LTC Bullet: Long-Term Care News and Analysis
Friday, July 13, 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 skip our usual ***news*** section and dive straight in.
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)
POLITICS, LEGISLATION AND PUBLIC POLICY
ECONOMICS, DEMOGRAPHICS AND DATA
HEALTH AND HEALTHCARE
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:
In my entire 24- year career in the long term care insurance industry I have never seen such a spate of articles in popular media – including print, digital, radio, TV - highlighting long term care as one of the top worries of aging Americans facing retirement. As a supporter of the Center for Long Term Care Reform and a subscriber to “LTC Clippings” I have been kept completely “in the loop” and fully up to date on the vastly increasing information flow about the need for LTC planning. I can not only see what my prospects and clients are reading and hearing about the industry but also have good quality information to share with the “centers of influence” that depend on me for information. The “clipping service” is just one of many benefits provided by the Center and I am grateful to Stephen and Damon Moses for providing a tool that has been so important over the years to the success of Franklin & Associates and Franklin Funding Reverse Mortgages. -- Barbara Franklin, CEO
Your clipping service is the best. I seldom give out insurance company brochures to prospects, much preferring the third party endorsement of published articles that are far more believable than an insurance company brochure. The news does a great job of creating urgency to act as well. You bundle them and send to my inbox for me to use, wonderful! I’m speaking to a group at lunch today and will be handing out an article that was published two days ago that you alerted me to. Keep up the good work, saves me time, and makes me money. -- Romeo Raabe, www.TheLongTermCareGuy.com
Please find below a sample collection of clippings we’ve sent to our Clipping Service subscribers over the past few months. 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.
7/9/2018, “Gen X's Deep Dive Into Financial Stress,” by Christy DeFrain, Advisor Magazine
Quote: “Gen X (born between 1965 and 1979) is now the second largest generation in the workforce today, and this group of ‘latchkey children’ and ‘slacker’ young adults can be viewed as America’s neglected middle child. Bookended by two much written-about generations — the Baby Boomers ahead and the Millennials behind — this driving force behind today’s companies is easily overlooked despite the fact that they are the most committed and engaged at work. Truly, Gen Xers are the source of power that keeps a business together”
LTC Comment: A new generation of LTCI prospects comes online.
6/28/2018, “The Infamous Medicaid Look Back Rule… Why Does it Matter and What Does it Mean?,” by Casey Sauerwine, Marshall, Parker & Weber LLC
Quote: “Engaging in trust planning or gifting more than five years before applying for Medicaid can be an effective strategy to protect assets from nursing home costs. Gifting ahead of time can reduce the amount of available assets an individual will have at the time a Medicaid application is completed. It is important to talk about trust planning and gifting with your elder law attorney if you are considering going down one of these paths.”
LTC Comment: Academics who favor turning LTC over to the government pretend Medicaid planning is so minor as to justify they’re ignoring it. This is a sample of the kind of information elder law firms all across the country routinely purvey to their affluent clients.
6/21/2018, “Senior living might want to take a new look at an old friend,” by John O’Connor, McKnight's Senior Living
Quote: “Odd as it now seems, there was a time when private insurance was allowed to sit with the grownups. … Turns out the sellers grossly underestimated how expensive and likely senior living services would turn out to be. Most of the dozens of firms that once sold private long-term care coverage culled it from their portfolio as quickly and quietly as possible. … But a rebound of sorts appears to be underway. A growing number of firms are starting to sell hybrid products that combine LTC insurance with a potential life insurance benefit. More than a quarter million of these combo policies were sold last year, primarily as estate-planning tools. By comparison, the number of traditional LTC policies sold was only 66,000.”
LTC Comment: If LTC provider pooh-bahs and their political allies paid attention to the real problem—dependency on Medicaid and crowd out of private financing—all forms of LTC insurance would resurge.
6/20/2018, “New screening tool could help diagnose early cognitive decline in dementia from home,” Science Daily
Quote: “An international team of scientists have developed a new way to screen for age-related cognitive decline at home using a test which asks people to detect sounds and flashes on their laptop or phone.”
LTC Comment: Early diagnosis is more critical than ever as behavioral modifications to reduce or reverse cognitive decline become more seriously considered.
6/13/2018, “Medicare Takes Aim At Boomerang Hospitalizations Of Nursing Home Patients,” by Jordan Rao, Kaiser Health News
Quote: “With hospitals pushing patients out the door earlier, nursing homes are deluged with increasingly frail patients. But many homes, with their sometimes-skeletal medical staffing, often fail to handle post-hospital complications — or create new problems by not heeding or receiving accurate hospital and physician instructions. Patients, caught in the middle, may suffer. One in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions such as dehydration, infections and medication errors, federal records show. Such rehospitalizations occur 27 percent more frequently than for the Medicare population at large. Nursing homes have been unintentionally rewarded by decades of colliding government payment policies, which gave both hospitals and nursing homes financial incentives for the transfers. That has left the most vulnerable patients often ping-ponging between institutions, wreaking havoc with patients’ care.”
LTC Comment: Rewarded? Really? Medicaid pays nursing homes less than the cost of providing their care for 60% of their residents which is why medical staffing is skeletal. Nursing homes have to maximize relatively generous Medicare reimbursements for a small minority of their residents to make up part of the difference. Poor public policy is the problem and can’t be solved by punishing LTC providers with more regulation and penalties.
6/2/2018, “'Invisible workforce' of caregivers is wearing out as boomers age,” by Jackie Crosby, Star Tribune
Quote: “Growing numbers of Americans face the immense and often overwhelming challenge of caring for an aging parent or other loved one, a burden that will skyrocket as 76 million baby boomers move into their 80s and need help coping with dementia, cancer, heart disease or just plain frailty and old age. … Soon, Minnesota and the nation will reach a demographic crossroad. In 2030, the first wave of the baby boom generation will turn 85, an age when people are twice as likely as those even a decade younger to need help getting through the day.”
LTC Comment: Good article on the topic especially because it recognizes the sea change coming in 2030. Add to the wave of boomers turning 85 the exhaustion of Social Security and Medicare “trust funds” and you have a clear view of the coming mayhem.
5/17/2018, “The Hidden Costs Of Caregiving,” Securian Financial
Quote: “Securian Financial recently conducted a survey of more than 800 people currently providing, or who have provided, unpaid care to a parent, in-law or spouse who is aging, or has a disability or chronic disease. The survey found the majority of caregivers (60 percent) spend more than 10 hours per week caring for a family member, and about one in four (29 percent) spend more than 20 hours per week. Women (32 percent) are more likely than men (26 percent) to spend more than 20 hours each week on caregiver duties.”
LTC Comment: Information to share with prospects and clients to trigger and sustain their concern about planning ahead for long-term care.
5/9/2018, “Why Families Need a Plan for Caregiving,” by Kimberly Lankford, Kiplinger’s Personal Finance
Quote: “Kamilah Williams-Kemp, 43, is the head of Northwestern Mutual's long-term-care insurance business. She was the primary caregiver for her mother last year.”
LTC Comment: The personal story of one of our own in the LTCI business.
5/2/2018, “The Myth of Outliving Your Retirement Savings,” by Gail MarksJarvis, Reuters
Quote: “Most retirement research points to an impending retirement crisis for about half of Americans who save too little. But a new study suggests that behavior like Anderson’s makes the outlook far less dire. Because people worry about outlasting their savings, most adjust by living humbly – often overly so. Consequently, they make even modest savings last for years longer than expected by researchers.
“What can devastate financially are divorce, caring for a mentally or physically ill adult child who cannot work, and long-term care expenses, according to the Society's research. Still, debilitating healthcare costs are far more rare than people fear, according to the EBRI research. Half of retirees face no nursing home expenses since Medicare covers short recoveries after hospital stays and Medicaid can help when resources run out.”
LTC Comment: Unfortunately, the author here fails to mention that the supposed rareness of debilitating healthcare costs doesn’t make those costs less impactful to those who experience them.
5/2/2018, “Medicare Advantage Plans Can Pay for Many LTC Services in 2019: Feds,” by Allison Bell, ThinkAdvisor
Quote: “The Centers for Medicare and Medicaid Services is getting ready to let Medicare Advantage plan issuers add major new long-term care benefits to their supplemental benefits menus.”
LTC Comment: Medicaid made nursing home care free in 1965 without enforcing spend-down rules thus desensitizing the public to LTC risk, locking in institutional bias, and impeding private financing of LTC through savings, home equity conversion and private insurance. This new government venture into “free LTC” will also end badly.
4/27/2018, “Largest LTCi Claim Exceeds $2 Million,” by Jesse Slome, Advisor Magazine
Quote: “A single long-term care insurance policyholder claim has exceeded two million dollars (actually $2.6M for a female). The largest claim still being paid to a male policyholder reached nearly $1.6 million. Why is this important? First, it’s the first time we’ve seen a single claim in excess of $2 million. Second, because consumers mistakenly perceive this protection in ‘investment’ terms … will I get my money back? Advisors need info like this to tell the story properly! When it comes to LTC insurance (or most insurance for that matter) some will get NO benefit … some will get SOME benefit … and a few will get HUGE benefit.”
LTC Comment: Fascinating findings. I wonder how many million-dollar claims Medicaid has paid.
4/20/2018, “No Spend Down,” by Stephen D. Forman, LTCA Weekly Reader
Quote: “The Employee Benefit Research Institute (EBRI) always publishes high-quality research. In their latest study they find that retirees do a poor job of asset decumulation. Those with few assets (who enter retirement with median assets of $31,740) still have $24,000 eighteen years later, a parsimony which is ‘not irrational,’ according to the authors. But even when assets are plentiful upon retirement (a median of $857,450), eighteen years later this group still maintains a healthy bank account worth $763,900. In short, EBRI finds that retirees spend their income (what comes in, goes out), but rarely touch assets. That's what the chart above illustrates. (This is not what ‘life cycle theory’ or traditional financial planning has presumed.)”
LTC Comment: So much for the idea that wide swaths of the American public are spending down into impoverishment for long-term care. As we’ve explained frequently and most recently here, Medicaid pays for most expensive LTC in the USA and for most Americans it’s easy to get after care is needed without spending down significantly.
4/20/2018, “Couples in retirement face average health care costs of $280,000, Fidelity estimates,” by Adam Shell, USA Today
Quote: “Fidelity estimates it will cost a couple $280,000 to cover their health care costs in retirement, up 2% from last year and 75% since its 2002 estimate of $160,000. The math assumes a couple retires at 65 and is eligible for Medicare. The cost for care for males in retirement is an estimated $133,000, while the tab for women, who tend to live longer than men, is $147,000.”
LTC Comment: Annual update excludes long-term care costs.
4/19/2018, “'60 Minutes' To Air Unprecedented Video Study On The Progression Of Alzheimer's,” by Robin Seaton Jefferson, Forbes
Quote: “The chief medical correspondent to CBS News and professor of medicine at NYU Langone Medical Center has spent the last 10 years recording the effects of Alzheimer’s disease on a patient and her husband, who over the course of his study have become not only his subjects but his friends. … LaPook will share his journey and their stories-said to be the longest video study of its kind-Sunday on "60 Minutes," chronicling the long-term devastation of Alzheimer’s disease on both patient and caregiver.”
LTC Comment: Watch this 60 Minutes episode if you have access. If not, click the article for the story. See also: “LTC Bullet: The End of Alzheimer’s.”
4/15/2018, “65% of Baby Boomers Are Making a Huge Financial Mistake That Could Leave Them Broke,” by Christy Bieber, Motley Fool
Quote: “Many pre-retirees think they don't need to worry about healthcare because they anticipate care costs will be covered by Medicare. But the reality is that Medicare makes seniors responsible for picking up a significant percentage of their cost of care. Seniors may face high deductibles, coinsurance costs, premiums, and coverage limitations. … There are also many services Medicare doesn't cover, including hearing aids, long-term care, and dental care. … Qualifying for Medicaid could also help you afford care costs by subsidizing Medicare premiums and paying for some services not covered by Medicare, such as routine nursing home care. While there are strict asset limits to obtain Medicaid, an attorney can help you to develop a plan that protects your wealth and still allows you to obtain coverage.”
LTC Comment: There’s the essence of the problem in a nutshell. People are in denial about the long-term care risk, but not irrationally so because “an attorney can help you” protect your wealth and get the government to pay if you ever need LTC. The truly irresponsible parties in this public policy fiasco are the academics, politicians and policy-makers who refuse to take this simple, obvious reality into account. For details see How to Fix Long-Term Care Financing.
4/4/2018, “Caring for elderly parents can put a dent in your budget,” by Sarah O’Brien, CNBC
Quote: “The biggest monthly expenses for caregivers are medicine and medical supplies ($273), food ($159) and personal-care items ($151).
About half of current and past caregivers did not know in advance that they would be stepping into that role.
In advance of finding yourself in that situation, whether expected or not, it's worth having a conversation with your parents about how they envision their care if they reach a point where they no longer can care for themselves.”
LTC Comment: Sound advice.
3/26/2018, “As Trump Targets Immigrants, Elderly Brace To Lose Caregivers,” by Melissa Bailey, Kaiser Health News
Quote: “Nationwide, 1 million immigrants work in direct care — as CNAs, personal care attendants or home health aides — according to the Paraprofessional Healthcare Institute, a New York-based organization that studies the workforce. Immigrants make up 1 in 4 workers, said Robert Espinoza, PHI’s vice president of policy. Turnover is high, he said, because the work is difficult and wages are low. The median wage for personal care attendants and home health aides is $10.66 per hour, and $12.78 per hour for CNAs. Workers often receive little training and leave when they find higher-paying jobs at retail counters or fast-food restaurants, he said.
“The country faces a severe shortage in home health aides. With 10,000 baby boomers turning 65 each day, an even more serious shortfall lies ahead, according to Paul Osterman, a professor at Massachusetts Institute of Technology’s Sloan School of Management. He predicts a national shortfall of 151,000 direct care workers by 2030, a gap that will grow to 355,000 by 2040. That shortage will escalate if immigrant workers lose work permits, or if other industries raise wages and lure away direct care workers, he said.
“‘What people don’t seem to understand is that people from other countries really are the backbone of long-term care,’ said Sister Jacquelyn McCarthy, CEO of Bethany Health Care Center in Framingham, Mass., which runs a nursing home with 170 patients. She has eight Haitian and Salvadoran workers with TPS, mostly certified nursing assistants. They show up reliably for 4:30 a.m. shifts and never call out sick, she said. Many of them have worked there for over five years. She said she already has six CNA vacancies and can’t afford to lose more.
“Osterman, the MIT professor, said the sum of all of these immigration policy changes may have a serious impact. If demand for workers exceeds supply, he said, insurers may have to restrict the number of hours of care that people receive, and wages may rise, driving up costs. ‘People aren’t going to be able to have quality care,’ he said. ‘They’re not going to be able to stay at home.’”
LTC Comment: Politics + demographics = LTC - TLC.