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Elder Orphanism

March 17, 2016 by Honey Leave a Comment

Elder OrphanismWe will be reading more about elder orphans. Even if we have a slew of kids, we are likely to wind up as elder orphans. We must plan for this right now.

Here is a link to a beautiful column describing what the future is likely to look like.

Thanks to the author, Dave Nesbit, for allowing me to re-publish this.

“New Year’s Day is a time to turn the page on our bad habits and start new and positive behaviors.

Here’s a challenge of what self-interested baby boomers should resolve to do now—reach out with personal compassion and respect to younger people. This might seem to be inverted thinking from “respect your elders.”

Over the last century, progress in transportation and technology enabled the settling of our vast country and made the intergenerational family farm all but obsolete. Maybe your children, as mine, are now adults who have relocated outside of our geographic area to fill the labor needs of America’s expanding economy. As 20th century labor mobility has undercut traditional family life, affordable cellphone plans appeared in response.

In 1915, a 3-minute coast-to-coast phone call cost $20.70, which was 3 percent of the $687 average annual income. By 1940, that same call cost $3, when the average house rented for only $30 per month. By 1970, the 70-cent cost was the same as a McDonald’s quarter-pounder. Now the insignificant cost of a lengthy call, along with Skype, might deceive us into believing that our family needs are fulfilled by inexpensive communication. They aren’t.

Today’s communication is not much more meaningful than when I as a child chimed in “Hello Grandma, I love you” during a 3-minute call. Fifty years ago, Bell Telephone advertised that “long distance is the next best thing to being there.” Maybe it is, but it’s a “poor second” and an inadequate balm for the loneliness and vulnerability of older persons who are distant from their family’s younger generations.

When I was growing up, my mother “adopted” three widows who shared special times with our family. Those surrogates helped to fill the void of absent biological grandparents, who I rarely saw. Until she was in college, our daughter did not realize how lucky she was to grow up in the same town with two sets of grandparents who she saw often and knew well.

Especially since our children live out of state, I’m glad that my wife and I own long-term care insurance and have colleagues at Keystone Elder Law. Both will be great assets when aging causes us to become frail, and we need to develop and implement a caregiving plan. It certainly would be a healthy supplement if a surrogate, family-like relationship would develop outside of our organizational environment.

I have witnessed such an intergenerational relationship develop among members of a service club, when one is missing a parent/grandparent(s) and another is missing a child/grandchild(ren). Similarly, such relationships can originate naturally among neighbors. Churches that seek a means to translate scripture into practice could encourage and nurture intergenerational surrogate families.

Pennsylvania rewards live-in caregivers. The state initiates an action during probate to recover Medicaid funds paid to provide care in a nursing home. However, live-in caregivers who do not own their own home and who lived with an unrelated frail person for at least two years prior to that person relocating to a nursing home, may inherit the home free of any estate recovery.

In his futuristic novel titled “2030,” Albert Brooks suggests that, by that date, the national debt will have outpaced the gross national product, medical breakthroughs with cancer and other diseases will enable longer life expectancy, and older persons will be confined in worn-out and all-but-forgotten cruise ships that are anchored off the West Coast. Young people, who work harder and receive less, will be incited to form gangs and become violent against older people, who seem selfish to them.

Could surrogate families be a possible antidote for both the intergenerational separation caused by mobility, and the pessimistic clash between the young and old as told in Brooks’ novel?

Over the past half century, the American melting pot has blended Catholics and Protestants, and Christians and Jews, into neighborhoods and families. Is it too hopeful to imagine that Judeo-Christian families and neighborhoods will assimilate peaceful Muslims? Would acts of kindness from Judeo-Christians to vulnerable younger Americans not only lead to surrogate families, but also make our younger generation less vulnerable for recruitment by radicals who promote terrorism?

As my wife and I visited our children and grandchildren in south Florida over Thanksgiving, I observed a significant number of interracial families. This contrasted with my recent, sad experiences with a couple of families in which a parent had alienated their child decades ago because of an interracial relationship. Could it be that racial intolerance within families is waning as rapidly as the relevance of the cost of a long-distance call?

The legislature and courts have forced a legal settlement of most of the controversial sexual preference issues. Is Brooks correct that the emerging issue for the 21st century will be the young versus the old? According to a Pew Foundation study, the declining percentage of Americans who are younger than age 15 will cross over the growing percentage of Americans who are over age 65, at the number of 20 percent, just before the year 2030.

How will the legislature and courts manage public resources and entitlements, when fewer younger people are available to support the larger number of older people who live longer? Will life-prolonging drugs be provided to the poor? Will Medicare have maximum lifetime benefit? Will the cost of long-term care for seniors deplete Medicaid funding for young families and children? Will the ethics of assisted suicide and euthanasia be considered seriously?

Politicians have kicked the can of painfully real solutions into the future. Our children will be taxed excessively, not only to repay escalating public debt created by our generation, but also to pay for entitlement programs to take care of aging baby boomers. Be proactive about this dilemma.

If not out of shear kindness, then in recognition of your probable future long-term care needs, create a surrogate family. Find younger people in your neighborhood, service club or church to befriend graciously now. Maybe they will respond in kind to manage and advocate for your care in the future.”

Filed Under: Denial, Elephant in the Room, I'll Just Self-Insure, Information About LTC, The Magic of owning long-term care insurance Tagged With: Baby Boomers, Better Homes and Gardens, Boomers, Elder Orphanism, elder orphans, home care, Information About LTC, long-term care, Medicaid

Extraordinary Story of Devotion…and No LTCi

March 14, 2016 by Honey Leave a Comment

Helping Mother Bathe
Elizabeth helps her mother bathe.
Mark Makela for The New York Times

A story in yesterday’s New York Times titled “Living With the Parents I’m Losing to Alzheimer’s blew me away. I hope non-subscribers can open it.

Here’s the accompanying slideshow.

The story is about Elizabeth Wolf, a very generous, candid, public person with a blog at www.upsidedowndaughter.com.

Read the column or blog to learn that five years ago Ms. Wolf was enjoying young adulthood and exciting new pursuits when she gave them up and returned home to become her parents’ primary caregiver. Both parents have Alzheimer’s Disease. She’s doing this with the help of her extremely devoted husband.

We know from graphic, detailed information in the story about finances and day-to-day coping, neither parent owns long-term care insurance (LTCi).

If you’re like me, you are forced to wonder how extremely different Ms. Wolf’s life and relationships with her husband and parents would be if one or both parents owned LTCi.

Filed Under: Denial, Elephant in the Room, Helpful Information About LTC, I'll Just Self-Insure, Information About LTC, New York Times Tagged With: Elizabeth Wolf, Long Term Care insurance, long-term care, LTC, LTCi, Medicare, Paula Span

LTCi Pays – Have the Conversation Now!

March 3, 2016 by Honey Leave a Comment

LTCi PaysThe following piece was authored and is re-published here with the permission of my dear friend and colleague Tobe Gerard.

Tobe makes two points. The first is that long-term care insurance (LTCi) policies are normally purchased many years in advance of being needed. We are now seeing “the tip of the iceberg” of claimants who need to collect from their LTCi. For the foreseeable future, we should see annual increases in the number of claims being filed and the amount of money being paid out for LTC.

The second point Tobe is making is that it is typically a son or daughter who assists with the claim. LTCi claims are not onerous, but policyholders are typically not able to manage them alone. Letting kids and other trusted individuals know you own LTCi is sometimes difficult, but worth it. Knowing a parent owns LTCi proves to be a balm and a source of extra piece of mind and security for all involved.

Here is Tobe’s excellent blog:

According the the American Association for Long-Term Care Insurance, long-term care insurance (LTCi) companies paid $8.15 billion in claim benefits to 260,000 policyholders in 2015. That number is 4% more than what was paid out in 2014. We are all living longer, and though your clients hope to never have to use their policies, the good news is that policyholders and their families are benefiting from owning this important insurance protection. When the rubber hits the road, LTCi policies are paying out!

With that in mind, many advisors encourage their clients to have “the long-term care conversation” with their adult children. It’s not an easy conversation, but it is an important one. Having this conversation early allows adult children to know that their parents have thought things through and have a plan in place. Among other things, breaking the ice by having this conversation early allows adult children to know their parents own LTCi policies. The reality is that in most instances it will be the adult children who will be involved with filing the initial LTCi claim and, in many cases, supervising the care that will be required over time. Adult children want to learn what their parents have in mind. Owning a LTCi care policy should never be kept a secret!”

Filed Under: Helpful Information About LTC, I'll Just Self-Insure, Information About LTC Tagged With: AALTCI, home care, long-term care, LTCi, the American Association for Long-Term Care Insurance

What are the Best LTCi Options?

February 19, 2016 by Honey Leave a Comment

LTCi Benefit BankIn part one of his two part series about understanding long-term care insurance (LTCi), Forbes columnist Wade Pfau describes how LTCi prices are determined. He explains what an elimination period is, what a benefit period is, what a monthly benefit is, and what a LTCi “pool of money” or “benefit bank” is. He also describes different types of inflation protection.

In part two of the series What Are The Best Coverage Options for LTCi? Dr. Pfau describes the types of care LTCi covers and what entitles you to collect from your LTCi.

One thing is clear from reading these articles: LTCi is complex. No matter how bright someone is, ethical advice, preferably from an experienced LTCi specialist like me, is necessary for one to make a confident, wise decision on affordable LTCi they’ll be satisfied with for the rest of their life.

Mr. Pfau actually recommends having an elder law attorney study review LTCi contracts. This is unnecessary. Elder law attorneys generally specialize in wills, trusts, probate, etc, not insurance contracts. In addition, today’s LTCi policies generally have straightforward language a college educated consumer can read and understand. An experienced agent can and will confirm what the contract language means. The elder law attorneys I know are not particularly astute on LTCi contracts. A few of them are clients who relied on me for advice.

I’ve loved Dr. Pfau’s Forbes LTC series because he is so credible and astute. He expresses complexities in easy-to-understand language. He has truly done readers a service with this LTCi series.

As much as I respect and admire him, I think he’s wrong about some minor details, but as a whole, he really gets things right. This series is powerful and useful.

Filed Under: Elephant in the Room, Helpful Information About LTC, I'll Just Self-Insure, Information About LTC Tagged With: Forbes, Long Term Care insurance, long-term care, LTCi, Medicaid, Medicare, Wade Pfau

Impurities

February 11, 2016 by Honey Leave a Comment

I am a huge, long-time admirer of Ron Hagelman.

ImpuritiesIn his February, 2016 Broker World Magazine column titled, “Impurities,” Ron compares the long-term care insurance (LTCi) industry’s evolution to that of classic sculpture. Rodin’s painstakingly slow, thoughtful, methodical, reflective chipping away at a plain block of marble resulted in the timeless magnificence of his sculptures.

Similarly, the LTCi industry has also evolved and reacted over many years with thoughtful, holistic tweaks, adjustments and adaptations to its products.

Ron and I are both very hopeful about today’s LTCi products. We like them, they’re effective, they work. I’ve seen hundreds of claims get paid to my policyholders.

Ron cites the 2014 Society of Actuaries LTC Section study “LTC New Business Pricing: How Safe Is It?” as evidence the LTCi industry has learned from experience. Here’s a blog I did about this study. Today’s LTCi products are priced correctly. Rate hikes on today’s policies should be unusual and not of great consequence.

Here is Ron’s column in its entirety:

The inherent beauty of universally recognized “art” is something that is created as a process of elimination.  Michelangelo released David from a solid block of inanimate marble. By methodically chipping away and discarding what was not necessary, something of permanence and exception was revealed. By systematically removing impurities something of transcendent truth may be discovered. The artist involved is actually only a facilitator guided by previous rules of engagement and extensive experience in the pursuit of lasting accomplishment.

Although it may be a stretch to compare the current residue of our grand LTCI experiment to the artistry of Auguste Rodin, it is impossible to ignore our ongoing intention to create something of substance and beauty. Our industry’s dedicated attempt to define and serve a public outcry to diminish the financial and emotional impact of unattended and ill prepared chronic illness risk has certainly represented a historic process of elimination. We have accumulated substantial experience and we have consistently removed the parts that were not working. If it was superfluous, ineffective, overpriced or undersold it has been trimmed away. Our 20-plus year hard headed crusade to expose the reality of the risk and identify a cost effective insurance management tool may be finally beginning to reveal an object of permanence and purpose. Public and private initiatives to reform and improve the market have begun to narrow their focus and solidify around the essentials of future success:

• All the moving parts require attention and some form of structural cooperation between the insurance industry and imbedded governmental support will be required.

• Most claims are fairly small and middle market benefits need to focus on upfront expense and immediate support. By the same token the potential for catastrophic risk must remain at the heart of the individual sale for the more affluent.

• Regulatory reform is now mandatory from the NAIC to state and federal legislatures. This should include greater benefit flexibility and a willingness to consider innovative ideas. Why not allow immediate long term care access to current tax preferred accounts?  Additional tax incentives should also include an enhancement review of existing tax deferrals, premium deductions and credits.

Perhaps the clearest evidence of our ability to remove impurities can be found in the recent research conducted by the SOA’s LTC Section and the ILTCI offering LTCI New Business Pricing: How Safe Is It?  The primary question asked was to identify any differences between past and current pricing stability. I don’t think anyone would argue with the notion that rate increases are the primary scourge of consumer confidence and lackluster sales. The question is: Have we learned from our marketing  mistakes and our growing volume of claims data?  The truth is we have learned from experience.  We do have more information to fine tune pricing assumptions.  We are offering less risky product and the actuaries are using better modeling tools. Rate increases are, of course, the result of the inherent clash of current reality versus the initial assumptions concerning lapse rates, morbidity and mortality. The research team looked at three dates for comparison purposes (2000, 2007 and 2014).  Our current volume of claims experience has taught us that our morbidity experience was somewhat worse than anticipated over time. Our mortality rates are now more conservative, and as you well know our lapse rates are now much more conservative. The companies have learned from each other and  premiums have stabilized with very little difference today in pricing between carriers. The bottom line is we simply have much more information on which to base future assumptions. For example, we are able to evaluate 16 times as much data in 2014 as in 2000 for all policy years and 70 times as much claims information. The reliability of current pricing as it relates to the possibility of future rate increases has increased dramatically over time. In 2000 the chances of future rate increases was about 40 percent, in 2007 it was 30 percent.  However, in 2014 it was only 10 percent. The profitability of the product has also increased—caused by bone on bone lapse assumptions, better understanding of the claim and a low predictable interest rate environment.

We do apparently learn from our mistakes. We can adjust to new realities. We do profit from accumulated sales wisdom. It’s not getting any easier, but it does seem to be emerging from relative chaos into a clear and trustworthy vision sculpted and solidified by experience.  We  have all accumulated our share of marble dust helping to create a transcendent image void of disfiguring impurities. We may yet gaze upon a sculpture that will withstand the test of time.

Other than that I have no opinion on the subject.

Author’s Bio
Ronald R. Hagelman Jr., CLTC, CSA, LTCP
CLTC, CSA, LTCP, has been a teacher, cattle rancher, agent, brokerage general agent, corporate consultant and home office executive. As a consultant he has created numerous individual and group insurance products. A nationally recognized motivational speaker, Hagelman has served on the LIMRA, Society of Actuaries, and ILTCI committees. He is past president of the American Association for Long Term Care Insurance and continues to work with LTCI company advisory boards. He remains a contributing “friend” of the SOA LTCI Section Council and the SOA Future of LTCI committee. Hagelman is president of Broadtower Insurance Solutions, a national IMO helping BGAs enhance LTCI production. Hagelman can be reached at Broadtower Insurance Solutions, Inc., 156 N. Solms Rd., New Braunfels, TX 78132. Telephone: 830-620-4066. Email: rhagelman@broadtowerinsurancesolutions.com. Website: www.BroadtowerInsurance.com.


Filed Under: Helpful Information About LTC, I'll Just Self-Insure, Information About LTC Tagged With: Broker World Magazine, Long Term Care insurance, LTCi, Ron Hagelman, Society of Actuaries

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