LTC Bullet: Dying with or of Covid and the Double Whammy of a Second Wave in the Coming Flu Season

Friday, September 25, 2020


LTC Comment: For fresh thinking on the pandemic and long-term care, look no further than “60 Seconds with Steve Monroe.” We explain after the ***news.***

*** TAKE THE SURVEY: It’s not too late to participate in the nation’s largest opinion survey of agents and advisors that we announced and described in “LTC Bullet: The Who is Selling What to Whom, Why & How Survey.” Read more about this important study in Ron Hagelman’s Broker World column this month. You have until October 8 to do your part by contributing to our knowledge of this critical subject. Take the survey here. ***

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*** TRUE FREEDOM, 9/14/2020, “True Freedom and GoldenCare USA Partner to Provide Seniors with Innovative Home Care Solutions

Quote: “True Freedom announces our Preferred Marketer partnership with GoldenCare USA, an Integrity Marketing Group company. True Freedom is the only company that provides nationwide home care plans for seniors as an alternative to traditional insurance. GoldenCare and their western-states counterpart, American Independent Marketing, have been leading subject matter experts in long-term care for more than 40 years. By partnering together, they can now serve more Americans by providing unique options for long-term care.”

LTC Comment: Congratulations to long-time friend and corporate member Golden Care on this exciting new partnership. ***



LTC Comment: Do we face double pandemic jeopardy when flu compounds the Covid crisis this fall? What does it mean to die “of” Covid when the Coronavirus only shortens the life by a week or two of people with multiple co-morbidities?

Those are two of the intriguing questions raised and answered by Irving Levin Associates Steve Monroe in his weekly video series “Sixty Seconds with Steve Monroe.” Stephen M. Monroe has been a healthcare and senior care financial expert for over 30 years. In addition to being an often-quoted healthcare finance expert in mainstream media, he has published over 50 bylined articles dealing with various aspects of investing in health care and senior’s housing. He is also called upon to keynote and speak at organizations such as the American Seniors Housing Association, Assisted Living Federation of America, National Investment Center for Seniors Housing and Care, American Health Care Association and the New York State Health Facilities Association, among others. 

I’ve followed Steve’s analysis for two decades or more, ever since I became intrigued by the role of finance in shaping the type and availability of seniors housing. When he told me many years ago that he bought private long-term care insurance and it cost him less than the cost of a daily cup of coffee, that sealed it for me. I’ve followed his thoughtful commentaries ever since.

Here are two of them that he and his employer have allowed me to share with you. This material is proprietary so not usually available for free. If you find it helpful, there’s more where this came from and you can subscribe for a 60-day free trial here.

Beware the Flu Season?,” by Steve Monroe, August 26, 2020

Almost every conversation surrounding the coronavirus and outbreaks in nursing homes or assisted living communities eventually gets around to the double whammy of a “second wave” combined with the upcoming flu season.

Yes, providers will have to be vigilant, but they have never been as well prepared for the flu season as they are today. Think about it. Less than a year ago, do you remember ever walking into any senior care facility where the staff were all wearing masks, where hand sanitizers were everywhere, where your temperature was taken at the entrance, where mobile residents were wearing masks? No, it never happened except if someone had the flu.

My bet is that there will be a record number of people, in and out of senior care, who will get the flu shot this year. And transmission will be lower because most Americans are wearing masks in public, hands are cleaner than ever before, and we are all still coming into contact with fewer people on a daily basis than at the start of any other flu season.

The coronavirus will still be with us, but because of the extra care taken in all senior care communities, its prevalence has declined and the double whammy with the flu season will not be as bad as people fear.


Death By or With COVID,” by Steve Monroe, August 28, 2020

We are sure every provider is sick and tired of hearing about how many residents have died of COVID-19 in a nursing home or assisted living community. The problem is that the classification may be all wrong.

Unfortunately, there may be a financial reason for such classifications, as in more reimbursement, or more governmental aid. And for those who can profit from making this pandemic seem worse than it is (yes, they do exist), piling up the number of COVID deaths helps to make their case. It has certainly helped the mainstream media and their advertising dollars. But here is the problem, at least as it relates to the deaths in assisted living, memory care and nursing homes. What the statistics don’t differentiate is those residents who died “of” COVID from those who died “with” it.

Let us explain. Most people who are long-term residents in nursing homes, or assisted living and memory care communities, have multiple health issues, commonly referred to as co-morbidities. It is a word often used in the senior care industry, but particularly during this pandemic. 

In its most simple definition, a comorbidity is the presence of one or more “additional” health conditions, usually co-occurring with a primary condition. And we are not talking about minor health problems, but major ones, usually chronic and often cardiac or respiratory related, as well as diabetes. To be un-politically correct, these residents today have several health problems, any one of which could result in their death at some point. 

In addition, the average length of stay for these residents is relatively short, even in the best of times, especially compared with independent living communities or CCRCs, not to mention active adult communities with their much younger average age. They have moved into nursing homes or AL/MC [assisted living/memory care] communities in a frailer condition than 20 and even 10 years ago. In many cases, they are going to die in six or 12 months even without a pandemic.

So, when a 90-year resident in a memory care wing (true story), on hospice, with maybe three weeks to live gets infected with the coronavirus and dies in two weeks, she is listed as having died “of” COVID. But that is not true. She died “with” COVID. She actually could have died from any of her comorbidities, if not just old age, but that is not how it is recorded. She becomes a statistic as one of the 170,000 and growing deaths from COVID. [The reported U.S. death toll passed 200,000 on September 22, 2020, a little less than a month after this column was published.]

The entire senior care industry has to get this message out and the only way to do so is to track what really is happening inside your buildings. The overall number of deaths “by” COVID will go down, and the industry can make a better case to the consumer for what is really happening to seniors under their care. We would love to receive your statistics, on or off the record.