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Potential Concerns and Risks for Traditional LTCi

January 29, 2016 by Honey 2 Comments

Bait And SwitchForbes contributor Wade Pfau is doing the world great good with his series of articles about the urgent need for long-term care (LTC) planning.

What I like so much about Mr. Pfau is his credibility. He is a highly qualified financial planner and academic at The American College.

Financial advisors are generally fee-based, not commission-based, like I am. Because he does not make commission from his advice, some may consider him to be more credible than agents who sell long-term care insurance (LTCi).

In his January 19, 2016 Forbes column titled, “Potential Concerns and Risks of Traditional LTCi” Mr. Pfau describes the history of long-term care insurance and the mistakes made with this product in the past.

Since he is not an LTCi specialist, I can’t fault him too much for not quite “getting the whole story” on what causes and caused past LTCi rate hikes.

An example is this “bait and switch” accusation, which is wrong: “Buying based on who offers the cheapest price is risky, since the company may be seeking upfront sales with the intention of increasing premiums later.” It’s more complicated than this. Carriers are not interested in making lots of sales now and suffering unhappy clients, bad public relations, and reduced sales later. This has never been their strategy.

With an average LTCi buying age of 57 and an average claim age 25 or more years later, plus ever changing mortality rates and demographics, no prior experience to go on, and required reserves earning unusually low interest rates for longer than anyone could have imagined, how could the earliest LTCi carriers realize that their assumptions would be so far off that significant rate increases could not be avoided?

Mr. Pfau does correctly state that today’s LTCi products are expected to have very stable rates.

He also correctly describes the public’s resistance to buying LTCi. He gives some good reasons but fails to point out the #1 reason people don’t buy LTCi: DENIAL! To be fair, however, he has mentioned denial in his prior columns.

Mr. Pfau does mention people sometimes lapse their LTCi shortly before they need to use it, due to cognitive decline. This doesn’t happen often, but I have seen and dealt with it, and it is highly upsetting. It is also highly avoidable. By and large, LTCi policies have very low lapse rates. The study Mr. Pfau refers to giving high lapse rates has been refuted.

It is up to policyholders to plan for the high odds of mental incapacity by appointing and empowering, not arguing with, trusted individuals to act on their behalf. I have learned that one of the earliest and most subtle indicators of mild cognitive impairment is making bad business decisions. Such bad decisions often go unnoticed, again, due to denial by the policyholder and family members.

Today’s LTCi policies, thankfully, have stronger protection against unintentional lapses.

I still love Wade Pfau and greatly appreciate his very clear writing and ability to make complicated concepts understandable. His articles are very factual, with very few flaws.

 

Filed Under: Helpful Information About LTC, I'll Just Self-Insure, Information About LTC Tagged With: Forbes Magazine, Long Term Care insurance, long-term care, LTCi, Medicaid, Medicare, The American College, Wade Pfau, www.forbes.com

New Study Predicts LTC Costs and Odds

August 9, 2015 by Honey Leveen Leave a Comment

Confused WomanA recent Forbes article by Howard Gleckman announced the publication of a new study predicting the odds and costs of needing long-term care. Here’s a link to the new UE-ASPE (Urban Institute – Office of Assistant Secretary for Planning and Evaluation) Study.

Media and non-wonky people like me will find the survey difficult to interpret.  I will share what I feel readers should take away from this study.

The study interprets the incidence of paid care only!

The statistics in the new study predict a lower incidence of long-term care (LTC) need, and less financial exposure than we expected. But it only deals with Long-Term Services and Supports (LTSS), which is paid care, typically funded by savings and government (Medicare and Medicaid). Despite this limited scope and possible bias (I will not comment on that here), it gives compelling reasons to own long-term care insurance (LTCi).

Actuaries should be able to use this new information to more accurately price LTCi policies. Hopefully, this will cause increased competition in the LTCi marketplace.

The study estimates about half (52%) of Americans turning 65 today will require LTSS. Make note: LTSS consists of paid care only!

The study fails to properly acknowledge the extremely high, often catastrophic incidence of non-LTSS (informal, unpaid care, typically provided by family and friends) and the physical, emotional and phychological havoc it creates. Long-term care insurance (LTCi) pays a high percentage of this type of care.

Two out of three (66%) of older people with disabilities who receive LTSS at home get all their care exclusively from their family caregiver, mostly wives and daughters. Another quarter (26%) receives some combination of family care and paid help; only 9% receive paid help alone.

Many people who need LTC do not need LTSS. They have dementia or a chronic need for assistance with their Activities of Daily Living (ADL’s). This is precisely what LTCi pays for. Most of us do not own LTCi. People often make makes excuses and rationalize not purchasing LTCi, often with later regret. Spouses, children, and siblings (most of them women) become caregivers, not by choice, and often at great financial sacrifice.

Lost income and benefits over a caregiver’s lifetime is estimated to range from a total of $283,716 for men to $324,044 for women, or an average of $303,880.

There are additional flaws with the new study. I will not address them here. I just hope academics will use this new information well. I also hope that media will pause and research carefully before writing about this study.

In the LTCi industry we always say you should look through the windshield, not the rearview. This study uses historical information. With the increasing incidence of single adult households, the emergence of increasing numbers of “elder-orphans” (those without, at distance, or estranged from children) plus my anecdotal observations, even the best studies may prove to be inaccurate.

Filed Under: Helpful Information About LTC, I'll Just Self-Insure, Information About LTC Tagged With: ASPE, Honey Leveen, Howard Gleckman, LTSS, Office of the Assistant Secretary for Planning and Evaluation, Ubran Institute, www.forbes.com, www.honeyleveen.com

Finding Good Nursing Home Care Is Not Easy!

July 2, 2014 by Honey Leveen Leave a Comment

Good Nursing Home CareA 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.

Filed Under: Elephant in the Room, Helpful Information About LTC, I'll Just Self-Insure, Information About LTC Tagged With: AARP, assisted living, Howard Gleckman, Lexington Place Nursing Facility, Medicaid, Nursing Homes, SCAN Foudantion, The Commonwealth Fund, www.forbes.com

The High Cost of Elder Care

December 29, 2011 by Honey Leave a Comment

Here’s a link to a great testimonial for long-term care insurance (LTCi) from www.forbes.com. The blog is titled The High Cost of Elder Care. The author describes how the  LTCi his parents purchased is allowing his father to access the type and quantity of care he now needs, without wrecking undue havoc with  family members lives or finances.

The author is quoting $30/hour for home health care. I cannot find information on where the father lives, but this high hourly cost for care causes me to believe he resides somewhere other than TX. Here in TX, high quality home health care costs about $20/hour. If this family lived here, this same LTCi policy would have preserved even more of the family’s wealth.

Filed Under: Helpful Information About LTC, Information About LTC Tagged With: Forbes Magazine, home health care, Honey Leveen, Long Term Care insurance, LTC Insurance, www.forbes.com

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Phone: 713-988-4671
Fax: 281-829-7177

Email: honey@honeyleveen.com

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