LTCi Current Events

LTCi Current EventsI’ve just returned from my third long-term care insurance (LTCi) conference of the year, where I again was told that sales of new LTCi policies were down 26.5% in 2013 in terms of premiums and 22.9% in terms of number of policies. That’s the bad news.

The good news is that we have many excellent products to help people prepare for the high risk and cost of needing long-term care. Some are new and some are traditional LTCi products. The newer products are non-traditional life insurance and annuity policies specifically designed to protect for LTC. These products greatly leverage premiums paid in if long-term care is needed. These new products are good; the bugs are out. They work.

LTCi premiums can be made reasonable and affordable. What may not be reasonable is needing LTC for anything but a short period of time and not owning LTCi.

If you are middle class-to-affluent, it is irrational to put off responsible LTC planning.

Sadly, most people remain irrational about the need for responsible LTC planning. There is something about the human psyche that dislikes having conversations about unpleasant, yet probable events in the future. I meet many people who can afford to own LTCi, yet instead they spend the cost of LTCi premium on “toys.” Such people are often financially and emotionally unprepared when the need for LTC arises. Sadly, such circumstances will increase as time passes.

This past year, the media has been more helpful than ever when it comes to broadcasting why the government can’t and won’t pay for LTC, as well as how important it is for Americans to plan for LTC on their own, in advance.

Despite this, Americans still refuse to acknowledge this grim, true advice.

Medicaid, a government funded program, pays for the majority of LTC in the US. Click on this link to see my blogs on why Medicaid-funded LTC is not the type of care people who own LTCi would choose.

Please share this information with people you care about. Do not be discouraged when they make up excuses to avoid LTC planning; instead, I hope you’ll keep trying to influence them. The time to plan and be prepared for LTC is now.

Promises That Can Bend Without Breaking

Bending Without BreakingPromises That Can Bend Without Breaking is the title of a Modern Love column in the New York Times. I am a faithful reader of Modern Love. Each column features the most intimate, interesting, and unusual aspects of loving relationships.

This column features a couple, married 28 years, who live in an assisted living facility. They are only 49 and 50 years old. He is perfectly healthy, but his wife is suffering from dementia that is comparable to mid-stage Alzheimer’s disease.

As odd and unusual as it is to see people this young living in an assisted living facility, this is the right solution for them. With this arrangement the husband can be with his wife and safely continue his full-time job.

The column reads like an obituary of sorts, and that’s what it essentially is. The couple had a wonderful, joyous, interesting marriage for most of their 28 years together until the wife’s health issues occurred about six years ago.

Because they have the income (he is still working) I must guess they can afford assisted living, which normally runs $4,500 – $6,000 per month. (Here is Genworth’s current Cost of Care Survey.) I am nearly certain she does not own long-term care insurance.

The author talks about the marriage commitment, “until death does us part.” No doubt this commitment is much easier for this couple to uphold because sufficient money is available.

This column also illustrates the fallacy of a common objection to long-term care insurance (LTCi) purchase: “I’m too young; I’ll wait to purchase LTCi.” Sadly, at age 43, the wife in this story became uninsurable. Then she began to need the care LTCi would have paid for.

People who are insightful and mature enough to purchase LTCi in their 30’s and 40’s save a lot of money on their LTCi by capturing much lower premiums.  They also lock in their policies when they are still insurable, so they don’t have to deal with unexpected tragedies without the resources of an LTCi policy.

Testimonial for LTC insurance

LTCi TestimonialAn obituary of Gaye McCutchen,  who was highly educated and accomplished, deliberately makes mention of the long-term care insurance (LTCi) she owned, and how beautifully it worked.

I cannot tell from the obituary whether Ms. McCutchen collected from her policy for days, months, or years. But I can tell from the obituary that her LTCi made a striking difference in the quality of her life.

Here’s a quote from the obituary:

“Thankfully, her foresight in purchasing Long Term Care Insurance (LTCi), many years ago, made it possible for her to use her policy to pay for excellent home care during her illness. We thank all of the caregivers provided by Home Care Solutions, but special thanks go to Emelda Buezo and Charlene White. Gaye loved these dear ladies due to their warm and caring nature and upbeat spirit.”

Maybe Ms. McCuthen had the money to pay for all the care she needed from her savings. One thing I have observed, though, is that when people are sick, they don’t have time (or often cognitive ability) to finagle/buy/sell/liquidate/re-organize their estate to pay for unplanned, expensive long-term care costs. Often, the treatment of their illness is all-consuming, time-wise, physically, and emotionally.

People (and their loved ones) dealing with illness are often fearful and in no position to shrewdly re-arrange their finances. We often see affluent people who can afford the right long-term care resist getting the type of care they need.

Being ill and physically dependent, after a lifetime of independence is an incredibly sad thing. It must only compound such sadness when savings start flying out the window to pay for care costs, as well.

LTCi ownership is about having dignity, options and choices without hesitation or pause, just like Ms. McCutchen did. It is necessary to plan in advance if you want to ensure the type of quality outcome Ms. McCuthen had. LTCi premiums are not necessarily expensive. What can be expensive is needing long-term care for anything but a short period of time, and not owning LTCi.

Nursing Home Murders: Connecting the Dots with Medicaid-Paid LTC

Connecting The DotsWith permission from The Center for Long-Term Care Reform, I republish their Monday, April 28, 2014 post about my prior blog.

The reason I chose to cover the horrific nursing home murders still in the headlines here in Houston, is because there is a link between failing to plan responsibly for long-term care well in advance and tragic outcomes, whether or not they’re of the magnitude of the Lexington Place murders.

Many who can afford reasonably priced long-term care insurance simply won’t entertain it. They make excuses to avoid such conversations. It’s an uncomfortable conversation to have.

The horror and negligence that occurred at Lexington Place Nursing Home may be isolated (or maybe not since most of us choose to turn our heads away from this type of event). Even so, the importance of these posts is to understand that such events may be indicative of a widespread trend that’s just beginning.

I’ve chosen to cover these tragic murders because to me, they’re the tip of the iceberg. The industrialized warehousing of the indigent who need care will increase as our national debt grows, Medicaid and Medicare reimbursements continue to drop, and the partisan stalemate in Washington continues.  And this financial catastrophe is approaching at an increasingly rapid rate as government programs are deluged with unprepared Baby Boomers who need long-term care but did not plan for it when they were able to afford and obtain reasonably priced long-term care insurance (LTCi). Sadly, events like the Lexington Place murders may become more common.

This blog and the one before it are meant to educate. If these tragic posts help even one person wake up and decide to defer their purchase of a new flatscreen TV or more expensive car in favor of buying a reasonably priced LTCi policy, they’ll be worth it.

LTC E-Alert #14-014:  The Nursing Home Murders and LTC News and Comment

Monday, April 28, 2014

Seattle -

LTC Comment:  Did you see the news coverage last week about two nursing home residents bludgeoned to death by their roommate in Houston?  We opted not to cover it then, but the story does illustrate an important point.  Nursing homes, especially those in poorer areas, are heavily dependent on Medicaid which pays them less than the cost of providing the care.  Generous Medicare reimbursements help to make up part of the shortfall (at least for now), but the nursing homes most heavily dependent on Medicaid resort to cutting caregiver staff to a minimum and paying extremely low wages in order to operate.

So what?  Well, Honey Leveen, the self-proclaimed “Queen of Long-Term Care” and the Center’s Regional Representative in Houston, draws out the ramifications in her recent blog post here.  We encourage you to read it and to follow her links to more of the background.  Honey points out that the nursing home in which the murders occurred has “nearly all” Medicaid residents.  She opines that inadequate revenue led to dysfunctional management which resulted in poor care and finally in this awful crime.  She links to an earlier article she wrote for LifeHealthPRO questioning the value of “Partnership” policies that leave people dependent on Medicaid’s mostly nursing-home based care.

This is sad stuff, but information all LTCI producers should consider as they advise clients on long-term care planning.

If I’m Not Here, Call Claim Jockey

Claim Jockey LogoWhile at the recent Society of Actuaries Long-Term Care Conference, I met with Wendy Rinehart, the owner and founder of www.ClaimJockey.com. Claim Jockey performs a much needed service.

I often forget how spoiled my clients are. I’ve been answering their calls, offering guidance, and explaining how their LTCi policies work for 23 years now. This is highly unusual. I often have clients surprised when I pick up the phone and they find me still alive, well, accountable, and happy to take whatever time is necessary to counsel them about how to collect from their LTCi. I also often recommend germane services based on the circumstances they describe. To the consternation of some clients, I also offer advice and opinions, whether or not I’m asked!

After doing what I do: selling and servicing long-term care insurance (LTCi) for many years, Wendy became aware of a crying need not being tended to. That’s why she founded www.ClaimJockey.com.

What happens when there is no agent like me around? This is the case for most LTCi policyholders. I believe the majority of agents who sell LTCi do not achieve success and are therefore not available and accountable to their clients after the sale. When policyholders call the name and number on the business card stapled to their policy, they often don’t find their agent.

LTCi policyholders often try to call their agent when they need help urgently.  This can be a very scary time. It’s sad that at the point when many are more vulnerable than they’ve ever been, there is no one trustworthy to talk with.

This is where Wendy and www.ClaimJockey.com step in. Claim Jockey can interpret and explain the caller’s LTCi policy. They can assess whether a claim is warranted. And they can assist with the claim.

I salute Wendy for recognizing these needs and creating www.ClaimJockey.com. She and her staff are truly helping with a great need.

Moving Story About How Long-Term Care Insurance Works

What follows is a true story about a friend and colleague. An extraordinary health event occurred. My friend’s long-term care insurance (LTCi) kicked in, exactly as planned. LTCi has provided dignity for my friend and her family, plus choices and options that would otherwise not be possible.

My Story: Talking the Talk and Walking the Walk

by Allan Shoff 

LTCi DignityThis is the story of my wife, Karen Shoff, and the role long-term care insurance has played in our lives.

Karen is the love of my life. We’ve been married for 33 years. She was active, passionate and accomplished in her varied life endeavors. Our rich family life was a huge source of satisfaction to Karen. We have two grown children, 12 grandchildren and one great grandchild. Our daughter, son-in-law, and five of our grandchildren have now moved back from Israel to help with Karen’s care. 

In 2009, Karen had some tingling in her left arm. We went to Cedars Sinai Hospital’s emergency room where they did several examinations, including a brain scan. There were problems with the machine’s calibration—and with the technician giving the brain scan. Karen got eight times the recommended radiation dosage. Within a short time, she began to experience memory loss. We were part of a class-action lawsuit and received a fairly paltry settlement, which only paid for about eight months of Karen’s care.

Over the past four years, Karen has continued to lose function. She no longer speaks to people or interacts with anyone at a personal level. She has some pain, but more discomfort and fear of falling. Music therapy has been helpful to her, but over the past few weeks, she has become more and more withdrawn, spending virtually the whole day with her eyes closed, and communicating very little with anyone. 

Many readers of this newsletter know of Karen. Karen was one of the most passionate, knowledgeable, reputable, accomplished long-term care insurance specialists in the country. She was a visionary and a true leader. She was a featured speaker at NAHU’s 2001 National Convention and a long-time member of the Million Dollar Round Table. She was always seeking ways to give back to the insurance profession and the world. She did whatever she could to foster interest in long-term care insurance education and responsible financial planning. 

Karen has her undergraduate degree from Cornell, a master’s from Smith College School for social work, and a master’s from the Leonard Davis School of Gerontology at USC. The early part of her career was spent as a social worker at a nursing home. 

Karen’s experience as a nursing home social worker made a huge impression on her. In addition, her own experience with her father compelled her to write her widely acclaimed book, “There’s No Place Like [A Nursing] Home”. You can learn about this book and buy a copy at www.longtermcarela.com or email me at shoffandshoff@earthlink.net. Many advisors have found the book to be a powerful tool in their practice. 

The book intimately tells the story of our experience caring for my father-in-law at home. At age 97, my father-in-law suffered a massive stroke. His doctors told us they did not expect him to survive more than a week. Against all odds and advice, but with the wholehearted support of our family, we flew Karen’s father from New York to our home in Santa Monica, CA, and provided him with 24-hour care for the last 11 months of his life. Due to the excellent care Karen arranged for her father at home, he exceeded all expectations and regained his speech. Although he would not re-gain other skills, he found pleasure reminiscing and participating in other facets of family life. Karen publicly expressed, as often as she could, how precious to us all his last few months were.

Thank goodness Karen talked the talk and walked the walk by placing ample long-term care insurance on herself.

 Karen has been using caregivers since August 2011. At present, she has 24-hour care with three regular caregivers. One is a nurse who spends about 15 hours a day here, plus two additional part-time caregivers. In addition, our daughter, son-in-law and grandchildren all help in various ways. I do what I can, but the whole situation is very trying for me.

 Karen owns two CNA LTCI policies, each with lifetime benefit periods and 5% annual compound growth increases. These policies cover about 85-90% of Karen’s care expenses. Without her LTCI, the necessary, dignified, loving level of care Karen receives would be entirely impossible.

The relationship between money and a dignified, peaceful death.

Along with my prior blog about choosing the right healthcare proxy, my dear friend also consented to share the following, intimate account of her father’s passing, as a service to readers of this blog.

I am conveying her story because it is the perfect example of the difference having ample money to pay for long-term care makes.

Money creates options. With money, comes access to higher quality long-term care. If you don’t have many millions of dollars saved, you must rely on long-term care insurance if you wish to access high quality long-term care.

As you read this story, imagine how different D’s father’s end of life would have been if he had not had ample money to pay for the independent living community plus the 12-hour a day home health care her father needed. Most families do not have the wealth to do this.

D’s father required rather extensive care for about seven years at a total cost of nearly one million dollars.  This would obviously be a financial catastrophe for the typical American family, in addition to causing physical and emotional sacrifices for most families. Fortunately, all three siblings agreed to spend as much wealth as necessary on their father’s care. This is not always the case. As you read D’s story, you will see that because her father had superb care from others, D did not have to provide daily  hands-on care for her father. However, D was actively involved in checking on her father’s care – which contributed significantly to its high quality. She also provided essential emotional support to her father on a daily basis. 

This combination of no financial stress plus D’s daily presence by phone or in person over a 7-year period undoubtedly extended his life and significantly added to its quality. 

LTCi ownership is about making sure you have access, dignity, options, and choices if you need long-term care, at minimal financial, physical, and psychological sacrifice to those you love most.

 

D’s story:

Dad moved into independent living with an aide. He had end-stage macular degeneration & hearing impairment.  Having an aide enabled him to have a better quality of life, interacting with others. He made new friends, lost others, but powered on. Managing Dad’s care was my full-time job during his final years.

I took Dad for his check-ups, especially his pulmonologist, a wonderful caring man. Dad had been on oxygen constantly, for the last 3 years as his lungs were failing. I was unhappy about Dad’s color, so I took him for a check-up. I received the news that the end was near and it was going to be bad. The doctor was right. Witnessing my father’s death was gut wrenching. I was determined to make Dad as comfortable as possible.

Dad’s last week was spent gasping for air, completely overheated, sweating profusely. When I called, he had kept hanging up the phone on me. I did not realize how close the end was because of this.

Dad’s 97th birthday came, he woke and asked if he was 97 yet. Then he said “Good!” and went back to sleep. Close family and friends spent his birthday sitting with him, talking to him, holding his hand.

Periodically, I would ask him if wanted to be held, he would nod yes. So I would get in bed with him and hold him. At one point, he started patting my tush and I reminded him that I was his daughter. He replied, “ I diapered that tushie, it’s mine,” laughed, and fell back to sleep.

Hospice had been called, but they were a bit late in arriving. By then, his whole body had quieted down, no more gasping for air like a fish out of water and profuse sweating. The RN said he was ready to go, based on his posture, appearance, and his not waking anymore. The purpose of Hospice was to give liquid Morphium to ease my father’s suffering.

Two days after Dad’s 97th birthday, on the last night of Passover, he died. He had fun, joy, laughter delighted in his family and grandchildren. He was always the best dressed man in the room. I can also say he was not always a joy. He could be oh so cranky, with the best of them, but witty. We had a standing date every Wednesday and he sang me good-night every night, in that croaky voice that couldn’t carry a tune with a bucket.

 

Choosing a Healthcare Proxy and Long-Term Care Planning

Planning for long-term care and choosing a healthcare proxy (HCP) must both be done as far in advance as possible, with as much honesty as humanly possible.

Be very sure that the people you choose as your HCP will carry out your wishes.

Both are done because people wish to have the highest possible caliber of care, dignity and options, even if they have limited, or no capacity to make decisions.

Choosing the right HCP also ties in to long-term care insurance (LTCi) purchase because both are done out of the utmost consideration and love of others.

Both actions are done to ensure the least amount of stress and discord for surviving family and friends.

The following is a true story, shared by a very close friend:

“Because my father did not want my sister to feel left out, he named her as his second health care proxy (HCP). That was a bad decision and the wrong reason to grant a HCP.

My Dad lived a long and very productive life, retiring at 87. As he approached 90, some medical issues that he had since his late 20’s became much worse.  But each was survivable.

With Dad’s consent, my siblings and I decided that there would be no surgeries or heroic measures taken to keep him alive. 

Despite his failing health, Dad was astute and very capable of managing and understanding his business affairs. He ably directed his wishes. He appointed our brother Power of Attorney. As Dad was filling out the HCP form with his attorney, he said to me, ‘You are number 1. You will make my medical decisions with and for me, as you have been doing for years. I have to give your sister something, or she will feel totally left out, so I am making her #2. I do not want her husband  involved in the decisions.’ Dad also had a Do Not Resuscitate (DNR) order, much to my sister’s surprise.

 For years, I took care of all of Dad’s medical care.  My sister only visited from time to time, when Dad was hospitalized, or to spell me for a day or two. She had a family, lived out of town and was busy with her life. The key thing Dad didn’t want was to die in a hospital with tubes sticking out of him, strangers around him, alone. He was very clear about this.

My sister chose to ignore our father’s DNR, along with his wishes. 

My sister was visiting.  Sitting in Dad’s living room, She heard Dad’s agonizing gasps but chose to overlook them. She did not call me. When I got there, she said to me cheerily, ‘what’s up?’ 

I dropped my things on the floor and immediately went to Dad; I knew this was it. That sound, that sound, that unmistakable sound was horrifying. I believe my father was in pain. Unnecessary pain. I do not understand how anyone could sit in a room obliviously over-hearing painful gasps. She did look in on him from time to time, but she was out of touch with reality. She continued texting, making calls, laughing, etc.

Once I got there and she acknowledged the severity of the situation, she said, ‘I am #2 HCP and my husband says Dad should be in the hospital with an IV drip for his dehydration and someone should work on a small bedsore that had appeared in the last few days and he should be intubated.’

 My father’s lungs had ceased to function. Her behavior was nuts. I replied, ‘Your husband is not the one with the HCP and you cannot delegate. You can refuse your responsibilities or do what Dad wants. This is the end. The RN has given you the facts. I can have the MD call you directly to tell you the same thing.’  My sister insisted on calling her husband. Our brother had to assertively remove our sister from Dad’s apartment.”

A very difficult situation was made much harder just by the bad choice of a HCP.

Make sure your wishes are known. My attorney has a copy of my last wishes to back up my HCP, just in case some stranger butts in to change your decisions.

My advice is make sure that those you select as HCP are chosen for the right reasons. They should be reliable, in the loop on medical status, doctors, meds. They must be capable of making decisions without consulting a spouse or someone else for every move, and they must be able to defend your wishes and act in your best interests, first and foremost.

 

Sign that I’m Getting Old: I See Actual Evidence of Income Inequality

In my prior blog, http://honeyleveen.com/2014/income-inequality-is-here/, I gave irrefutable proof that income inequality is here. Due to the human tendency to deny facts that are unpleasant, it is often difficult for even smart, educated people to acknowledge this.

The email below comes from an informed prospective client who works in the long-term care industry. Every day she sees families in crisis, largely because their loved one does not own long-term care insurance (LTCi).  She believes LTCi is the only solution for middle-class people who want to secure their dignity and options, should the probable need for long-term care arise. She sought my help upon the strong recommendation of her friend.  We had a good rapport, and I showed her reasonable LTCi premiums. At the point of placing her LTCi application, she froze in fear, like a deer in headlights :

“Honey,

Just wanted to touch base with you. I want to be respectful of your time. My week became crazy at work. Things went haywire with individuals quitting and getting laid off. I am going to hold up on my long term care insurance. I will pay the increase when I get the insurance. I may be getting laid off. I will know some time in Feb. I do not want to take on added expense until I know something. Thank you kindness and patience with me. 

Tracy”

When I began selling LTCi 23 years ago, I did not get many objections like the one above. True enough, there was horrid, incorrect, sometimes scathing media coverage of LTCi in those days. This is not as true nowadays. People were also convinced Medicare would pay for their long-term care or that their kids would care for them. Thankfully, both of these myths have been largely dispelled.

Now we have income inequality replacing the obstacles described above and throwing a wrench into what I believe would be an otherwise thriving LTCi industry.

This is sad to me. With the presence of income inequality, there is a stronger than ever need for LTCi ownership.

 

 

New study shines light on family long-term care providers

A new study by the AARP Public Policy Institute and the United Hospital Fund reports on just how much care, and what type of care employed family members (unpaid caregivers) provide. The findings are alarming. They show that despite their workplace obligations, nearly half of all employed family caregivers perform many of the tasks we normally associated with licensed health care professionals, including a range of medical/nursing tasks, such as medication management, wound care, using meters and monitors, and more.

An earlier report by the same authors found that nearly half of family caregivers (working and non-working, combined) nationally performed such medical and nursing tasks. This new report shows that family caregivers who also work, perform medical/nursing tasks at about the same rate non-working family caregivers do.

These findings surprised the researchers, who expected more of a difference between the extent to which employed and not-employed caregivers perform medical/nursing tasks.

The report also examines the characteristics and stress levels of working versus unemployed family caregivers. No surprise here: employed caregivers have more stress.

Much of the stress family caregivers face would be alleviated with the presence of long-term care insurance.