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Take Responsibility, Folks!

December 2, 2013 by Honey Leveen Leave a Comment

Unhappy CaregiverThank you again, Dear Abby, for providing fodder for this blog.

When I read this recent column, written by a daughter whose mother is evidently in a Medicaid-paid nursing home and receiving less than respectful care,  I said to myself, “grow up; face the truth and don’t pawn the blame off on others.” The daughter’s sugary sweet letter smacks of the misguided denial I often see. It is cloaked in the daughter’s dysfunctional view of reality. The daughter aims her complaints at her mother’s caregivers, who are simply the most visible, yet non-responsible, cause.

As usual, Abby  does not address the actual problem, which is the public’s widespread avoidance of conversation and responsible planning for long-term care, well in advance. However, she did give a correct answer to the letter writer, which is, “don’t blame the messenger”! Abby also correctly noted that the caregiver is the lowest ranked, lowest-paid, least respected, and in the most understaffed area at the nursing home. These caregivers do their best. They often work two or more jobs, and really must have heart and soul to want to do this type of work. Don’t blame the caregiver for the low quality care you are nearly certain to receive in Medicaid-funded nursing homes.

Filed Under: Helpful Information About LTC, Information About LTC Tagged With: Dear Abby, Honey Leveen, LTC Insurance, ltc planning, LTCi, Medicaid, Nursing Homes, www.honeyleveen.com

Jawboning De Rigeur, But of Little Use

November 26, 2013 by Honey Leveen Leave a Comment

Recent coverage of long-term care by the parent company of the Public Broadcasting System’s NewsHour, and the SCAN Foundation, caught my eye.  (Watch below)

I want to thank Steve Moses, President of the Center for Long-Term Care Reform for bringing this story to my attention.

Steve has given me permission to re-publish portions of his blog, below. You will read how Steve pokes holes in the testimonies of some of the most reputable LTC experts in the country.

Before you read Steve’s comments, I wish to editorialize. All we ever seem to see covered in the news – whether it’s mainstream media reporting on long-term care or political posturing – is jawboning about the need for long-term care conversation, discussion, and planning. The words strewn by various LTC pundits appease and sound appealing, but they are without teeth. Nothing concrete is recommended for addressing the 5,000-pound elephant in the room, which is: how do we pay for long-term care presently and when we are deluged with a Silver Tsunami of Baby Boomers who are woefully unprepared to pay for their long-term care? The lack of solutions to this mounting dilemma is disheartening, frightening, and frustrating for my colleagues and me.

I am doubly disappointed when I see such insipid, superficial reporting from sources I normally have great respect for: PBS and NPR. Here’s a blog I did about comparably inept, superficial, inaccurate LTC reporting on the Diane Rehm Show on NPR: /2012/reaming-diane-rehm/

Here’s a blog I called Neither Party has a solution for the oncoming deluge of Medicare/Medicaid services. This blog describes why neither Republicans nor Democrats wish to broach the subject of long-term care planning. Another blog, entitled Dismal Outlook for Medicare, Social Security, also explains why it is a politically unsavory no-man’s land for either party to broach the subject of realistic long-term care financing. Here’s a blog I did titled National Commission on LTC Finds No Solutions for LTC Crisis. Here are the National Commission’s actual recommendations: http://www.ltccommission.senate.gov/recommendations.cfm. Read them, and you will see the same insipid jawboning and fluff as Steve describes in his comments below.

By the way, Steve, thanks for your acknowledgement and praise for my AMG (Altruistic, Masochistic, Genius) status! (Read Steve’s comments to learn about AMG’s.)

Here is Steve Moses’s critique of the recent LTC forum, titled “Global and Regional Models for Long-Term Care: Can They Work Nationally?“:

LTC BULLET: PBS’S 6 TIPS FOR LTC MISS THE MARK

LTC Comment: Millions watch the Public Broadcasting System’s NewsHour every night. So when that show addresses long-term care it’s worth paying attention.

You can read about and view videos from a forum, titled “Global and Regional Models for Long-Term Care: Can They Work Nationally?,” that MacNeil/Lehrer Productions (the NewsHour’s parent company) and the SCAN Foundation sponsored on Monday.

But if you have better things to do, such as advising consumers on how to protect themselves from LTC risks and costs without depending on tottering government programs, let me save you some time.

Following are quick summaries of PBS’s “6 tips for averting America’s looming long-term care crisis” followed by our critique of each.

PBS Tip #1: “Keep it Local” The Urban Institute’s Howard Gleckman says don’t seek a “single answer.” Rather work from the bottom up with friends, neighbors and families taking the lead. “To the degree that we can, government can at least try to stay out of the way of those solutions . . ..”

LTC Comment: Hear, hear! Finally something from this writer with which I can agree. But true to form, he reverts to form a few sentences later, advocating more and bigger government programs.

PBS Tip #2: “Change the Financing” Former CMS Administrator Dr. Mark McClellan, currently with the Brookings Institution, says “let people control how [Medicaid] money is spent on their behalf. That’s what’s behind our ‘Money Follows the Person’ [MFP] initiatives in states around the country . . ..”

LTC Comment: Terrific. MFP programs are a vast improvement over the current LTC financing system which makes providers–not patients–the program’s customers. But “Money Follows the Person” still depends on payments coming from an unsustainable welfare program. Making Medicaid more attractive to more people is not a solution.

PBS Tip #3: “Focus More on the Poor” Dr. E. Percil Stanford, president of Folding Voice and the KIND Corporation, says “Unfortunately, considerable [LTC policy] attention from the most well-intentioned institutions and organizations has focused primarily on the middle and upper classes.” Instead, he says, they should focus laser-like on the poor elderly.

LTC Comment: Right on, but how? No answer from this source. Research shows Medicaid’s LTC program benefits the middle-class and affluent as much or more than the poor. The solution is to target scarce public benefits to the needy and use some of the savings to incentivize early and responsible LTC planning by more prosperous people.

PBS Tip #4: “Build a Comprehensive National Strategy” AARP’s Debra Whitman wants us to spend more government money to help family caregivers, grow Medicaid, expand “affordable” housing and transportation, “integrate” health care services, and eliminate LTC impoverishment.

LTC Comment: Typical AARP eyewash. Not a word about where the money will come from to pay for such wishful public program expansions. The federal government already borrows a third or more of everything it spends. It forces interest rates to near zero to make such borrowing feasible temporarily. Watch out when this bubble bursts.

PBS Tip #5: “Begin the Conversation” Jennie Chin Hansen, CEO of the American Geriatrics Society [AGS], thinks we should “chat and chew” LTC issues with our friends and colleagues creating a “study group” opportunity to “discuss the universal journey.” She says “Let’s proactively help each other build greater confidence, clarity and capacity.”

LTC Comment: Doesn’t that advice sound vacuous coming from the head of the AGS? We’ve been jaw-boning long-term care for decades without addressing the real problem, i.e. government pays for most high-cost LTC which anesthetizes consumers to the risk and crowds out responsible LTC planning and private financing.

PBS Tip #6: “Make It a Human Right” Dr. Laura Gitlin of the Center for Innovative Care in Aging says “We need to grow a long-term care system based on . . . [the] principle . . . that long-term care is a basic right.”

LTC Comment: Of all the empty rhetoric in this program, the prize for thoughtless irresponsibility goes to this proposal. If people have a basic human right to long-term care whether or not they are able or willing to pay for it, their “right” means someone else must provide LTC whether or not they are compensated for their effort. That is the definition of slavery, which is what this ostensibly caring academic actually advocates.

Closing LTC Comment: When I see the subterranean quality of LTC policy analysis displayed in program’s like this one, I’m nearly ready to despair. The one thing that keeps me going is that a few of you AMGs (altruistic, masochistic geniuses) are still out there having truly valuable conversations with real consumers about how actually to protect themselves from escalating LTC risks and costs.

The whole wobbly Rube Goldberg apparatus of government-financed LTC puts enormous obstacles in your way. It gives away what you’re trying to sell. It makes your product unprofitable by manipulating interest rates so that its programs are artificially viable. It falsely assures citizens they’ll be taken care of by bankrupt social programs already under-funded by trillions of dollars. Yet you soldier on. Somehow.

Hail to the AMGs!

Filed Under: Correcting Ignorant Public Figures, Helpful Information About LTC, Information About LTC Tagged With: Center for Long-Term Care Reform, Honey Leveen, NPR, Public Broadcast System, SCAN Foudantion, Stephen Moses, Steve Moses

Understanding Rate Hikes

November 18, 2013 by Honey Leveen Leave a Comment

Rising CostsAs far as I can tell, every reputable long-term care insurance (LTCi) carrier that’s sold LTCi for more than five years  has given its policyholders at least one rate hike. I will attempt to explain what causes LTCi rate hikes and what to do about them.

What causes rate hikes?

  1. LTC insurance policies have extraordinarily high persistency, which means that about 95% of all LTCi, industry-wide, remains on the books after it is sold. When LTCi is properly placed, hardly anyone ever drops their policy.  LTCi persistency is higher than actuaries anticipated
  2. LTCi policies also have incredibly long “tails”, meaning that an LTCi policy sold to a 55-year old might stay on the books 30 or more years before it is collected from
  3. Protracted, low, interest rates
  4. Claims that last longer than expected

These characteristics combine to cause a perfect actuarial storm for LTCi carriers and policyholders.

LTCi’s high persistency rate and long tail are unique. Because of both of these traits, when an LTCi policy is issued, the carrier must post very large amounts of reserve funds. The carrier invests the reserves in conservative, long-term assets. The majority of LTCi’s profitability is derived from interest earned on these posted reserve funds. When interest rates plummeted unexpectedly in recent years and stayed down for so long, when policies experienced higher than predicted persistency rates, longer “tails” and claim durations, prior actuarial assumptions became incorrect. Rate hikes are a means to adjust for these inaccurate assumptions and to ensure that all policies are paid in full when clients collect on them.

It’s a good thing LTCi carriers do this. They act in a responsible way. I would rather have LTCi carriers give rate hikes to be able to honor their obligations to policyholders, than behave like the federal government and make financial commitments that it cannot meet in the future.

If clients cannot increase their payments to cover the rate hikes, the majority of LTCi carriers allow policyholders to pare back their LTCi at time to get their premiums back down. Even if an LTCi policy needs to get pared back to keep its premiums affordable,  the policyholder will normally still have a high-performance policy.

What causes public alarm and outcry over LTCi rate hikes?

When I get client calls in response to news of their LTCi rate hike, reactions typically consist of fear, anger or a mixture of both.

I blame the media and the insurance industry for much of  these reactions.

The media is historically under-educated on the subject of LTCi. Today, with fewer journalists  and less freedom than ever to adequately research before tight deadlines, the media often gets the story of LTCi rate hikes all wrong. There are exceptions. Terry Savage is one. She’s one of a dying breed of true journalists with the luxury of being able to meticulously research her stories before they’re published. More often than not, media runs “if it bleeds, it leads” stories about LTCi. Such incorrect stories describing “intolerable” LTCi rate hikes, without providing adequate explanation, are the norm in mainstream media, not the exception.

The insurance industry must also accept some blame because of its high employee turnover. It is highly unusual for the selling agent to be still active, accountable and present when clients receive rate hikes.  And when policy holders inquiring about the increased premiums do not receive the proper explanations and information, their logical reaction is a combination of anger and fear. When this  results, lacking a competent agent’s insight, help and advice, policyholders too often make the wrong decision about their LTCi policies.

The truth is, even with rate hikes factored in, the original LTCi policy is normally still a steal of a deal. It is easy to prove this. All we need to do is take the rate hiked LTCi policy’s current monthly or daily benefit (if it has built-in automatic growth every year, its current values are usually significantly higher than what the policy started at). We then compare rates for a replacement LTCi policy at the policyholder’s current age, not their original buying age. When we compare the prices of equivalent new coverage with the present policy’s benefits, and at the client’s present age, the results are normally quite shocking. Even with the rate hike taken into account, the original LTCi policy is still very inexpensive, compared to what a new, comparable policy would cost.

In my experience, policyholders calm down when they understand the impact of insurers’ claims experience and low interest rates. When the circumstances causing LTCi rates hikes are explained to them in a businesslike, rational, professional manner, the majority of my clients choose to keep their LTCi policies and tolerate the rate hike.

I lament that so many LTCi policyholders have no one they can trust and turn to for advice when their rate hike letter arrives. This can cause unintended, bad headlines and publicity for LTCi. This in turn gives people and families additional excuses to put off having conversations about responsible and reasonable long-term care planning.

I have seen in excess of 300 of my clients’ LTCi policies pay out lavishly and with ease, exactly as planned. This has given my clients increased dignity and options. It has prevented much stress and strife, both emotional and financial, for my clients families. I have never had a single claim denied in the 23 years I’ve been in practice.

Filed Under: Helpful Information About LTC, Information About LTC Tagged With: Helpful Information About LTC, Honey Leveen, Long Term Care insurance, LTC Insurance, LTCi, LTCi rate hikes, www.honeyleveen.com

Happy National Long-Term Care Awareness Month!

November 13, 2013 by Honey Leveen Leave a Comment

LTC Awareness Month November is Long-Term Care Awareness Month. The U.S. Congress has urged “the people of the United States to recognize (this) as an opportunity to learn more about the potential risks and costs … and the options available.” We’re proud to support this important educational campaign.

Long-Term Care Awareness Month was created by the American Association for Long-Term Care Insurance (AALTCi). It’s purpose is to encourage the public to plan for the possibility of needing long-term care well in advance of when it might be needed.

You protect against other risks like a car accident or house fire. A need for long-term care is a risk to your savings and to your retirement. It will impact your family and loved ones. Just as it is smart to plan ahead for retirement, it’s smart to plan now for long-term care.

Filed Under: Helpful Information About LTC, Information About LTC Tagged With: AALTCI, AALTCI.org, Honey Leveen, LTC Awareness Month, www.honeyleveen.com

Healthcare.Gov (ACA) and Long-Term Care

October 23, 2013 by Honey Leveen Leave a Comment

Dollar Being StretchedThanks to my colleague, Romeo Raabe, for permission to re-publish his blog, “Heathcare.gov (ACA) and Long-Term Care”.

No, long term care is not directly affected by the Affordable Care Act (ACA, AKA Obamacare) but there are some scary correlations between the two. I refer to this morning’s Wall Street Journal article about what is coming – in both healthcare and long term care.

Doctors are retiring in droves. Those near are taking early retirement to avoid the losses of treating people for less than they are reimbursed. Medicare payments are being cut way back just as 10,000 Americans a day are coming on board (and will each day for the next 18-19 years). The ACA takes large sums from Medicare to fund the ACA. Doctors are reimbursed less and less, as more people are starting to use Medicare, hoping to get doctor appointments scheduled. Doctors often discourage their children from entering the profession. Others won’t accept new patients over the age of 50 (who will get Medicare in 15 years).

Medicaid, the primary payer of long term care in America, is being stretched to millions of uninsured Americans for medical care now. This leaves less for the already under-reimbursed long term care facilities. Nursing facilities tell me they lose between $2000 and $3400 per month on every resident on Medicaid. They cannot make you leave if you run out of funds and turn to Medicaid, but they can – and do – say no to your entrance. If you lose money on every customer, you cannot make it up on volume! They do it gently, asking about what care you will need, and then apologizing that they do not have the staff, currently, to deal with those needs. If the “desirable” LTC facilities turn you away, what choice does this leave you? The less desirable facilities, or one far away that will accept you? I wonder if the people who “wisely” divested their homes and fortunes years ago realized the box they have put themselves in.

More doctors are going into “concierge” medicine, accepting only those patients willing to pay an annual retainer of $500-$3000 a year for ready access and longer consultations. Some LTC facilities also are turning away all Medicaid entrants. The ambience will be nicer, with more staff and better activities and food, and all will pay their fair share with no cost shifting. That is where I want to go when needed, and I have the income from my LTC insurance policy to pay for it. Wouldn’t you like to be in a position to choose such care as well?

With the ACA starting enrollments just as the Medicare Advantage season starts, there is confusion with some going to the wrong site for information and to sign up. Many Americans already believe that LTC is free from the government, and do not realize that Medicaid is not given because you are old, or disabled, it is given because you are impoverished – a fancy word for broke. Why would someone plan to end up that way and dependent on a government that you may have heard rumors of being short on funds itself? LTC insurance is often less expensive than people imagine, and most do not need as much as they initially suspect. Wouldn’t it be prudent to at least investigate?

Filed Under: Affordable Care Act Obamacare, Helpful Information About LTC, Information About LTC, Uncategorized Tagged With: ACA, Affordable Care Act, Medicaid, Medicare, Obamacare, Romeo Raabe, Wall Street Journal

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Honey Leveen, LUTCF, CLTC, LTCP
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Phone: 713-988-4671
Fax: 281-829-7177

Email: honey@honeyleveen.com

Email: honey@honeyleveen.com

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