Search Results for: nursing homes

The State of FL is Dumping Disabled Children

September 8, 2012 by Honey Leave a Comment

A story in today’s Houston Chronicle, titled “Florida hit for putting disabled kids in nursing homes”, ties in beautifully to the blog I wrote yesterday, “Medicaid in Deep Trouble No Matter Which Party Wins the Election”.

The Chronicle article illustrates the great lengths some money-strained governments are already going to to slash their Medicaid budgets. Medicaid is what pays for long-term care for the disabled children described and impoverished elderly.

I have good reason to fear that what this article describes is just “the tip of the iceberg” compared to what’s in store. People don’t properly prepare and the government just can’t afford to provide decent long-term care. This trend does not show signs of reversing.

If you want to ensure quality choices, dignity, and reduced family stress and strife, and you don’t want to risk wiping out your life savings doing so, you need to talk about reasonable and responsible long-term care planning, then take action and prepare, NOW!

Here are some quotes from the Houston Chronicle story:

“Florida health and disability administrators have been systematically dumping sick and disabled children – some of them babies – in nursing homes designed to care for elders, in violation of the youngsters’ civil rights, the U.S. Justice Department says.”

“In recent years, however, Florida health administrators have relied upon nursing homes to house hundreds of children who could safely live at home with their parents – often at less expense to the state, advocates claim. Assistant US Attorney General Thomas Perez said the state has cut millions from programs that support the parents of disabled youngsters, refused $40 million in federal aid that would have enabled some children to stay or return home, encouraged nursing homes to house children by increasing their per diem rate – and even repealed state rules that limited the number of kids who could be housed in adult nursing homes.”

Medicaid is in Deep Trouble, No Matter Which Party Wins the Election

September 7, 2012 by Honey Leave a Comment

A great front page New York Times story came out Sept 7, 2012 by Nina Bernstein, called “With Medicaid, Cost of Long-Term Care Looms as a Rising Cost”.

The gist of this article is that no matter which party wins the election, hold on to your hats concerning Medicaid, which pays for about half of the cost of long-term care, nationwide. Medicaid is going to erode. It is eroding. It has eroded. Due to slashed reimbursements and broad middle-class access, Medicaid is already the last choice if home health care or assisted living are feasible instead.

I’ve pasted some quotes from the article, below.

“With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance.”

“Many people mistakenly assume that Medicare will cover long-term care, but at most it covers 100 days of rehabilitation, not so-called custodial care — the help with activities of daily life, like eating and bathing, that the aged can need for years.”

(It should already be clear to readers of this blog that Medicare can’t, and won’t pay for long-term care. Only reasonably priced long-term care insurance or personal savings and sacrifice pay for the more dignified options people prefer.)

“More than $80,000 a year on average for a nursing home — who can sustain that?” said Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long Term Care. “We’re forced, most of us, to go onto Medicaid. People don’t realize this.”” (I inject that many people are not forced to go on Medicaid unless they’ve failed to make responsible – and reasonable – plans for long-term care in advance.)

“While Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes — those proposed, and others already under way…The presidential election may decide Medicaid’s future. But many states faced with rising Medicaid costs and budget deficits are already trying to cut the cost of long-term care by profoundly changing Medicaid coverage, through the use of federal waivers.”

“Medicaid spends just under a third of its budget paying for long-term care for the disabled and elderly in nursing homes; this is more than five times as much as it spends on each poor child.”

The article goes into more detail on the different techniques states are using to try to trim their Medicaid budgets. It is my opinion that none of the proposed changes will improve the quality of Medicaid-paid long-term care; they will just shift around costs and add instability to this already strained program.

The bottom line is that the government cannot afford to provide decent long-term care. With the looming “Silver Tsunami” of Baby Boomers who are going to deluge it, the quality of Medicaid-paid long-term care is likely to continue to deteriorate. Counting on the government to pay for long-term care is foolhardy.

This article excellently describes Medicaid’s crisis and why it is ill-equipped to pay for long-term care. What it doesn’t even touch on is the fact that Medicaid-paid long-term care facilities are already the bleakest and scariest places to receive care. People do not choose Medicaid-paid long-term care. They default to Medicaid because they have no other options. And the real tragedy is that vast majority of American could have avoided this fate, but they denied that they would EVER need long-term care and therefore failed to take action before it was too late.

Aging Boomers Face Home Health Care Shortage

August 8, 2012 by Honey Leave a Comment

We are entering a crisis involving a soaring demand for home health care workers, according to this article in the August 5, 2012 edition of Bloomberg/Businessweek News.

According to the article, the US Labor Department projects that there will be a need for 1.3 million more of these workers during the next decade.

Yet the article reports the average wage for these workers is $9.70/hour, which is 4 cents an hour less than the average fast food server makes. Medical insurance is typically not included.

Nearly half of today’s home health care workers live at or below poverty level. Many receive government benefits such as food stamps.

If this soaring demand for home health care cannot be met, OR if people cannot afford such care because they have avoiding long-term care planning and have not purchased reasonably-priced long-term care insurance, people will probably be forced to move in with relatives or enter nursing homes, which will cost taxpayers even more.

Reaming Diane Rehm

June 22, 2012 by Honey 6 Comments

Believe-it-or-not, not everything you hear on the radio is true! I’ve just mailed the following letter to Diane Rehm, who recently aired a show on Long-Term Care insurance (LTCi) that contained many inaccuracies.

I’ve been specializing exclusively in sales and support of LTCi for over 22 years. Sadly, I can still only dream of the day that long-term care insurance will be truthfully and accurately covered by the media.

June 21, 2012

Dear Ms. Rehm:

I enjoy listening to your show whenever I can.

As an expert who has specialized in the placement of long-term care insurance (LTCi) policies for over 22 years, I took great interest in your May 29, 2012 program.

I have just listened to this show again online, this time isolating many inaccuracies.

Not a single one of your panelists represented the LTCi industry! One is a journalist, three are academics and or work at a non-profit. None are insurance licensed or have direct experience selling LTCi.

This was not a program on long-term care insurance. This show was about exploring how and why the government needs to pay for long-term care. This show could or should have more aptly been called “Options for Publicly Paid LTC” or “How to Fix Long-Term Care,” or “Why Publicly Paid LTC Needs Re-vamping.” This is Mr. Gleckman’s area of expertise and you spent a lot of on air time with him. Mr. Gleckman is unqualified to answer many of the questions you asked about LTCi, however, as were your other panelists.

I know how strongly you must feel about helping your listeners, but this program has hurt them. I understand this was inadvertent, but because your guests attempted to address questions they were unqualified to answer, LTCi was unfairly disparaged.

On the following pages I have identified just a few specific instances where false on-air statements and/or answers were given, resulting or the unwarranted disparagement of LTCi.

Your listeners deserve to know the truth about LTCi. Studies show that over 95% of all LTCi claims are paid and that LTCi policyholders are very satisfied at claim time. The reasons that claims are rejected are straightforward and should have been clearly explained to your listeners.

LTCi premiums do not have to be expensive. What can be expensive is needing LTC for a lengthy amount of time and not owning LTCi.

LTCi is about making sure that people have the dignity, options and choices they’ve been accustomed to throughout their entire life, including at the end of life, when the cost of healthcare is most likely to be catastrophically high. You did not emphasize this, yet this is what should have been highlighted. In addition, LTCi preserves wealth. Most people buy LTCi for the first reason and consider wealth preservation to be a secondary benefit. (This is why people with high net worth AND people with barely any net worth often buy LTCi.)

The primary reason why more people do not own LTCi is because they are simply unwilling to discuss or imagine a future in which they might require long-term care, not because premiums are high.

Mr. Gleckman’s goals for public LTC financing sound great in theory, but in light of practical issues like today’s political environment and huge budget shortfalls, LTCi policyholders do not and will not count on this. And neither should Americans without LTCi.

Currently, the majority of LTC in the USis paid for with government dollars. Few things in life are easier to demonstrate than the already inferior quality of government-paid nursing homes, and this is before the deluge of Baby Boomers starts overwhelming this system.

This program has hurt your listeners badly. You would do your listeners a true service if you would invite some guests who are actually experts on LTCi onto your program. I would be happy to help you identify such individuals.

Please see the following pages for examples of falsehoods aired on your program.

Sincerely,

Honey Leveen

Documentation of May 29, 2012 Diane Rehm Show LTCi disparagment

Minute 2:10

Ms Langford states that Lifetime benefits are “extraordinarily expensive,” which is false and disparaging of LTCi.

Minute 2:45

Ms. Langford states that built-in 5% compounding is what has driven recent Long-Term Care Insurance (LTCi) rate hikes. This is patently false. The primary reasons are: higher than anticipated persistency and artificially protracted, low interest rates on the sizeable reserves that insurance companies are required by law to maintain to cover claims. For more information on the causes of recent LTCi rate hikes, read the article National LTC Events, found at

http://archive.constantcontact.com/fs024/1102230271684/archive/1109959361711.html

Ms. Langford quotes the average cost of care as $238/day. This is the average cost of nursing home care. People who own LTCi are highly unlikely to receive care in nursing homes because LTCi enables them to afford preferable options like assisted living and home health care. However, people who do not own LTCi and spend down their life’s savings until they qualify for Medicaid will likely wind up in nursing homes. It is wrong to peg the average cost of care for a LTCi policyholder at $238/day.

Mr. A states that LTCi is for the relatively affluent, this is false.

Minute 4:38

Repeatedly, points are made about LTCi preserving wealth. LTCi is primarily about preserving dignity and options, then wealth. I did not hear discussion of how much choice LTCi offers at all. This was a very large omission.

Minute 5:00

LTCi is not just for the top 15%, it predominantly for the middle class, who are most exposed. Very affluent people, as well as those with little net worth, also purchase it. Virtually all my policy holders want to ensure their dignity by having options and to reduce and/or avoid family arguments about money. LTCi is a solution that can be reasonably priced for almost anyone insurable, if they willing to learn about it.

Minute 5:50

Ms. Langford states the Lifetime benefit periods have driven recent LTCi rate hikes. Again, consult the brief article National LTC Events at

http://archive.constantcontact.com/fs024/1102230271684/archive/1109959361711.html

for the correct explanation of recent rate hikes. Ms. Langford also stated that Lifetime benefit periods and 5% compounding have caused recent LTCi market contraction. The cause of LTCi market contraction is the same cause as the recent LTCi rate hikes: higher than anticipated persistency and artificially protracted, low interest rates.

Minute 6:40

The discussion was on nursing home care. This is not where most LTCi policyholders get their care. People who own LTCi can normally get care at home or in an assisted living facility.

Minute 7:20

Mention was made that LTCi premiums are too high for moderate income people. This is false! What a disservice to your listeners! The panelist further discourages purchase of LTCi by stating that it is not a product for the broad middle class. This is false. LTCi can be made very affordable. The conversation was steered towards the use of Medicaid for LTC provision. This is economically irrational and unsustainable, and what about the quality of Medicaid-paid LTC? What is your preference? To be marooned in a Medicaid LTC facility, or would you prefer to receive your LTC at home or in an assisted living facility? The quality of Medicaid-paid LTC is a subject that was simply not addressed by your panelists. Furthermore, they are unqualified to answer your in-depth questions about LTCi and came to you with a clear anti-LTCi bias.

Minute 20:00

There was discussion of the stability of LTCi carriers. If you’d had actual LTCi experts on, they would have explained how and why LTCi carriers are enormously stable, and in fact a lot more trustworthy and capable of paying for LTC than the government is. What a pity LTCi was again disparaged.

Minute 20:18

A comment was made about the “disarray” of the LTCi industry, I believe by you. This is an inflammatory, false, and disparaging comment. The LTCi industry is in a state of contraction, not disarray. This comment was not useful to the public who are eager to actually learn about LTCi. Instead, throughout this program, the public was dissuaded from carefully evaluating LTCi. This was a true disservice.

Minute 22:04

Mention of LTCi’s high cost was made. LTCi can be made very affordable. What’s not affordable is needing LTC for a lengthy amount of time and not owning LTCi. If your panelists were qualified to talk about LTCi, they would have said this.

Minute 30:50 and again at minute 51:40

There was discussion of “surprise” rate hikes. LTCi rate hikes are unusual. LTCi rate hikes are neither arbitrary nor easy to get, due to strict government regulation. Disclosure of the possibility and carriers history of rate hikes is made obvious in all LTCi sales materials. Agents are carefully trained to explain this possibility and can be sanctioned if they don’t. All clients should understand this can happen when they place their applications.

Government Shift to Care at Home

May 10, 2012 by Honey Leave a Comment

In “A Shift From Nursing Homes To Managed Care at Home” (New York Times, February 24, 2012) Joseph Berger notes that shrinking Medicaid and Medicare funds are forcing closure of more and more nursing homes – 350 nursing home have closed over the past six years nationally. For example, New York State plans to transfer 70,000 to 80,000 people needing over 120 days of Medicare-covered long-term care (LTC) to their homes. Studies suggest that care at home can cost less than in a nursing home, so such a policy may stretch scarce Medicaid funds a little further.

Shifting Medicaid funding from nursing homes to in-home care sounds great. Caregivers really like this idea. The whole notion of avoiding nursing home stays is very appealing.

Many policymakers cling to the notion that such a shift will save money, but this is far from the truth.

I quote the following from Steve Moses of the Center for Long-Term Care Reform:

When compared to an elderly population for whom traditionally available care is offered, recipients of expanded community-based services do not use significantly fewer days of nursing home care.[1]

An increasingly large number of studies, including the results of a national channeling demonstration program, have shown that non-institutional services typically do not substitute for nursing home care, but, rather, represent additional services most often to new populations.[2]

Although community-based LTC programs proved beneficial to both clients and informal caregivers in the LTC demonstrations, they did not prove budget neutral or cost effective.[3]

For Medicaid to afford quality home health care for all recipients it must have fewer recipients. By tightening eligibility, closing eligibility loopholes, preventing Medicaid planning, and enforcing estate recovery, the program can do a better job for fewer genuinely needy eligibles. When middle class and affluent people understand their savings and home equity are at risk for LTC, they will avoid Medicaid dependency by paying privately from savings, home equity conversion and private insurance.

Here are the footnotes:

[1] General Accounting Office, “The Elderly Should Benefit From Expanded Home Health Care But Increasing Those Services Will Not Insure Cost Reductions” (Dec. 7, 1982) p. 43, http://archive.gao.gov/f0102/120074.pdf.
[2] John F. Holahan and Joel W. Cohen, Medicaid: The Trade-off between Cost Containment and Access to Care, (Washington DC: The Urban Institute Press, 1986), p. 106.
[3] Kenneth G. Manton, “The Dynamics of Population Aging: Demography and Policy Analysis,” The Milbank Quarterly, vol. 69, no. 2, 1991, p. 322.

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Search Results for: nursing homes

The State of FL is Dumping Disabled Children

Medicaid is in Deep Trouble, No Matter Which Party Wins the Election

Aging Boomers Face Home Health Care Shortage

Reaming Diane Rehm

Government Shift to Care at Home

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