LTC Bullet: Long-Term Care News and Analysis Friday, September 27, 2024 Seattle— 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. 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. Contact Damon at 206-283-7036 / damon@centerltc.com 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. ------------------ 9/23/2024, “Nearly two-thirds of Americans fear Medicare will not be there when they need it,” by Nationwide, PRNewswire Quote: “Americans are increasingly concerned about the future of Medicare, with nearly two-thirds (63%) fearing the program will not be there when they need it, according to the annual Nationwide Retirement Institute® Health Care Costs in Retirement survey. When asked about their biggest retirement planning stressor, one in five (20%) selected Medicare running out of money.” LTC Comment: Many people rely on the solvency of Medicare, but one particularly vulnerable group--nursing homes (and their residents)--depend on it to make up for low Medicaid reimbursements. Furthermore, the questionable financial viability of America’s entitlement programs is all the more reason to save, invest or insure for future healthcare and long-term care needs. ------------------ 9/22/2024, “You
say you want a resolution?,” Quote: “It’s clear the long-term care field is in a tough spot. At a time when worker shortages have never been more severe, regulators are pushing for minimum staffing benchmarks. “One proposed response was a resolution to overturn the directive. But Republicans have now announced they won’t pursue that option, as it would face a certain veto from the Biden administration. “The nursing home industry needs more than just regulatory demands — it needs real, targeted action. That means new policies where you invest in building a stronger long-term care workforce and ensure providers aren’t shortchanged by inadequate reimbursement. “The stakes are too high to rely on mandates that don’t address the core issues. What’s needed is a comprehensive, strategic plan to strengthen the long-term care industry — before things get really ugly.” (Emphasis added) LTC Comment: One core issue that should be addressed is limiting access to Medicaid resources to those who truly have no other options and requiring those who can save, invest or insure for their long-term care needs to do so. This would divert many people away from overburdened and under-funded nursing homes and into care setting they prefer, thereby targeting scarce Medicaid resources to those who truly need it and improving conditions for all. ------------------ 9/19/2024, “Longer lives, divorces, smaller families mean more older adults are living alone,” Kathleen Steele Gaivin, McKnights Senior Living Quote: “More older Americans are living alone, either by choice or by circumstances, than 50 years ago, according to the US Census Bureau. “As of 2023, about 28% of people aged 65 and older lived by themselves, the agency said. That’s up from about 10% of older adults living alone in 1950.” LTC Comment: The fraying of the familial safety net, combined with the demographic challenges brought by the cresting age wave, leaves LTCi poised as an even more valuable resource. ------------------ 9/16/2024, “What if Medicaid paid market rates?,” by Stephen A. Moses, McKnights LTC News Quote: “Most of long-term care’s problems boil down to heavy dependency on low Medicaid reimbursement rates. The program paid 61% of total U.S. LTC spending in 2022 at about 70% of private-pay rates. Economists explain that government price fixing causes market disruptions. Set prices too low, and shortages occur. “Providers are forced to compensate by compromising on services. Most complaints about questionable LTC quality, high cost, inadequate staffing, caregiver shortages, too much nursing home and too little home care, all the big challenges would improve or disappear entirely if Medicaid paid market rates. “But something else will happen. Cost shifting to private payers in order to compensate for low Medicaid rates will no longer be necessary. The market rate for LTC will settle substantially below the private pay rate but well above the current Medicaid rate. Everyone, including private payers and Medicaid, will pay that market rate infusing the LTC service delivery system with desperately needed revenue and resolving most of the problems challenging LTC today.” LTC Comment: Read this concise explanation of America’s LTC problem, and what to do about it, in Steve’s latest “Guest Column” for McKnights LTC News. ------------------ 9/12/2024, “The States Are Dangerously Dependent on Medicaid-Expansion Dollars,” by Gary D. Alexander, National Review Quote: “A recent study by the Paragon Health Institute points out that a fundamental flaw with Medicaid expansion is its inequitable distribution of federal funds. As currently implemented, the program has the federal government covering 90 percent of the medical costs of able-bodied adults but only 50 to 75 percent of the costs of elderly, disabled, and child recipients — populations that tend to require the most expensive and intensive care. This creates a perverse incentive for states to prioritize the coverage of healthy adults, who are cheaper to care for, while the truly vulnerable are left underfunded. This imbalance isn’t just fiscally irresponsible — it’s morally wrong. The system effectively rewards many individuals who could seek insurance through other means, while it forces states to bear a heavier financial burden for those who genuinely depend on Medicaid for survival.” LTC Comment: Upside down ethics and perverse incentives infect Medicaid in so many ways as we point out often here. Kudos to my Paragon Health Institute colleague Gary D. Alexander for shining the light of scrutiny on this example. ------------------ 9/2024, “Beyond the Numbers: Assisting Clients with LTC Concerns,” by Danielle Andrus, Journal of Financial Planning Quote: “There are a lot of statistics that planners can employ to illustrate the risk that their clients will face regarding future care needs. A common one is that 70 percent of people who live to age 65 will need paid long-term care at some point. Bill Comfort, owner of Comfort Long-Term Care and director of training for the Certification in Long-Term Care (CLTC) designation and continuing education program, believes this overstates the true risk of needing care. ... Margie Barrie, a long-term care insurance specialist with ACSIA Partners, believes that whether you buy an insurance policy or not, everyone needs to have a plan for long-term care.” LTC Comment: This article by the editor of the Journal of Financial Planning cites LTCI industry experts Bill Comfort and Margie Barrie at length. Click through to see what they have to say. ------------------ 8/28/2024, “I don't have a spare $150,000, so long-term care insurance is absolutely worth the cost,” by Angie Chapman, Business Insider Quote: “With lifespans longer and families more spread out, it's essential that I think about long-term care. Long-term care insurance comes in many forms at many costs, including as part of a life insurance policy. I hope to have a long, comfortable life, but I'm preparing for whatever is ahead.” LTC Comment: Short, sweet and to the point. And in a business magazine! ------------------ 8/25/2024, “Long-term care is in trouble,” by John O’Connor, McKnights LTC News Quote: “The American Health Care Association/National Center for Assisted Living released some updated supply and demand numbers last week. To say they are concerning would be an extreme understatement. In a nutshell: Since the onset of COVID-19, nearly 800 nursing homes have closed, displacing almost 30,000 residents. ‘It’s not hyperbole to say access to care is a national crisis,’ said Mark Parkinson, the organization’s president and CEO. He’s right. Nursing homes are closing faster than new ones can open, and the challenges aren’t just logistical. They’re existential.” LTC Comment: John O’Connor has edited McKnights’ LTC newsletters for decades. When he’s this worried about America’s nursing homes, we all should be. To make sense of what ails LTC, read the Paragon Health Institute’s “Long-Term Care: The Problem” and “Long-Term Care: The Solution” and watch this “virtual LTC event” featuring age wave visionary Ken Dychtwald and leading LTC researchers. ------------------ 8/2/2024, “Listen to Ken Dychtwald on the Georgetown CRI Podcast,” Age Wave Quote: “Age Wave is delighted to have partnered with the Georgetown Center for Retirement Initiatives for two events this year. In June, Ken Dychtwald delivered a keynote presentation at their 2024 Policy Innovation Forum in Washington DC. He also just appeared on their podcast "The State of Retirement: Shaping the Future," where he was interviewed about ‘What is the New Retirement in an Age of Longevity?’” LTC Comment: Click through for more insights from the inimitable Ken Dychtwald. ICYMI, check out the Paragon Health Institute’s “virtual LTC event” hosted by Ken Dychtwald and featuring yours truly. ------------------ 7/24/2024, “How States Can Support Individuals In The Long-Term Services and Supports Gap,” by Laura Benzing, Hannah Godlove and Megan R. Burke, Health Affairs Quote: “But what about the large population of middle-income Medicare beneficiaries nationwide who do not qualify for Medicaid and cannot afford to hire a home health aide? These individuals fall into an ‘LTSS gap’ where care is difficult, if not impossible, to access. … Near Medicaid-eligible individuals who fall into the LTSS gap experience higher rates of disability and less access to potential family caregiver support compared to Medicare beneficiaries with higher incomes. … State policy makers can consider opportunities to address the LTSS gap under existing authorities including expanding Medicaid eligibility and State Plan Amendments, Section 1115 Demonstrations, Older Americans Act funding, and other state-driven initiatives.” LTC Comment: Health Affairs published my comment on this article. It begins: “Respectfully, there is no ‘LTSS Gap’.” It continues to explain how high-income and high-asset people routinely qualify for Medicaid LTC benefits, crowding out needier people from better care. Click through to read the article and my comment. Next Friday’s LTC Bullet will include a more detailed critique of the article and why its recommendation—ever more government spending on LTC—is exactly the wrong prescription for what ails LTC. ------------------ 7/12/2024, “States Set Minimum Staffing Levels for Nursing Homes. Residents Suffer When Rules Are Ignored or Waived.,” by Jordan Rau, KFF Health News Quote: “An acute shortage of nurses and aides in the nation’s nearly 15,000 nursing homes is at the root of many of the most disturbing shortfalls in care for the 1.2 million Americans who live in them, including many of the nation’s frailest old people. They get festering bedsores because they aren’t turned. They lie in feces because no one comes to attend to them. They have devastating falls because no one helps them get around. They are subjected to chemical and physical restraints to sedate and pacify them. … Now the Biden administration is trying to guarantee adequate staffing the same way states have, unsuccessfully, for years: with tougher standards. Federal rules issued in April are expected to require 4 out of 5 homes to boost staffing. The administration’s plan also has some of the same weaknesses that have hampered states. It relies on underfunded health inspectors for enforcement, lacks explicit penalties for violations, and offers broad exemptions for nursing homes in areas with labor shortages. And the administration isn’t providing more money for homes that can’t afford additional employees.” LTC Comment: Nursing homes are caught between the rock of inadequate reimbursement and the hard place of mandatory quality. Compulsory staffing levels won’t help any more than wage and price controls fix market imbalances. The fundamental problem is excessive government interference, i.e. funding and regulation, in the long-term care market. The only way progress will ever be made is to identify what causes the problem and address it with real market-based solutions. That’s what the Paragon Health Institute did in two reports: “Long-Term Care: The Problem” and “Long-Term Care: The Solution.” ------------------ 7/2/2024, “Older adults’ home equity tops $13 trillion in first quarter,” by Kathleen Steele Gaivin, McKnights Senior Living Quote: “Homeowners aged 62 or more years saw their housing equity grow by $328.5 billion in the first quarter, according to data released Friday by the National Reverse Mortgage Lenders Association. The increase brings older adults’ housing equity to a record $13.19 trillion, according to NRMLA. Housingwire reported that the increase marks ‘a recovery after decreases observed over the past year.’” LTC Comment: Good news indeed because home equity is America’s true LTC safety net when Medicaid, Medicare and Social Security fail. ------------------ 6/27/2024, “Battle Flares Over Long-Term Care Insurance Rate Hike Rules,” by Allison Bell, ThinkAdvisor Quote: “Some regulators want special rules for the oldest insureds and phase-ins of big increases. Trade groups said regulators should stick with rules meant to keep insurers in business. Genworth said some moves to soften rate increase blows may create confusion or lead to bigger total increases. … ‘Deviating from actuarial principles may lead to inadequate premiums, jeopardizing insurer stability and consumer protection,’ according to a letter to the LTC Actuarial Working Group signed by Jan Graeber of the American Council of Life Insurers and Ray Nelson of America’s Health Insurance Plans.’” LTC Comment: “Deviating from actuarial principles may lead to inadequate premiums?” Well, yeah. That’s exactly what’s happened to America’s big entitlement programs which are underfunded to the tune of many trillions of dollars. When the time comes to pay benefits, private LTCI carriers will be able to pay if regulators don’t hamstring them with un-actuarially-based requirements. Hard to imagine the government entitlements will be able to pay benefits, except in vastly deflated dollars. ------------------ 6/21/2024, “Protecting and Preserving Property When Paying for Long-Term Care,” by Christine A. Barone, The National Law Review Quote: “‘I have to sell my house to pay for my nursing home care.’ This is a common misconception among persons requiring skilled nursing home care and/or their family members. Oftentimes a person requiring long-term care in a nursing home will require Medicaid benefits to pay for that care as nursing homes costs can average anywhere from $10,000 to $15,000 monthly. Selling one’s home and using the proceeds to pay the nursing home is not the only option in these cases. A proper long-term care and asset protection plan, even if your only asset is your home, can protect the value of your property for your loved ones and/or for your supplemental needs and care. … As such, it is important to meet with a qualified elder law attorney to discuss your options in regards to property and qualification for Medicaid benefits for long-term care.” LTC Comment: Between this shyster and the hard-working LTC insurance agent, who do you think will make the sale? Still wonder why so few people pay premiums to get the coverage lawyers and Medicaid give away? Shame on The National Law Review. ------------------ 6/11/2024, “Revenue pressures driving home care consolidation, private equity’s growing influence, provider group says,” by Adam Healy, McKnights Home Care Quote: “Pressures such as insufficient government reimbursement and rising Medicare Advantage penetration are contributing to consolidation in home care and hospice, LeadingAge told regulators last week in response to a February request for information surrounding healthcare market competition.” LTC Comment: Crowding out small providers and commoditizing home health care does not bode well. The growing cozy alliance between big government and big business subverts the potential benefits from a freer LTC marketplace. ------------------ 6/8/2024, “Soaring premiums, denied benefits, delayed payments show crisis in long-term care insurance,” by Jeremy Olson, Star Tribune Quote: “The Minnesota Department of Commerce has to approve any rise in premiums, but it's proving impossible for the agency to balance its goals of protecting consumers from massive monthly bills and keeping private insurers in business. … A key miscalculation by insurers: They didn't anticipate the five-year rise in U.S. life expectancy since 1980, so they underestimated the number of people surviving long enough to need long-term care. Many plans also came with inflation adjustments that exponentially increased the value of their benefits, especially as policyholders outlived projections. Insurers also overestimated the proportion of policyholders who would cancel their plans. … Policyholders can cut premium increases by agreeing to reduced benefits — waiving future inflation growth or capping the dollar amount of benefits or the number of years they can be used. … Denials of benefits are increasingly common as policyholders beset with disabilities or dementia — or adult children taking on new care-giving roles — struggle with insurance paperwork.” LTC Comment: Hit pieces on LTC insurance are nothing new. I remember one especially virulent article that the New York Times brought to press on opening day of the 7th annual Intercompany LTC Insurance Conference in Dallas (LTC Bullet: Sucker Punched in Dallas, April 10, 2007). Just once, it would be nice to find some balance in media coverage. Maybe compare how miserably Medicaid and Medicare have done in managing LTC financing. Or mention the Federal Reserve artificially dropping interest rates to zero and crushing returns on carriers’ reserves. Or how about recognizing how well and creatively the LTC insurance industry has managed its challenges, creating new hybrid products and dealing with premium increases responsibly, unlike the government programs that cannot pay future claims but have done nothing to adjust. It would be nice to see some recognition that the vast majority of complaints about failure to pay claims turn out to be specious, based on expecting carriers to pay when contractual policy conditions are unmet. Don’t hold your breath. But do soldier on fellow fighters for LTC reform! ------------------ 6/6/2024, “Ageless Aging: A Woman’s Guide to Better Healthspan, Brainspan, and Lifespan,” by Maddy Dychtwald, Age Wave Quote: “Ageless Aging presents a pioneering new way for women to feel energetic, purposeful. and vital while gaining the upsides of aging, including more happiness, wisdom, and resilience. It provides a holistic action plan based on cutting-edge research that helps women take advantage of the scientific, medical, psychological, and spiritual tools, tips, and advice available to help women live better longer. It’s available wherever books, ebooks, and audiobooks are sold. You might enjoy some of Maddy’s recent interviews where she addresses many of the themes in her book: LA Times ‘Want to live to 100? That May Depend on Your Sex,’ MarketWatch ‘Women Live Longer than Men, but there’s a ‘Dark Side,’ and Barron’s ‘Women’s Guide to Retirement and Aging.’” LTC Comment: Another fine offering from the Dychtwalds, this time from Ken’s wife, Maddy. ------------------ 5/31/2024, “The Costs of the Rising Cost of Long-Term Care,” by Lee Pruitt, ElderLawAnswers Quote: “Do you have a family member who is receiving some form of long-term care? If you don’t, the chances are good that someday you will – and that day may not be too far away. … Long-term care insurance offers a way to safeguard against the high costs of long-term care, providing financial protection, choice, and peace of mind. However, it’s essential to carefully consider the cost, benefits, and your unique circumstances before purchasing a policy. Consulting with an elder law attorney, financial advisor, or insurance specialist can help in making an informed decision tailored to individual needs and financial situations. Contact an experienced elder law attorney near you today to talk further about your options for affording long-term care. They can walk you through the options that may be available to you and help you understand the benefits and costs.” LTC Comment: More Medicaid planner double talk. They used to pooh-pooh LTC insurance because it competes with their cash cow, Medicaid planning. But when putting affluent people on welfare got too much negative publicity, they changed their tune. Now they say, LTC insurance is wonderful, so come to us so we can tell you how expensive it is and that you should rejigger your income and assets to qualify for Medicaid. Legal fees are much less than insurance premiums. |