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Long Term Care

Apr 18
Love0

Will I Ever Live In A Nursing Home?

By Uncategorized

How Much Care Will You Need?

The duration and level of long-term care will vary from person to person and often change over time. Here are some statistics (all are “on average”) you should consider:

  • Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years
  • Women need care longer (3.7 years) than men (2.2 years)
  • One-third of today’s 65 year-olds may never need long-term care support, but 20 percent will need it for longer than 5 years

Distribution and duration of long-term care services

Type of care Average number of years people use this type of care Percent of people who use this type of care (%)
Any Services 3 years 69
 

At Home
Unpaid care only 1 year 59
Paid care Less than 1 year 42
Any care at home 2 years 65
 

In Facilities
Nursing facilities 1 year 35
Assisted living Less than 1 year 13
Any care in facilities 1 year 37

Who Pays for Long-Term Care?

The facts may surprise you.

Consumer surveys reveal common misunderstandings about which public programs pay for long-term care services. It is important to clearly understand what is and isn’t covered.

Medicare:

  • Only pays for long-term care if you require skilled services or rehabilitative care:
    • In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days).
    • At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time.
  • Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services
  • You will have to pay for long-term care services that are not covered by a public or private insurance program

Medicaid:

  • Does pay for the largest share of long-term care services, but to qualify, your income must be below a certain level and you must meet minimum state eligibility requirements
  • Such requirements are based on the amount of assistance you need with ADL
  • Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay for long-term care services, but only for specific populations and in certain circumstances

GOOD TO KNOW

Like public programs, private sources of payment have their own rules, eligibility requirements, copayments, and premiums for the services they cover.

Health Insurance:

  • Most employer-sponsored or private health insurance, including health insurance plans, cover only the same kinds of limited services as Medicare
  • If they do cover long-term care, it is typically only for skilled, short-term, medically necessary care

There are an increasing number of private payment options including:

PLAN BEFORE YOU HAVE A NEED

Planning for the eventuality of needing long term care is critical in reducing stress and uncertainty. Meeting with an Elder Law attorney familiar with the rules of Medicaid qualification is a step in the right direction. Contact our office for a no-obligation consultation to see if developing an estate plan with the goal of Medicaid qualification is a right fit for you.

Apr 09
Love0

Caretaker child exception can protect residence of Medicaid recipient

By News

Caretaker Child and Medicaid Qualification

Children are often confronted with difficult decisions when time and age catch up with their parents. Many children have been pushed into the role of being primary caregiver for their parents. The motivation stems from the very reasonable wish to keep parents at home for as long as possible despite health and medical issues of parents that indicate the parents need additional assistance with activities of daily living.

When children assume the role of caregiver to their parents with the goal of being able to avoid nursing home care for parents, there are benefits to this arrangement. Beyond the obvious advantage of the peace of mind of knowing you are doing all that you can keep your parents comfortable.

When a parent reaches the point in life where medical needs are increasing, it is prudent for the surrounding family to contact an elder law attorney who can explain the necessary and proper documents to have in place for parents so that children can assist with the parents legal and medical needs.

Children often become caregivers for parents.

In addition, the elder law attorney should be prepared to introduce you to the Medicaid program and how it works for people who are expected to need skilled nursing and long term care.

Family should advise the elder law attorney about any children living at the home caring for a parent. These facts create a unique opportunity to protect the home of the parent from possible long long term care costs while still maintaining Medicaid eligibility.

If a child lives with a parent of the two (2) year period before the parent needs to enter into a nursing home, an if the child had not been with the parent the parent would have had to live in a nursing home, the parent can transfer the home to the caretaker child without being disqualified from Medicaid benefits. The parents doctor needs to certify to this arrangement and time frame for this exception to the transfer penalty to work.

The below link to an article explains some of the things that will need to be demonstrated to take advantage of this Medicaid planning opportunity. In Rhode Island, the rules are similar to the attached article but concerned individuals should meet with an elder law attorney to discuss the caretaker child exception as it applied to their facts.

Source: James Contini column: Caretaker child exception can protect residence of Medicaid recipient

 

Want to lean more? Contact our office for a no-cost consultation.

Jan 08
Love0

Research in war against Alzheimer’s

By Uncategorized

Promising new research on Alzheimer’s at Butler Hospital and Brown University begins with a simple swab of the cheek

Cognitive impairment such as Alzheimer’s is a prevalent cause for needing long-term care. As the disease progresses, it undermines a persons ability to live independently in the community. Families who are faced with this disease, are a loss as to how to care for their loved ones. Estate Planning is a critical step in this process. Another, is learning and understanding more about the disease and what research is being done around it.

PROVIDENCE, R.I. — The weather one recent evening reflected the nature of the topic when a small crowd gathered at Butler Hospital to learn more about Alzheimer’s disease. It was cold and dark — in a word, gloomy.

Such is the illness, which erases memory and personality while burdening relatives and caregivers on its path to inevitable death. As yet, there is no cure.

But the man who drew these people from the comfort of home preaches hope, in the form of groundbreaking research he conducts with other scientists around the world.

On this evening, Dr. Stephen P. Salloway did more than preach.

Using the military metaphor he favors, he sought to enlist recruits in a new phase of a campaign he likens to the Second World War, when, against great odds, Allied forces defeated a mighty foe.

“I’m very excited that we are building an infrastructure worldwide to fight Alzheimer’s disease,” Salloway said as he began his presentation. “Many of our same allies in World War II are allies in this fight against Alzheimer’s.”

The scientist projected a slide describing research efforts around the planet, with Europe, Australia, North America and parts of Asia pinpointed as strategic centers.

“We are making progress, and there are other initiatives and consortiums, here and abroad, moving this forward,” Salloway said.

On he went, through slides of diseased brains, of German neuropathologist Alois Alzheimer’s first, historic patient, and of the APOE gene, which may indicate increased risk of the disease, depending on which of six possible variants an individual carries. Other factors, including age, diet, lifestyle and overall health, also influence risk.

With researchers elsewhere, Salloway and his team at Butler’s Memory and Aging Program are seeking volunteers to enlist in the so-called Generation Study, for men and women age 60 to 75 who are cognitively normal — but may be at risk, depending on their genetic makeup.

Screening begins with a swab of the cheek, which is analyzed for the APOE gene; eligible candidates may then decide to enroll in clinical studies of new medications, including a drug known as CNP520, which has just entered a trial sponsored by Novartis Pharmaceuticals in collaboration with Amgen and Banner Alzheimer’s Institute.

“Not only can you find out your genetic risk by having the APOE test,” Salloway said, “but then if you’re the right age group and meet the criteria and you’re interested, you could also participate in a prevention trial to try to lower the risk. We’re very excited about that.”

Many in the audience were as well. Eighteen would sign the necessary papers and have their cheeks swabbed. They would become the latest recruits in Salloway’s citizen army — which, when all studies and the Butler prevention registry are counted, now numbers more than 800.

Salloway’s aim is much higher.

Sandra Robinson Gandsman, a Pawtucket resident who spent most of her career in health-care marketing, was among those who enlisted with a swab and her signature. She was motivated, in part, by her knowledge of disease.

“Very honestly, this is more frightening than cancer,” Gandsman told The Journal. “If you get a diagnosis of cancer, there’s a possibility you can be cured. Certainly there are treatments that you can take. But Alzheimer’s — it’s kind of like, ‘Wow, there’s not much there.’”

The work of Salloway and others, she said, could put something there. Lives could be transformed for the better. New generations could escape the threat altogether if promising avenues prove true.

Sentiment also motivates Gandsman. She related the experience of a 73-year-old friend diagnosed with early-stage Alzheimer’s — that “mild” first of three phases of the disease characterized by “challenges performing tasks in social or work settings” and “forgetting material that one has just read,” among other symptoms, according to the Alzheimer’s Association.

“I noticed for a couple of years a lot of forgetfulness and repetition,” Gandsman said of her friend.

One day, she stepped on the tennis court with the woman, who had played the game for decades and was skilled at it.

“She didn’t know where she was,” Gandsman said. “She couldn’t keep score, but she didn’t know she couldn’t. She hit the ball and wasn’t sure where she was supposed to stand. I immediately called her husband. I thought she’d had a small stroke.”

She hadn’t.

“Her husband had been covering for her,” Gandsman said. “I didn’t realize it at the time.”

It was not hyperbole.

The prevalence of the disease doubles every five years after age 65, reaching as high as half of all people 85 and older. Lacking major advances, by 2050 an estimated 125 million people worldwide will have dementia, a broad category of brain afflictions that includes Alzheimer’s. Health-care costs for U.S. Alzheimer’s patients was estimated at $259 billion in 2017, a figure that does not include the billions of hours of free care, typically accompanied by significant emotional and other stresses, that family and friends provide.

Beyond the statistics is the reality of becoming one, as Salloway’s audience — mostly middle-age and older — acknowledged.

“If you ask older people what disease they fear most, what’s number one?” Salloway said.

“Alzheimer’s,” was the collective response.

“Why?”

But optimism co-exists with alarm, which is another theme Salloway strikes when he speaks to the public, as he does regularly. Building an army is more than a desk job.

“In order to make a difference, we need to find better treatment,” he said. “Congress is getting older and they’re worried about Alzheimer’s, too. That’s one of the few things that Democrats and Republicans agree on: that Alzheimer’s is bad. And so there is now a national plan to fight Alzheimer’s, with a major goal of developing breakthrough treatments by 2025. And we’re working hard to meet that goal.”

Congress has done more than pay lip service, Salloway said, and his slide confirmed it: National Institutes of Health funding for Alzheimer’s research rose from $448 million in 2011 to $991 million in 2016, surpassing the billion-dollar mark last year, when it reached $1.39 billion. This year, research funding is projected to reach $1.8 billion.

“Cancer is $6 billion, so we’re still well below that, but we’re making progress,” said Salloway, a professor at Warren Alpert Medical School of Brown University. “You might have heard that Bill Gates announced he was investing $100 million in Alzheimer’s research. That’s terrific. We’re so excited about that. I think that’s going to stimulate others to donate as well.”

Special-education teacher Donna de Chauny doesn’t have millions to invest; like Gandsman, she answered Salloway’s call out of noble purpose.

“If some of the research that we participate in helps further the information that helps find a cure, then I am happy to participate,” de Chauny said.

“When you watch somebody you love go through it, it’s just terrible,” de Chauny said.

Before moving from her home in North Carolina to Warren, Collene’s symptoms had become increasingly pronounced, even as she endeavored to hide them.

“She knew she couldn’t remember things,” her daughter said. “Every time you’d talk to her on the phone, the same things would repeat themselves because she was trying to have a conversation. And she couldn’t really gather the words to react to what you were saying in an appropriate way.”

But she kept trying to maintain a veneer of normalcy, even after relocating to Rhode Island.

“She would pour her coffee on her cereal in the morning and think nothing of it,” de Chauny said. “We’d say, ‘I don’t think that’s going to taste too good, Mom.’ And she’d say, ‘Oh, that’s always the way I have it.’”

Collene was not the only family member to suffer from Alzheimer’s, de Chauny said; all three of her mother’s siblings also died of the disease.

Salloway spoke to that during the swabbing event, the second held at Butler, saying that remaining mentally and physically active and socially engaged appear to reduce risk, as do “eating a balanced, Mediterranean-type diet,” sleeping well, quitting smoking, maintaining healthy weight and blood pressure, and other measures. All are encapsulated in the mantra: “What’s good for the heart is good for the brain.”

But more than lifestyle is involved in Alzheimer’s, which is characterized by buildups of two proteins in the brain: tau, which forms tangles inside neurons, and amyloid, which forms damaging plaque in connections between nerve cells. The precise mechanism of these protein buildups is not entirely understood, but research has brought advances.

One recent development has been a type of Positron Emission Tomography, or PET, technology that can reveal the presence of plaque years before symptoms of Alzheimer’s appear; previously, a diagnosis could be confirmed only at autopsy, with a microscopic examination of the brain.

Another has been clinical trials of Aducanumab, a drug made by Biogen that has demonstrated success in reducing amyloid plaque. The drug holds such promise that the paper describing the research behind it made the cover of the Sept. 1, 2016, edition of Nature, one of the world’s leading science publications. Salloway was one of the paper’s authors.

A third is a technique being developed by Salloway’s group and a team led by Peter J. Snyder, professor of neurology at the Alpert Medical School and Lifespan’s chief research officer, that could be used to diagnose Alzheimer’s by retinal imaging, a relatively simple and inexpensive procedure that an ophthalmologist could perform.

And there is more promising research elsewhere in the state, including that conducted by University of Rhode Island neuroscientist Paula Grammas, whose work focuses on the role the vascular system plays in Alzheimer’s. Grammas is the inaugural director of the George and Anne Ryan Institute for Neuroscience.

Salloway projected a slide, “Rhode Island as an incubator for innovation in AD research,” that included a photo of Grammas with Governor Gina Raimondo, URI president David M. Dooley, and former CVS Health Chairman and CEO Thomas M. Ryan, who established URI’s Ryan Institute.

“Rhode Island — because of our small size, everybody knows everybody,” Salloway said, to laughter.

But proximity and determination have more than comic value. With both, collaboration can flourish.

“We could really be an innovation center for Alzheimer’s research and prevention studies,” Salloway said.

Without volunteers, innovation would slow. And so, Salloway urged his latest recruits to encourage others to join the army.

“You’re already doing a lot to fight Alzheimer’s,” he said, “but I want you to take the Alzheimer’s challenge. I want you to tell five other people that you came here tonight to find out about Alzheimer’s research. We hope you will spread the word around.”

And also, host “swabbing parties” at homes or civic organizations, with the Butler team handling the logistics.

To learn more about Alzheimer’s research at Butler and how to enroll in a study, call (401) 455-6402 or visit butler.org/memory

Alzheimer’s disease research funding

$448M

National Institutes of Health spending in 2011

$1.39B

NIH spending in 2017

$1.8B

NIH projected spending in 2018

$6B

NIH spending on cancer research in fiscal 2017


Sources: NIH, U.S. Senate Committee on Appropriations

Source: Researchers build ‘citizens army’ in war against Alzheimer’s

Aug 17
Love0

Higher health-insurance rates coming to R.I. for 2018

By Uncategorized

Health-Insurance rate increases

A number of Rhode Island health-insurance companies have been granted permission for double-digit rate increases to their premiums for 2018.

The new rates released Thursday by the Office of the Health Insurance Commissioner range from increases of 5 percent to 12.1 percent. In six of 12 cases, the rates app

Insurance Policy

roved are less than the increases requested by the insurance companies. Collectively, the 2018 premium approvals are $16.7 million lower than what insurance companies requested.

The rate increases approved for the individual market, which covers roughly 47,000 people, are: Blue Cross Blue Shield of Rhode Island, 12.1 percent; Neighborhood Health Plan of Rhode Island, 5 percent.

The rate increases approved for small-group market, which covers roughly 60,000 people, are: Blue Cross Blue Shield of Rhode Island, 7.3 percent; Neighborhood Health Plan of Rhode Island, 6.3 percent; United HealthCare HMO, 8.1 percent; United HealthCare PPO, 8.1 percent; Tufts Health Plan HMO, 6 percent; Tufts Health Plan PPO, 6.5 percent.

The rate increases approved for the large-group market, which covers roughly 123,000 people, are: Blue Cross Blue Shield of Rhode Island, 10 percent; United HealthCare, 8 percent; Tufts Health Plan HMO, 9.8 percent; Tufts Health Plan PPO, 10.4 percent.

Having health insurance is the first step in the process of planning for medical issues and paying for your care to address those issues. However, health insurance is only one piece in the health care planning puzzle. People need to be aware that health insurance does not pay for every health related expense. One major expense it does not pay for is nursing home care, or skilled nursing care. These medical expenses are not covered by health insurance and should you or a loved one find yourself in a position to need to reside in a facility, many are overwhelmed with the financial burden it imposes. Thus planning your estate and planning for these expenses is critical. Call us to discuss how you can plan for these expenses.

Source: Higher health-insurance rates coming to R.I. for 2018

Jun 15
Love0

AARP ranks Rhode Island 32nd among states in meeting long-term care needs

By Uncategorized

Source: AARP ranks Rhode Island 32nd among states in meeting long-term care needs

PROVIDENCE, R.I. — Rhode Island ranks 32nd in the nation, and the worst in New England, when it comes to meeting the long-term care needs of older residents and people with disabilities, according to a scorecard released this week by the national nonprofit AARP.

The good news: Rhode Island showed improvement in all but one category.

“The vast majority of older Rhode Islanders want to live independently, at home, as they age — most with the help of unpaid family caregivers,” Kathleen Connell, state director of AARP Rhode Island, said in a statement released Wednesday. “Even facing tight budgets, Rhode Island is making progress to help our older residents achieve that goal. However, this scorecard shows we have more to do, and we need to pick up the pace.”

Rhode Island ranks 22nd nationally “support for family caregivers” and 24th in “quality of life and quality of care.” The state ranks 35th in “effective transitions,″ or how effectively the state transitions residents between nursing homes, hospitals and homes — the only category that showed a decline.

The report — “Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers” — is the third in a series that ranks states overall and on 25 separate indicators in five key areas: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and effective transitions between nursing homes, hospitals and homes.

Unpaid family caregivers provide the bulk of care for older Rhode Islanders, in part because the cost of long-term care remains unaffordable for most middle-income families, according to AARP Rhode Island. More than 134,000 Rhode Islanders help care for their aging parents, spouses and other loved ones so they can stay at home. AARP estimates the value of this unpaid care at about $1.78 billion.

“Many [family caregivers] juggle full-time jobs with their caregiving duties,″ Connell said, while “others provide 24/7 care for their loved ones.” Family caregivers “save the state money,″ she said, “by keeping their loved ones out of costly nursing homes – most often paid for Medicaid.″

Rhode Island improved its rank from 50th to 44th in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care at home and in the community.

The report comes at a time when proposals in Washington are being considered to drastically cut federal Medicaid funding, which Connell said “would threaten these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on.″

The scorecard was developed AARP with the support of The Commonwealth Fund and SCAN Foundation.

The AARP Rhode Island has more than 138,000 members age 50 and older in the state.

New England Scorecard Rankings (best to worst):

Vermont: 3

Connecticut: 10

Massachusetts: 11

New Hampshire: 16

Rhode Island: 32

Rhode Island’s scorecard:

Overall: 32

Affordability and Access: 34

Choice of Setting and Provider: 30

Quality of Life & Quality of Care: 24

Effective Transitions: 35

-larditi@providencejournal.com

(401)277-7335

On Twitter: @LynnArditi

Jan 25
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Early Diagnosis Beneficial for People with Dementia

By Medicaid Planning and Gifting, Uncategorized

The devastating impact of Alzheimer’s disease and Dementia

A TPT documentary aims the national spotlight on looming Alzheimer’s “epidemic” and its financial and emotional toll on families. The devastating impact of Alzheimer’s disease and Dementia on his own mother — and on his father, who struggled to care for her — first prompted Gerry Richman to take a hard look at the disease. As vice president of national productions at Twin Cities Public Television, he was the mastermind behind a 2004 Emmy-winning documentary called “The Forgetting: A Portrait of Alzheimer’s.” Now, Richman is back with another eye-opening film on the subject. “Alzheimer’s: Every Minute Counts” — airing across the country Wednesday — chronicles the struggles of people living with Alzheimer’s and the emotional and financial challenges it poses for their families. It also forecasts, through interviews with doctors and researchers, a looming crisis for the country as baby boomers enter their senior years and their risk of developing Alzheimer’s increases.brain_slices

The current numbers are scary enough. More than 5 million Americans have Alzheimer’s — with one new case identified every minute. In addition to the emotional toll, it can cost tens of thousands of dollars to take care of someone with Alzheimer’s, making it one of the most expensive diseases and provoking some health experts to predict that it will collapse both Medicare and Medicaid — and the finances of millions of people. Although Alzheimer’s can strike people younger than 65, it generally occurs in those much older. The risk of developing the disease doubles every five years after 65, according to the National Institute on Aging. It becomes much more common among people in their 80s and 90s. With longer life spans come greater numbers of people at risk of Alzheimer’s. “There hasn’t been a large population of 85-year-olds until this generation,” Arledge said.
The full article can be found HERE.

When you or your loved one is diagnosed with a cognitive issue, planning for how to handle the soon to be increased needs of your loved ones is critical. Discussions as to immediate and long term needs must be had with your medical advisers and with your financial advisers. Financial advisers are as important as medical as there must be a plan in place as to how to pay for the additional services needed.

When you need to develop a plan about how to handle the cognitive issues of a loved one, contact our office for a no-cost consultation to discuss your facts and options.

MJL-Blog-Footnote-1

Dec 29
Love0

Funding Long-Term Care for an Aging Global Population

By Uncategorized

Funding Long-Term Care is a Global Issue

Bobbie Preddy’s mother ran out of money years ago. She’s 98 years old and if she lives longer than six more months, Preddy might be out of cash, too.

Preddy’s mother requires round-the-clock care, due to frequent urinary tract infections and related conditions. Together, Preddy and her mother determined the only way she could get the support and care she needed was at an assisted-living facility. But costs for even one of the cheapest facilities in the market are hundreds of dollars more than Preddy’s mother can afford with her pension checks each month.

“I’m going to run out of money and my mother might still be alive,” she says. “And I don’t see anything, anywhere that can help that.”

Preddy’s dilemma is not uncommon. Her mother is one of more than 8 million individuals in the U.S. that require support from long-term care services, according to the Centers for Disease Control and Prevention, the great majority of whom are more than 65 years old. Family Caregiver Alliance, a nonprofit support organization for caregivers, lists at least 10 different options for living arrangements, each with varying degrees of provided care, independence and cost. According to the insurance company Genworth, the average annual cost for a private room in a nursing home in the U.S. is more than $90,000, and a year in an assisted-living facility is more than $40,000 , expenses that are not always covered by public insurance programs.

Globally, the number of older persons is growing faster than any other age group. In 2015, one in eight people was more than 60 years old, according to the United Nations. By 2030, they project an increase to one in six people, or 1.4 billion individuals over the age of 60.pbn-article

When it comes to aging, experts say the greatest challenge our world currently faces — more than pensions or birth rates — is planning for and financing long-term care.

Long-term care is like an “exploding bubble,” says Randall Ellis, a professor at Boston University whose research is focused on health economics. “It’s the largest uninsured risk for the aging population.”

In the U.S., when people face the dilemma that Preddy does with her mother — once houses have been sold, a lifetime of savings has been depleted and health conditions have reached the point that in-home care is not an option — others may rely on Medicaid to cover costs.

In 1965, Medicare and Medicaid became the first public health insurance programs in the U.S. when they were signed into law by President Lyndon Johnson. Medicare was intended for individuals over 65 years old and those with end-stage renal disease, or kidney failure. Medicaid was intended to cover low-income individuals. But as of fiscal year 2014, long-term care services accounted for about a third of Medicaid spending, or $152 billion.

Preddy’s mother is well beyond 65 years old and, with an annual income of about $17,000, would be considered low-income by many. Her pension is far from enough to pay for her long-term care, but it is enough to disqualify her for both public health insurance programs and leave her family scrounging for funds.

“There’s an extreme bias in the allocation of resources away from older people to other groups,” says Peter Lloyd-Sherlock, a professor of social policy and development at the University of East Anglia in the U.K. whose research focuses on the social protection of older people in developing countries. Costs associated with long-term care — financial and otherwise — are inevitable, he says, and the systems created to distribute those costs exemplify the values of that society.

Taking care of an individual at home will always be less expensive than bringing him or her to a nursing home or assisted-living facility, says Terry Hokenstad, a professor of global health at Case Western University. Policies and programs that support informal caregivers like family members, he said, make it easier to keep older adults at home and out of long-term care facilities longer, therefore reducing their overall costs.

In a number of European countries, pension funds are used to compensate unpaid caregivers. Denmark and the Netherlands automatically cover time spent outside the labor force due to caregiving, while Germany and Norway reward caregivers with additional credits to their own pensions.

 “Say an older person has a stroke and goes into the hospital,” Hokenstad says. “The first thing we (Americans) think is to get them to a nursing home. The first thing they think in the Nordics is how they can get back into their own home and what sort of improvements are needed to make it happen.”

But Naoki Ikegami, president of the Japan Society of Healthcare Administration and the Japan Health Economics Association, warns against a reliance on informal care for older adults. A long-term care industry has a public responsibility and legal obligation to provide appropriate care, he said, but it’s difficult to monitor whether family members are actually caring or not.

Instead, restricting the “medicalization” of long-term care — maintaining a separation between health care spending and activities and those related to long-term care — can keep expenses down. “Health care can always be interpreted as a life or death situation,” he says. “In health care, we give doctors a blank check to do whatever the patient needs. But with long-term care, we can rely on a more objective way of measuring need.”

In 2000, Japan developed a universal insurance program for long-term care in response to public outcry against growing problems of neglect. Funded by tax revenues and higher premiums for those over 40 years old, out-of-pocket costs for long-term care services are limited to a 10 percent co-payment. A revision this year raised that rate to 20 percent for those with above average income.

Ultimately, national and global debates on long-term care come down to whether the responsibility to look after our growing elderly population should be a public or private one. Like Japan and Denmark, most developed countries have favored strong, publicly funded social safety nets.

For Josh Wiener, former director of the Aging, Disability, and Long-Term Care program for the non-profit research organization RTI International, creating a successful system is a matter of finding the political will to make long-term care a policy priority.

“Long-term care is higher on the political agenda mostly everywhere else than it is in the U.S.,” he said. “Germany established a long-term care insurance program at a time when they were dealing with the unification of the East and the West. They recognized a need and they went ahead and did it.”

The same happened in Japan, where policy makers saw they had an aging population and agreed to address it . But the U.S., he said, tends to avoid the conversation.

For a while, private insurance plans that allow individuals to protect a greater share of their assets dominated the long-term care coverage discussion in the U.S. But the number of providers for these private plans has decreased dramatically in recent years.

A voluntary public insurance program almost made its way into President Barack Obama’s health care reform plans in 2011. But the Community Living Assistance Services and Supports program, or CLASS Act, was quashed for fear of adverse selection, or attracting a disproportionate number of high-cost users, that would drive up premiums and because it couldn’t prove to be debt-free for at least 75 years as the law requires.

Bobbie Preddy and her mother share a caring and trusting relationship; they’re “simpatico,” she says. Preddy doesn’t hope for her mother to die, but she does hope that supporting her mother doesn’t have to cut too much into her own retirement savings.

Deidre McPhillips is a data reporter at U.S. News. You can find her on Twitter or email her at dmcphillips@usnews.com.

The original story can be found HERE.

MJL-Blog-Footnote-1

Nov 13
Love1

John Hancock Withdrawing From Long-Term Care Market

By Uncategorized

Major Carrier Withdrawing from Long-Term Care Market

John Hancock Financial, owned by Manulife Financial Corp., a Canadian firm, is pulling out of the long-term care market for insurance this December. John Hancock has been one of the largest long-term care insurance providers in the United States with over 1.2 million outstanding policies. These policies will remain in effect, but no new policies will be sold moving forward. The move comes after years of premium increases for existing long-term care policies, flat consumer demand, and decreasing avenues in which to distribute long-term care insurance. This withdrawal signals what many financial planners, government officials, and financial service firms have known for years—that the United States is nearing a long-term care planning crisis.

Long-term care insurance information, form, Folders and stethoscope.

Long-term care for seniors is very common, with over 70% of people aged 65 and over needing some long-term care during their lives. And the costs can be staggering, with a semi-private nursing home room costing well above $100,000 annually in some states. Instead of self-funding this cost or buying long-term care insurance, most individuals rely on family caregivers, who often go unpaid, to provide the care. However, this system of relying on family members could also soon be faltering. According to an AARP Study, The Aging of the Baby Boom and the Growing Care Gap, the ratio of potential family caregivers to high-risk people in their 80s will decline from 7-to-1 in 2010 down to 4-to-1 in 2030, and is expected to decline to just 3-to-1 in 2050.

As Hancock withdrawals from the marketplace, Americans are quickly finding themselves with fewer options to fund their long-term care expenses. Limited options coupled with a decrease in available family care givers may force many retirees to rely exclusively on Medicaid as a long-term care funding source. However, Medicaid generally requires that an individual spend down his or her assets before qualifying for government assistance. Additionally, relying on Medicaid means giving up a lot of control over how and where you receive long-term care services.

For years now, state governments and the federal government have been looking at ways to cut back reliance on Medicaid, which could mean increased reliance on state filial laws like the one applied in HCRA v. Pittas.. In this case, a son was required by the court to pay his mother’s $93,000 nursing home bill pursuant to Pennsylvania’s filial responsibility law. Almost half of all U.S. states have a similar law in place, making certain family members potentially liable for another family member’s long-term care expenses. In Pennsylvania, this type of law has even been applied to allow a child to recoup from his siblings the costs the child incurred while taking care of a parent at home.  It is possible that states will rely on these filial support laws to ease the burden on Medicaid by requiring family members to chip in for some of the long-term care costs when possible.

Long-term care planning remains crucial, and while John Hancock is withdrawing from the market, other firms like Lincoln Financial, Thrivent Financial, and Genworth are still providing long-term care insurance policies, at least for the time being. However, some of these companies, like Genworth, have seen significant premium increases on existing policies.

Long-term care planning still remains a crucial part of retirement planning and it must be done well in advance of when care is actually needed. If you are thinking about long-term care insurance, in many cases, the best time period to begin planning is in your 50s and early 60s, as it becomes significantly more difficult to qualify for long-term care insurance in your late 60s and 70s. However, other options also exist, like hybrid long-term care and annuity or life insurance products, which have grown in popularity over the last few years. These products can serve multiple functions and can have less restrictive underwriting requirements than long-term care insurance. Ultimately, John Hancock’s withdraw highlights the challenges facing both Americans and companies trying to find the right solution for long-term care funding.

CLICK HERE TO READ FULL ARTICLE BY JAMIE HOPKINS

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Sep 26
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145 Year Old Man is Longest Living Human

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Longest Living Human Says He Is Ready For Death At 145

An Indonesian man who claims to be the longest living human in recorded history has described how he “just wants to die”. Mbah Gotho, from Sragen in central Java, was born on December 31, 1870, according to the date of birth on his identity card. Now officials at the local Oldest Living Manrecord office say they have finally been able to confirm that remarkable date as genuine. If independently co
nfirmed, the findings would make Mr. Gotho a staggering 145 years old – and the longest lived human in recorded history.

But despite his incredible longevity, Mr. Gotho says he has little wish to remain on this earth much longer. Mr. Gotho has outlived all 10 of his siblings, four wives, and even his children. His nearest living relatives are grand children, great grand children, and great-great grandchildren. One of Mr. Gotho’s grandsons said his grandfather has been preparing for his death ever since he was 122.

The full article published on August 16, 2016 by The Telegraph News on Mr. Gotho can be found HERE.

Longest Living Human and long-term care

Though no one could predict a life expectancy of 145 years (assuming it is verified), the point being you never know what life with bring you! What would you do if you were blessed with longevity? How would you live? Who would care for you? Do you have a plan?

Few would ever plan for 145 however a proper plan that addresses needs for today, tomorrow and your 145th birthday can be created and should be discussed with your advisers.

Want to discuss your plan? Contact our office for a no-cost consultation.

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