A video is worth 1,000 words

Click here to see a video featuring former journalist Meryl Comer candidly, poignantly describing  how her life was turned upside down because she and her husband were unprepared for his Alzheimer’s diagnosis.

Now, in 180 degree contrast, watch this video illustrating the night and day difference long-term care insurance ownership makes for people and their families.

To Move or Not to Move…

Many elders insist on staying at home, rather than transitioning to an independent or assisted living facility.  I’ve been advising against doing this for years. Long-term care at home may cause isolation or possibly even caregiver abuse. Existing studies already prove the importance of social interaction for those needing LTC. Staying at home is not as safe from a medication management, home maintenance, proper nutritional and safety and security standpoint, either. Now, a new study, titled, “Myths & Realities of Continuing Care Retirement Facilities (CCRC’s)”  backs me up on this.

The study was performed by nationally recognized gerontologist Ken Dyhtwald of Age Wave and sponsored by Vi (71 South Wacker Drive, Suite 900,Chicago,IL 60606), a leader in senior living that currently operates ten continuing care retirement communities (CRCCs). 

 With careful research, the study debunks these five “myths:”  

1. “My current home will be the best possible place to live in my post-retirement years.”

2. “My current home is the best option to continue an active social life and stay connected with my friends.”

3. “It’s less expensive and more financially secure for me to stay in my current home.”

4. “It would be easy to get any care I need at home.”

5. “CCRCs are filled with old people who are sick and dying.”

The cost of Vi’s typical CCRC is approximately $2,800 per month, which covers rent, food, and all social/learning activities.  Even if your mortgage is paid off, property taxes, home insurance, utilities, food, transportation, maintenance/repairs, etc can add up to a very big number! 

 When it’s time to progress to assisted living, compared to the average $55,000 per year cost for home health care, the average cost of $39,000 per year in an assisted living facility looks pretty attractive.

 And, as always, the good news is that home health care care or assisted living at a CCRC will be covered by your long-term care insurance policy. 

I urge all seniors to visit some CCRCs in their area to see what a supportive, friendly home they offer.  I think you’ll find that these myths fade away very quickly.




In Daddy Issues: Why caring for my aging father has me wishing he would die (Atlantic Magazine, March 2012), Sandra Tsing Loh presents a personal account of the stress and sense of futility and eventual desperation she feels in her struggle to care for her aging father. 

Ms. Loh begins with Gail Sheehy’s description of the freedom 50-year olds experience after the kids are grown and their parents are enjoying their “golden years” by cashing in on frequent flyer miles to travel the globe – which differ from Ms. Loh’s experience as much as heaven differs from hell.

In fact, over 70% of all Americans over 65 will need some form of long-term care, and although Ms. Loh’s experience is extremely difficult, it is not uncommon.  Her account begins with her father’s plan that his much younger wife would care for him. This failed miserably when her signs of dementia began to occur at the same time he declined dramatically.

She continues with her futile attempts to hire caregivers (at her own expense), most of whom quit the first day because her father is such a difficult case.  Once she finally finds someone who can handle her father, she and the caregiver form a team, and the need for her substantial role wreaks havoc with her own life.  

This article is quite long and very difficult to read.  Her sad story and her honesty about her struggle are very provocative.  Many readers commented that the author is a self centered bitch, while just as many laud her for her candor and humor. Still others commented in spectacular detail about their resentment & anger towards their own needy parent. 

Since I see or hear about variations of this dilemma every day, I admire Ms. Loh’s candor and courage in telling her sad story, which she expressed with great honesty and a sense of humor. 

Anyone who takes the time to read it will want to own long-term care insurance.


The Cost of Entitlements Just Goes Up and Up

“Even Critics of Safety Net Increasingly Depend on It” (NY Times, Feb. 12, 2012, pp. A1, 24) presents frightening trends that threaten the well being of every American.  A myriad of benefits programs provided over $6,500 for every man, woman and child in the US in 2009, a 69% increase from 2000.  And although the primary objective of these programs was to keep Americans out of poverty, the poorest Americans no longer receive the majority of government benefits. 

Trends in the need and cost of these programs are sobering.  Nearly 50% of Americans lived in households receiving government benefits in 2010, up from 38% in 1998 and 44% just before the recession in 2007.  And spending on medical benefits is projected to rise 60% over the next 10 years.  As the baby boomers age, the number of Americans covered by Medicare will increase by one-third.  These increases will make spending on medical benefits higher than every other expenditure in the federal budget expect interest on the national debt – higher even than the money invested in education or defense!

And where will the money come from to cover all these national expenses?  Not from the taxes we pay.  For example, “a 45-year old woman who earns $43,500 in 2010 will pay taxes worth $87,000 to the federal government by the time she retires, BUT the government will spend $275,000 for her medical care before she dies.  As the economists say, “There is no free lunch.”

As the boomers age, increasing numbers of them will also need long-term care, which is covered by Medicaid or personal funds, NOT Medicare.  And, of course, the demand for long-term care will continue to increase – even as Medicaid funds shrink.  How sad…

One way to maintain your dignity in your final years AND to minimize physical, emotional and financial stress on your family is to own long-term care insurance to cover these expenses that can average over $70,000 per year.  You owe it to yourself and your family to give this option careful thought.

Perfect Storm Brewing in Texas Assisted Living Facilities

In “Budget cuts elicit fears for elderly” (Houston Chronicle, January 30, 2012, B1, B5), Renee C. Lee documented some frightening trends in Assisted living (AL) facilities throughout Texas.

As in virtually every state, the eldest Baby Boomers are turning 66 this year and the number of Texans needing long-term care will continue rising for the next two decades.  On a positive note, the number of AL facilities has increased from 1,355 in 2000, to 1,440 in 2007, to 1,621 in 2011.  Unfortunately, this growth is a mixed blessing because there are nearly 20% more facilities that must be periodically inspected to ensure that state regulations for the industry are being met.  And Texas has been slow to revise current regulations to adjust to the growing demand for long-term care. 

Second, the TX Department of Aging and Disability Services recently eliminated 60 inspectors who enforce state regulations!  Consequently, the typical AL facility will be visited every 18 to 24 months.  Even before the cuts in staff, horror stories of bedbugs, physical and sexual abuse by staff, and failure to report missing residents abound.  The only rational conclusion is that less inspection will result in failure to detect more mistreatment of the elderly.

Third, “Texas requires as little as 16 hours of on-the-job training for attendants, allows medication to be administered without a license and doesn’t require specific staff-resident ratios,” Lee reports.  Carmen Castro, an advocate for the elderly, referred to this situation as “the Wild West.”

So there you have it – a sobering combination of increasing need, less frequent inspection, and inadequate training and requirements for attendants is brewing in Texas (and very likely in many other states).  These conditions can only lead to more misery for our parents and grandparents – and ourselves – in their final years.

One solution, so course, is for seniors to be very careful to choose only the most reputable, well staffed AL facilities with the best endorsements from current residents.  Sadly, however, the high cost of quality AL can severely drain the life savings of many Americans needing long-term care.  So many must settle for the cheapest facilities they can find.

On the other hand, Americans who own long-term care insurance (LTCi) are armed with financial resources that enable them to be much more selective about the type of facility they choose.

Word of the Long-Term Care Crisis is Spreading

 “The long term care system in Hawaii is broken, “according to the December 13, 2011 Draft Final Report of the Hawaii Long term Care Commission (http://www.publicpolicycenter.hawaii.edu/documents/LTCC_FINALREPORT_draft14dec.pdf. 2424 Maile Way, Saunders 723,Honolulu,HI96822).  And as noted in several previous blogs, the crisis will get worse because of the aging of the Baby Boomers.  Furthermore, the population from which care givers are drawn is beginning to decline. 

 Members of this Commission clearly “get it.”  They note that 75% of people over 65 will eventually need some form of long-term care (LTC) and that people need to begin planning for this prospect well before they reach their 60s.  The report also cites an average cost of $80,000 per year in a nursing home and the lack of public funds to cover these enormous costs.

A recent survey (2011 Long-term Care Consumer Survey and Quiz Results John Hancock Life Insurance Company U.S.A., Boston, MA02117. https://www.jhltc.com/uploadedFiles/PDFs_for_Newslinks_and_Banners/January_2012/ltc_6284_0112.pdfo) includes encouraging evidence that public also “gets it.”  In a sample of 1,000 Americans aged 21 – 75, 82% agreed that it is irresponsible not to plan for the cost of long-term care.  On the negative side, however, only 11% actually own long-term care insurance (LTCi).  And while 62% agreed that LTCi was the best way to do such planning, only one-third were inclined to purchase a policy in today’s economy.

So news about the growing need for LTC and the lack of resources to fund care is getting to the public.  But Americans are still reluctant to invest their own money to purchase insurance for their own LTC.

The solution to this perplexing & frustrating problem is nicely summed up in the Hawaiian Commission’s first two recommendations:

“Conduct a long-term care education and awareness campaign

Treat the risk of needing long-term care as a normal life risk” (p. 10)

This has been my mission for over 20 years.

Is group Long-Term Care Insurance cheaper or better? Quite doubtful.

There are quite a few reasons why, more often than not, employer-offered long-term care insurance (LTCi) is not a better deal than a comparable individual policy.

According to a January 7, 2012 Wall Street Journal article by Leslie Scism, “When Should You Buy Insurance from your Boss?”, “Many people assume insurance offered by their employer is a better deal than they can get on their own. But while the premiums can be lower, such policies have drawbacks.”

LTCi Specialist Andrea Graham of Upstate Special Risk Services, Inc. inRochester,NY (thanks for allowing me to publish this, Andrea!) adds, “My background is employee benefits, and I will tell any producer who asks, individual LTCi is always better than group, even if the price is the same or higher.”

“Group insurers know they are dealing with working people, a generally healthy population. These carriers are also dealing with ‘young’ ages on average; in 20 years I had one death claim on an employee. Some types of insurance, dental for example, might only be available to a group – likewise for some health insurance benefits or riders. For this reason, employee benefits at the larger companies that offer group LTCi are usually very good (think GM, IBM), and employees rightly feel that their group benefits are better and cheaper than anything they could buy on the individual side. So they are dumbfounded to find that they can get a nicer LTCi policy, usually for the same or less premium, by shopping the individual market!”

“This is because all employee group benefits disappear or reduce significantly when the employee turns 65 and/or retires, and the carriers offering these coverages know full well that their risk is based on actively-at-work full-time young(er) employees. Hospitalization turns into Medicare. Any group life that might remain is reduced to a small death claim. Group disability stops when the employee stops working, and most employees do not offer dental or vision coverage to retirees.”

“Group LTCi is the only benefit a retired employee carries out the door with them, the only benefit that continues to grow in value just when the risk increases for the carrier. Carriers who specialize in guaranteed-issue group (John Hancock, Met Life, Prudential, CNA) are well aware of this, well aware of the adverse selection they will be accepting, well aware that they’re lucky to get 10 percent of employees to enroll”

“Therefore, these policies are more restrictive, offer fewer choices, and are usually more expensive than individual coverage, especially if the employee wants to include inflation protection.”

“You will never see 100% home care benefits in group coverage; you will have a 90-day elimination, no more no less, and no other riders are available. The community-care benefits in a LTCi policy are what matter, tell me what you’ll do to keep me out of a nursing home! Group contracts offer very little in the way of bells & whistles, they may say they’ll provide “informal” care but read the fine print, highly restrictive and informal might mean ‘not a home care agency,’ very little in the way of assistance or on-site care coordination which can be so valuable to a family. Most group coverage does not qualify for state partnership asset protection programs; they don’t try as most employees wouldn’t pay for compound inflation anyway.”

“There are employer-sponsored small groups, where better policies are available although maximum benefits might be restricted, but these would not be guaranteed issue although you might get some underwriting concessions for employees; most carriers offer some version of this type of group and I’m not including these small groups in the discussion above.”

Let me throw in my two-cents-worth!  In addition to agreeing with everything Andrea states, I want to emphasize that group LTCi typically has only one rate band and does not offer spousal discounts. Married people, and/or those in Preferred health, are penalized, in terms of rates, and “subsidize” the premiums of those in poor health. Therefore, if you’re not very healthy, especially if you’re also single and/or older, group plans may be a good deal for you.

In my opinion, choosing the right LTCi plan is very difficult for a typical employee and as a result, many group LTCi offerings have a low “take up” rate. My experience is that many just put off acting on their group LTCi offer because the choices are so complex and potentially confusing.

The very worst thing I see on a regular basis is someone’s insistence that their group LTCi is cheaper than any individual policy I can show them. Indeed, many have boasted that their LTCi is a bargain at only $25 or $50/month. But these premiums are that low primarily because they’ve chosen a policy with no built-in inflation protection. When I do an “apples-to-apples” comparison with an individual policy, the group policy’s cost is always higher. I emphasize again: group LTCi is not cheaper for the reasons Andrea and I have given!

LTCi purchased without automatic, built-in inflation protection, is often dangerous for policy holders. Such coverage can cause clients stress and insecurity in later years when they realize that their group LTCi’s benefits have not kept pace with the current care costs.