much as a $700,000 home. Imagine having to buy one for you and your spouse. These are things you should consider reviewing now before too much time passes. The older you are, the less time there is to make sure your financial plan is intact.”

LTC Comment: A pretty good article and reminder of the various costs associated with increasing longevity and how to prepare for them.


2/21/2018, “Immigration Curbs Will Weaken Social Security,” by Howard Gleckman, Forbes

Quote: “President Trump has proposed deporting hundreds of thousands of immigrants and backed curbs on legal immigration into the US. The president’s aggressive views on immigration have generated intense debate over the past year, but much of that discussion has ignored a key issue: What immigration restrictions would mean for the long-term health of Social Security.

A new study by my Urban Institute colleagues Damir Cosic and Rich Johnson finds that just one proposal—a Senate bill to reduce the number of permanent residency visas (green cards)-- would increase unfunded Social Security obligations by $1.5 trillion, or 13 percent, over the next 75 years. In the nearer term, it would accelerate by one year the date by which the Social Security trust fund is projected to be depleted—from 2034 to 2033.”

LTC Comment: This affects the long-term care industry because those would-be immigrant workers could fill positions as much-needed long-term caregivers and pay into Social Security and Medicare which are both connected to Medicaid via spend-through and reimbursement, respectively.


2/18/2018, “1.5 Million Retirees Await Congressional Fix for a Pension Time Bomb,” by Jim Tankersley and Alan Rappeport, New York Times

Quote: “The sprawling agreement to boost government spending reached by Republicans and Democrats this month quietly included a step toward defusing what could be a financial time bomb for 1.5 million retirees and hundreds of companies in the industrial Midwest and the South. The deal creates a select congressional committee to craft what could effectively be a federal rescue of as many as 200 so-called “multiemployer” pension plans — in which employers and labor unions band together to provide retirement benefits to employees.
Many of these plans are hurtling toward insolvency in the coming decade, with benefits owed to retirees projected to swamp what the plans can afford to pay. The 16-member, bipartisan committee will have to come up with a solution and legislation by the end of November, which the full Senate would need to vote on by the end of the year.

LTC Comment: Who’s going to bail out Social Security and Medicare?