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Bad Nursing Home Gets $14 Million Punishment

July 28, 2014 by Honey Leveen Leave a Comment

A July 25, 2014 story in McKnights, by Tim Mullaney, reports on a $14 million award ($12.5 million was awarded in punitive damages) to the family of a nursing home patient. This story was also covered in the Boston Globe on July 24, 2014.

Quoting from the Globe story, “Judge Krupp instructed the jury that while punitive damages can be awarded for a company’s bad behavior, they can also be used to dissuade other nursing homes from similar conduct…the judge explained that the whole purpose of the punitive award is to send a message that you can’t get away with this anymore.”

How wonderful if the problem could simply be fixed by a judge using the court system to “teach a lesson”!

Again, the 8,000 pound elephant in the room is being ignored.

Especially in Texas, but throughout the country, nursing homes get paid less per diem than it costs them to care for their patients. Medicaid, which pays for the majority of long-term care in the US, needs an overhaul.

There is no doubt in my mind that the nursing home sued accepted mostly Medicaid patients. Here are a couple of blogs I did about murders that occurred in Lexington Place nursing home in Houston. Lexington Place accepts mostly Medicaid paid patients.

When nursing homes do not get paid enough, there are not enough caregivers. This directly affects the quality of care nursing home patients receive.

Click here for several blogs I’ve done that explain why Medicaid paid nursing home care often leads to sad outcomes.

Those of us who own long-term care insurance (LTCi) are far more likely to have the money to avoid nursing homes and receive care at home or in an assisted living facility.

Horrible Story Illustrating Why Medical Insurance and Medicare Supplements Don’t Pay For LTC

July 8, 2014 by Honey Leveen Leave a Comment

I just came across an all-too-common, tragic story titled “Insurance abruptly stops covering Spokane man’s long-term care.”

This article came through my Google alerts, which are set for “long-term care insurance.” The title instantly caught my attention because I thought this might be bad press about long-term care insurance (LTCi). It wasn’t.

It turns out that this is a horrible story about what can happen without long-term care insurance.

In the over 23 years I’ve been selling LTCi I have never seen a LTCi policy not pay a legitimate claim. LTCi would certainly pay for the care described in this situation.

What this story illustrates so well is that Medicare and medical insurance cannot, will not, do not pay for long-term care. The story is about an innocent man named Doug who had a horrible motorcycle accident and suffered brain damage. His condition will not improve (that’s part of what’s causing the crisis). He needs constant skilled care. Medical insurance and Medicare do no not cover long-term care when there is no possibility of improvement. The best medical insurance and Medicare supplements only cover the type of care Doug needs for limited lengths of time.

In this horrible situation, the nursing home wants to kick him out. “The nursing home called me at 6:30 in the morning on the 11th, saying I had until the 15th to get him moved,” claimed Mrs. Barr (Doug’s wife).

Premera Blue Cross told her Doug’s condition “…wasn’t showing significant progress.”

She said that if she cannot find another solution, her only remaining option is putting Doug on Medicaid. Yet, her lawyer told her that once Doug is on Medicaid then she loses all of his social security, retirement, and life insurance.

In desperation, Mrs. Barr said, Doug even asked the people at the dialysis clinic to help him die.

Finding Good Nursing Home Care Is Not Easy!

July 2, 2014 by Honey Leveen Leave a Comment

A newly published survey called “Raising Expectations” by AARP, The Commonwealth Fund and the SCAN Foundation, is a report card for nursing facilities across the country.

The news for us in Texas isn’t good, reports Howard Gleckman in this Forbes piece on this new study, published June 25, 2014. The research finds that on average the most affordable facilities are in Oklahoma, the District of Columbia, Utah, Kansas, Missouri, Georgia, Texas, Iowa, Louisiana, and Arkansas. But nearly half of those states—Oklahoma, Utah, Kansas, and Texas– rank in the bottom 10 for at least 2 of the study’s 3 quality measures. Texas and Oklahoma rank near the bottom for all three.

Most of Mr. Gleckman’s piece describes how unable most Americans are to pay for their own long-term care. I will concentrate instead the correlation between low cost and low quality care.

In Texas, Medicaid nursing home reimbursement is one of the lowest in the country.

Nursing homes are not where anyone with great wealth or long-term care insurance chooses to receive care.

Here in Houston, we’ve made headlines lately with a spate of nursing home murders.

If nursing homes are paid less than it costs them to actually provide care (as they are in Texas), the result is a cascade of problems, including but not limited to insufficient, underpaid caregivers, inappropriate admissions (accepting extremely needful people in order to get the census up), increased safety and health hazards, patient negligence and warehousing, the list goes on.

The American Association for Long-Term Care Insurance (www.aaltci.org) states that approximately 80 percent of long-term care insurance (LTCi) claims are not for nursing home care. LTCi gives policyholders the ability to instead stay at home or access assisted living. My own experience is that very few of the approximately 300 LTCi client claims I’ve seen paid were for nursing home care.

Because a great many people choose to ignore the need for responsible long-term care planning and are therefore unprepared to pay when the need for care arises, the majority of long-term care in the US is paid for by Medicaid (Welfare). If you don’t plan and you don’t own LTCi, you are greatly increasing your odds of ending up in a nursing home.

Promises That Can Bend Without Breaking

May 27, 2014 by Honey Leveen Leave a Comment

Promises 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

May 19, 2014 by Honey Leveen Leave a Comment

An 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.

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Bad Nursing Home Gets $14 Million Punishment

Horrible Story Illustrating Why Medical Insurance and Medicare Supplements Don’t Pay For LTC

Finding Good Nursing Home Care Is Not Easy!

Promises That Can Bend Without Breaking

Testimonial for LTC insurance

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