Why Medicare Can’t/Won’t/Doesn’t Pay for Long-Term Care

Motley Fool LogoNo one researches and easily, clearly explains the need for responsible long-term care planning as well as The Motley Fool.

In their January 4, 2015, The Motley Fool explains why Medicare doesn’t/can’t/won’t pay for long-term care. They also advise people to prepare for long-term care costs ahead of time.

Motley Fool, I admire and love you! You do your readers — and the world — good, by explaining things succinctly, with great insight.

Nursing Homes Imperiled

Happy New Year, all!

Nursing Home CareI gave a larger than average end-of-year donation to Seven Acres, the Jewish nursing home here in Houston. It has a reputation of being top notch, in relative terms. It is as top notch as possible for a Medicaid-accepting, money-losing nursing facility. I have heard from friends with loved ones at Seven Acres that there are too few caregivers. Loved ones often wait a long time for help to come. Seven Acres is the best that any primarily Medicaid-funded nursing home can be. Unfortunately, even the best Medicaid-funded nursing homes have too few caregivers and tend to be warehouses for the elderly and infirm.

Here are just a few of the blogs I’ve done on the unsustainable state of long-term care (LTC) finance in the US: http://honeyleveen.com/?s=nursing+home. Because Medicaid pays less than it actually costs to provide care, most facilities run in the red. This causes them to cut corners on the quantity and therefore, the quality of care they can provide.

In its annual solicitation letter, Seven Acres states that in 2013, it “provided over $8 million in charitable care to over 85% of its resident population who rely solely on inadequate Medicaid funding.”

I feel bad knowing that my donation is a drop in the bucket and will not help with Seven Acres’ over all financial problems.

Increased demand for long-term care (LTC) and decreased Medicaid reimbursements will cause Seven Acres to continue to run in the red, in what I foresee as a continued downward spiral.

My donation will have no effect on potential changes and reforms that will be necessary to preserve Medicaid-paid LTC for our most vulnerable citizens. It will also have no effect on making political changes that are necessary to gain control over our country’s out-of-control Medicaid expenses.

The moral: take charge of your own future dignity and choices with a reasonably priced LTC insurance policy.

How’s Your LTC IQ? Take a Fun Quiz

LTCi IQ TestI hope you’ll enjoy taking the quiz below. I used it with great success at a talk I gave yesterday. I awarded a lottery scratch-off ticket to each person who gave a correct answer (I gave them printed copies of the article and told them where to find the answers). My students were quite engaged and seemed to enjoy it.

The questions below come from an October 28, 2014 US News and World Report article called, You’ll Likely Need Long-Term Care, But How Will You Pay for It? This article is great because it’s accurate, brief, straightforward, and well-researched. The article links its statements to the studies documenting them.

Long-Term Care (LTC) IQ QUIZ

1) What percentage of caregiving is done by unpaid family members and friends, including spouses, children and relatives?

2) What percentage of unpaid caregivers had to make financial sacrifices?

3) What is the #1 cause of bankruptcy in the US?

4) Nationwide, what percentage of LTC costs does Medicaid pay?

5) What percentage of Americans own LTC insurance?

6) What percentage of Americans are concerned about LTC costs?

7) What is the correct age to consider buying LTC insurance?

8) What is the annual cost of nursing home care?


1) 90%. I’ve done prior blogs on this.

2) 37%. I’ve done prior blogs on this.

3) Medical expenses which include LTC.

4) Two-thirds. See my blogs on Medicaid.

5) 15%. This is on the high side, other sources say closer to 11%. Bottom line: not enough of us!

6) 74% say they’d forego a cup of Starbucks a day to pay their LTC premiums. But they aren’t doing so!

7) In your 40’s. I’ve done prior blogs on why this is so.

8) $50,000/year. This is an average and is not for the accommodations you’d desire. Check out Genworth’s annual cost of care survey to find all care costs in your locale.

Denial Antidotes

Elephant In The RoomThe majority of us deny the fact that the odds we will need long-term care (LTC) are quite high (70% at age 65, according to www.longtermcare.gov). More importantly, we deny the potentially catastrophic consequences caused by needing LTC without being prepared.

Here are some denial-busting tools for the ones you care about, but who refuse to have a conversation about responsible, reasonable LTC planning now, while they are able to qualify for LTC insurance and find good rates.

Give your loved one this special, eight question LTC IQ Quiz.

Watch this brief video of Meryl Comer, graphically describing the havoc being unprepared for LTC caused:

www.honeyleveen.com/resources will link you to other highly informative sites like My Life. My Family, The Motley Fool, and Own Your Future Texas.

Knowledge is power. Failure to plan is planning to fail.


Stupid is as Stupid Does

Elephant In The RoomIn my prior blog we learned about  denial. The most common form of denial is implicatory denial. Here, the facts are not denied or re-interpreted, but instead the psychological, economic, political, physical or moral implications that conventionally follow from those facts are denied or ignored.

I see this with people’s refusal to plan responsibly for long-term care (LTC) all the time.

In other words, even though someone will accept the fact that at age of 65 and beyond, there’s a 70% chance that any of us will need long-term care, these deniers somehow have the inside track. People with implicatory denial are aware of these odds, but they refuse to believe this could happen to them. In other words, they’re psychic about this and can see the future. Everyone else will need LTC, but they (including their spouses) won’t.

An article in yesterday’s Los Angeles Times amused me. Its title is “Proved at last: Men really are idiots”. Of the 318 stunts that have qualified for Darwin Awards, 88.7% were done by men (Darwin Awards: awards for the stupidest, most dangerous, foolhardy stunts and activities). This correlates with what I see men doing about responsible LTC planning.

I’ve compared notes with many colleagues about this particular type of denial, and our experiences are similar. For some reason, women “get it” about the need for responsible LTC planning a lot more often than men. Most of the time, women instigate a conversation about LTC insurance with their husbands. Often, the husband puts the kibosh on the conversation. After all, he is psychic and has the inside track. He and his wife won’t need LTC. Everyone else will.

Denial is a Curious Beast

Denial Is A Curious BeastRefusal to plan for long-term care and refusal to believe manmade activities are creating global warming are caused by the same thing. What a revelation to me! A book called Living in Denial, by Kari Marie Norgaard examines the causes of climate change denial.

Here’s an essay about Dr. Norgaard’s book. I love the fact that her book defines the three different types of denial:

  • Literal denial. This is the outright refusal to believe the facts and to dispute the consensus science, and even to deny the existence of a scientific consensus. Many so-called “climate skeptics” fit into this category.
  • Interpretive denial. This involves not disputing the underlying reality, but using euphemisms and framing to distort meaning. An example of this kind of denial might be the Government of Alberta claiming that it is improving emissions intensity (emissions per barrel) from the oil sands, while absolute emissions of CO2 are increasing rapidly due to growing bitumen production.
  • Implicatory denial. Here, the facts are not denied or re-interpreted, but instead “the psychological, political or moral implications that conventionally follow” from those facts are denied or ignored.  Implicatory deniers accept the reality of human-caused climate change, but they live their lives as if the problem was little to do with them. This variety of denial is the main focus of the book. Most of us who live at a high standard of living in developed countries are guilty to some degree of implicatory denial.

These are exactly the same denial behaviors I see all the time!

For 25 years I’ve had well-educated, affluent friends and acquaintances who like, respect, and trust me, make excuses to not talk with me about reasonable, responsible long-term care planning. Intellectually, these people know better. They are making sound decisions in other areas of their lives, but they refuse to accept the fact that after age 65, they might be one of the 70% of us are going to need some sort of long-term care.

There’s little about denial that makes sense to me.

We Are In A Slow Cooker

Slow CookerThis article from the October 31, 2014 New York Times confirms that the majority of Americans believe in global warming. Republicans are more likely to deny human-caused climate change than Democrats are.  The New York Times article gives clear evidence of how and why Republicans just don’t want to discuss climate change, even though the public does want to see it addressed.

Even if Republicans were more willing to discuss climate change, the current political climate would probably prevent any affirmative climate change legislation from occurring.

The same lack of willingness to discuss climate change in Washington holds true for long-term care policy. I’ve written many blogs explaining why government (Medicaid)-paid long-term care is increasingly hazardous to families and our economy, yet nothing is being done about this in Washington.

If you want to ensure your dignity, options, and access to care and if you are among the 70% of us who will need long-term care after the age of 65, you better not depend on the government. Unless you are have absolutely no qualms about depleting your hard earned savings to pay for care that can cost upwards of $50,000/year, you better own reasonably priced long-term care insurance (LTCi).

Undeniable Proof That LTCi Is Good for America!

LTCi is Good for AmericaA report proving how and why long-term care insurance (LTCi) helps all of us and our country was just published. LifePlans conducted the study over a period of twelve years. It was commissioned by America’s Health Insurance Plans (AHIP).

Here’s background on  the report.

The report shows that that for LTCi policyholders:

  • A typical 60-year old LTCi policyholder would pay $188/month in premium for the same amount of care they would otherwise have to save $1,666/month, for 22 years, for.
  • Roughly 22 years of premium payments would be returned after only five months of collecting from the average LTCi policy.
  • The majority (97.6%) of all LTCi claims get paid. My experience has been that the only reasons LTCi claims are not paid are due to incomplete claim paperwork or no true need.
  • Most LTCi claimants agree that LTCi enhances access and flexibility as they seek to obtain to the services of their choice.
  • LTCi owners receive on average 35% more hours of care than those without, and their care is also more likely to address their needs.
  • The LTCi industry currently serves 7.4 million policyholders and is expected to pay out roughly $700 billion in claims over the life of those policies.

For Family Caregivers, the report shows:

  • Individuals caring for family members with LTCi are nearly twice as likely to be able to continue working as when there is no LTCi.
  • Caregivers of LTCi claimants experience less stress finding appropriate services for their loved ones.
  • LTCi enables family members to spend less time on hands-on care and more on social interaction and companionship, which leads to better experiences and less stress.

Why the report proves that LTCi is good for America:

  • Because LTCi covers a majority of LTC costs, insureds are not forced to depend on Medicaid.
  • Between 21 and 31% of insured nursing home residents would spend down to qualify for Medicaid if they did not own LTCi. Fewer than 5 percent of LTCi policyholders spend down to Medicaid.
  • Today’s 7.4 million current LTCi policyholders are expected to save the Medicaid program about $50 billion over their lifetimes. Annualized Medicaid savings per in-force policy are about $334.

The graphics in the report are great. They are straightforward and easy to understand, as is the report itself.  If you would like to receive a copy of the entire report, email me at honey@honeyleveen.com.

Mechanics and Basics of LTC Rate Increases

LTCi Rate IncreasesI’m fond of this article about long-term care insurance (LTCi) rate hikes from The Society of Actuaries Long-Term Care newsletter.

Yes, I belong to the Society of Actuaries! I have for years. I’m in the LTCi section. I get a quarterly newsletter and try never to miss their annual conference. I normally can barely understand lots of their newsletter articles (which, unsurprisingly, are usually written by actuaries) because they’re so technical.

Once in a while, however, actuaries write articles that are accessible to non-professional mathematicians. “Mechanics and Basics of Long-Term Care Rate Increases” is an example of such a rare event.

Click here to read my prior blog about how and why LTCi rate hikes occur.

Any detail-oriented person interested in really understanding the inner working mechanisms of LTCi should read both my blog and this article.

Human-Caused Global Warming Is Here But Denied, Just Like LTC Odds

Global WarningAccording to an article in the September-October issue of Audubon Magazine by Elizabeth Kolbert, who’s written the recently released “The Sixth Extinction: An Unnatural History,” 97% of all climate scientists agree that human-caused climate change is happening.

According to a Pew Research Center Study done earlier this year asking Americans about their own beliefs in global warming, only 45% of us believe human activity was the main cause. And only 58% of us know that carbon dioxide is the gas most scientists believe causes temperatures in the atmosphere to rise.

I am pretty fascinated by this denial of climate change. It parallels denial of the need for responsible long-term care planning in so many ways. I believe the psychological denial mechanism used to avoid believing in global warming is nearly identical to denial of the high probability of needing long-term care. Both are about avoidance of the most unpleasant facts. Both issues mandate discussion and education in order to understand them properly and to do something constructive about them.

Global warming has been in the press a lot lately and is now being given the credibility it deserves. Still, important discussions about it in Washington and most states is not occurring.

For most of the 25 years I’ve been selling long-term care insurance (LTCi), the press has often misrepresented the facts and typically led articles with a negative, inflammatory bias even when some truth follows. And financial pundits have often pooh-poohed the need for LTCi.

Recently, however, the press and pundits have begun to report affirmatively on the need for LTCi and  responsible LTC planning. Still, not enough of us are following their lead. In coming years, there will be a lot of Baby Boomers and their families in turmoil and crisis due to unplanned needs for LTC.

Here’s a cool website called What We Know. Its purpose is to educate the public, which hopefully, will create better public policy concerning global warming. This site is produced by the American Association for the Advancement of Science.

The long-term care insurance (LTCi) industry has comparable, highly reputable sites with outstanding LTCi content and education. Here’s one: www.aaltci.org. Find links to several more, here.

No one seems to read these sites. Or perhaps they read them and there is some type of emotional disconnect, an inability to assimilate such inconvenient truths.