Long-term care and long-term care insurance



Planning for long-term care and end-of-life preferences


• • • FIVE WISHES. Put this Aging with Dignity document and task at the top of your to-do list. Expressing your Five Wishes lets your family and doctors know:
* Who you want to make health care decisions for you when you can't make them.
* The kind of medical treatment you want or don't want.
* How comfortable you want to be.
* How you want people to treat you.
* What you want your loved ones to know.
The One Slide (PDF, Engage with Grace project). Download and print this one page with five questions that you should be asking each other well before you need to act on the responses. How intensely do you want medical intervention if things are looking critical, or do you just want to be let to die? Would you rather die at home or in a hospital? Do your loved ones know how you would want to be treated if your condition is terminal? Have you appointed someone you trust to be your advocate when the time comes? Have you written a living will,, appointed a healthcare power of attorney, or completed an advance directive? Watch this video for the Engage with Grace story.
Some Conversations Are Easier Than Others (Alexandra Drane, Eliza blog)
Lessons on End-of-Life Care From a Sister’s Death (Paula Span, New old Age, NY Times, 5-22-15) The more crucial function of advance directives may be to instruct the family, to tell the people who will make decisions for you what you want and, as important, what you don’t want
A Novel Way to Document End-of-Life Preferences (Paula Span, The New Old Age, NY Times, 7-25-13) Maybe a doctor, at a hospital or not, can without angst get end-of-life decisions in 10 minutes that families fear bringing up.
Glossary of terms associated with long-term care (Long-term care.gov)
How Americans' refusal to talk about death hurts the elderly (Sarah Cliff, Vox,1-11-15) Even as we learn more about extending life, we won't be able to improve the quality of life that precedes death. "One reason that nursing homes are so soulless is that it's often not the residents who made the decision about where they would live. Instead, it's their caretakers — often adult children — who chose the home, and their end-of-life priorities are frequently different from their parents'. Namely, where their parents value autonomy, children value safety." Let's let elders decide what's best for them.
Death: A five-part series (To the Best of Our Knowledge, Wisconsin Public Radio). This program gives one hour each to these topics (you can listen online or read the transcript, or both!):
---1) The Reckoning After decades of sanitized death, with dying, funerals, burial and grief shielded from public view, some people are now working to make death a greater part of life. In this hour, they talk with experts about how to begin these difficult conversations, and how they can transform both the dying and the surviving.
---2)Exit Plan . Some doctors don’t know how to talk with their patients about preparing for death, so there’s now a push to have frank conversations about end-of-life care. Includes one family’s story of working within Oregon’s “Death with Dignity” law.
---3) The Last Moment (on preparing now to meet death mindfully, on how one might feel a sense of wonder, and straight talk about near-death experiences.
---4) The Wake (Nov. 30) Explores the pain and healing power of grief, burial and mourning rituals throughout history, talks about why dead bodies can compel or repel us, and discusses of the new Ghanaian tradition of "fantasy" coffins inspired by people's work and dreams.
---5) After Life (December 7) Is death what gives life meaning? This hour explores the philosophical and religious dimensions of mortality and the afterlife -- talks about the art and poetry of remembrance. And now that much of our lives are lived online, how do we plan for our digital afterlives?

Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, a consensus report from the Institute of Medicine (IOM). A substantial body of evidence shows that broad improvements to end-of-life care are within reach. improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system.
Four paths to the end of life–one far more expensive than others–emerge in new study (University of Michigan News, 6-15-16) For nearly half of older Americans, the pattern of high spending on healthcare was already in motion a full year before they died. That's thanks to the care they received for their multiple chronic health conditions -- including many doctor visits and regular hospital stays over the year, not just in their final days. As a result, the study shows, the last year of life for this large group of seniors costs the Medicare system five times as much as the care received by the much smaller group of seniors who have a sudden burst of very expensive care in their last few weeks of life.
Place of death, over time (1989, 1997, 2007) (CDC data)
The Long-Term Care Challenge (video, Scott Simon, PBS video, Need to Know, 1-4-13, on the unforeseen costs of caring for an aging family member)
The realities of long-term care in America (Trudy Lieberman, CJR, 1-10-13)
Planning a Good Death booklet (free download from the BBC)
Everplans, a simple, secure way to let dependents and survivors know (should you die or become incapacitated): Can they find your will? Turn off your cable? Know how you'd like to be remembered?
The world's chief faiths (characterized by the BBC)
Compassion & Choices supports, educates and advocates for choice and care at the end of life -- improving pain and palliative care, enforcing living wills and advance directives, and legalizing aid in dying. Works to change attitudes, practices and policies so that everyone can access the information and options they need to have more control and comfort at the end of life. On its website are many helpful documents, guides, and links to helpful material, including
--- Get the Care You Want – No More, No Less. (must-read page on advance directives and more)
---Unwanted medical treatment toolkit and other resources for the media (and regular people)
---Stories about the end-of-life issues we all face
---Active cases involving patients' rights to get or suspend the end-of-life care they choose
No Easy Answers on Financing Long-Term Care (Judith Graham, New Old Age, NY Times, 9-19-13) "The federal Long-Term Care Commission published its full report on Wednesday, but it did little to change the perception that substantial relief for caregivers will be a long time coming." Geriatrician Joanne Lynne "believes that it’s a mistake to separate long-term care from broader reforms of Medicare and the health care delivery system." " The two primary financing options considered by the commission share “some commonalities,” said the commission chairman, "including agreement on the need for strong public programs and a role for the private sector." “If you look carefully at these two perspectives, you can begin to see a way forward.”
No Easy Answers on Financing Long-Term Care (Judith Graham, New Old Age, NY Times, 9-19-13) "The federal Long-Term Care Commission published its full report on Wednesday, but it did little to change the perception that substantial relief for caregivers will be a long time coming." Geriatrician Joanne Lynne "believes that it’s a mistake to separate long-term care from broader reforms of Medicare and the health care delivery system." " The two primary financing options considered by the commission share “some commonalities,” said the commission chairman, "including agreement on the need for strong public programs and a role for the private sector." “If you look carefully at these two perspectives, you can begin to see a way forward.”
Medi-Cal Long-Term Care: Safety Net or Hammock? (PDF of report from Pacific Research Institute with Center for Long-Term Care Reform)

Talking Turkey on End-of-Life Issues at Thanksgiving (Gail Rubin, A Good Goodbye, 11-24-14)

End-of-life issues (articles for WNET Before I Die special)

End-of-Life Care (Kojo Nnamdi radio program, WAMU, 8-26-09). With guests Malene Davis (President and CEO, Capital Hospice) and Perry Fine (professor of anesthesiology, University of Utah; attending physician, Pain Management Center; author, The Hospice Companion

Everplans , a site that lists all the steps to take to deal with a death, preferably well in advance.

Family Conversations About End-Of-Life Care (listen to Diane Rehm and guests on her radio show explore how to begin discussions about end-of life care--explaining some of the things that can go wrong if such discussions are not held."Armed with basic facts and good listening skills, it's possible to create a strategy that gives a loved one comfort and provides caregivers with peace of mind.")

Later End-of-Life Discussions May Mean More Aggressive Treatment (Randy Dotinga, HealthDay, 11-13-12). Terminally ill people who get early counseling about end-of-life care undergo less aggressive medical treatment in their final days, a new study reports. "By having these discussions earlier, patients can understand what's ahead and make decisions about what's good for them."

Long-term acute care.
At These Hospitals, Recovery Is Rare, but Comfort Is Not (Gina Kolata, Health, NY Times, 6-23-14) The Hospital for Special Care is one of 400 long-term acute care hospitals in the United States. These are no ordinary hospitals: Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes....These facilities often are tucked out of sight, and even many doctors do not know they exist."
What are long-term care hospitals (LTCHs)? (PDF, Centers for Medicare & Medicaid Services)
FAQs about long-term acute care hospitals (American Speech-Language-Hearing Association)
House, Senate Leaders Introduce Bill to Change Post-Acute Care System Steve teske, Bloomberg BNA, 6-27-14)
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Get Your S--t Together (Chanel Reynolds’s website "named for the scolding, profane exhortation that her inner voice shouted during those dark days in an intensive care unit," where her husband ended up after being hit while riding his bicycle. Excellent templates for end-of-life planning: Checklist, will, living will, power of attorney, details. Her husband died in 2009. Here's her story and advice: A Shocking Death, a Financial Lesson and Help for Others (Ron Lieber, NY Times, 1-11-13).

A Guide to Legal Issues in Life-Limiting Conditions (American Health Lawyers' Association)

Pitfalls Seen in a Turn to Privately Run Long-Term Care (Nina Bernstein, NY Times, 3-6-14). "...a closer look at Tennessee, widely cited as a model, reveals hidden pitfalls as the system of caring for the frail comes under the twin pressures of cost containment and profit motive. In many cases, care was denied after needs grew costlier — including care that people would have received under the old system...Like many advocates, [Gordon Bonnyman, former director of the Tennessee Justice Center, a patient advocacy group] originally supported managed long-term care, seeing it as a way to break the stranglehold of nursing home lobbies that opposed shifting more Medicaid money to home and community-based care. But now he says too high a price is being paid by very debilitated people denied care when they need it most."

Help! Keith Olbermann on 'The Life Panel.' "Have that conversation." Keith Olbermann's statement about the conversation he had with his father, who was exhausted and terrified from multiple procedures and complications after having his colon removed. Conferring with the doctors and asking them to give him a rest from procedures was a "life panel," not a "death panel."

Jane Brody's Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare Medically, Legally, and Emotionally for the End of Life -- a practical book, with explanations and to-do lists for everything from advance directives and why a living will is not enough to funeral plans, living with a bad prognosis and dealing with uncertainty, caregiving, hospice, communicating with doctors, assisted dying, organ donation, autopsy, and legacies.

Handbook for Mortals (full text online of consumer guide to end-of-life care by Joanne Lynn and Joan Harrold)

LeaveLight: A Motivational Guide to Holistic End-of-Life Planning by Marilyn L. Geary and Jacqueline Janssen. Designed to motivate you to write down your end-of-life planning (right up to what you want done with your pets), in a binder in which you express gratitude and forgiveness and express your wishes on everything from distribution of property to ways in which you want to be remembered (what you want in your epitaph and obituary/​death notice), and so on -- all the information your survivors need to honor your life and wishes and know how you felt about them. Includes practical info about things such as green burials and recommends participating in a Leavelight Circle: six participants in six 2.5-hour sessions complete their end-of-life plans, getting fear of doing so behind them.

Legal Guide for the Seriously Ill: Seven Key Steps to Get Your Affairs in Order, prepared by the American Bar Association Commission on Aging for the National Hospice and Palliative Care Organization. Step-by-step instructions on planning for health care expenses; managing health, money, property and personal decisions; planning for the care of dependents; knowing your rights as a patient; and getting your legal documents in order--with information on regulatory and legislative changes related to health care.

On Our Own Terms resources (links from Bill Moyers' program)

• • • Not Quite Six Feet Under (Tess Vigeland, Marketplace Money, conversations on American Public Radio about end-of-life planning, on topics such as estate planning, medical power of attorney, durable power of attorney, living wills, living trust, and wills--audio files and transcripts)

On Our Own Terms (listen online to various segments of Bill Moyers' PBS show on dying) and make use of On Our Own Terms resources (links to sites on care options, final days, therapy and support, and other resources). Download free the helpful discussion guide (PDF)

State Your Intentions With a Letter of Instruction. For a great example, see Kristie Miller's Letter of Intent. Kristie does a great job telling her family what she would want should she decline.

The 25 Documents You Need Before You Die (Saabira Chaudhuri, Wall Street Journal, 7-1-11). A plan for reducing frustration and financial pain for your heirs.

Compassionate Allowances. The list of 25 rare diseases and 25 severe cancers for which Social Security will fast-track the processing of claims for applicants whose medical conditions are so severe that their conditions obviously meet Social Security’s standards. Disabled World's explanations seem helpful.

Compassion and Choices (supports, educates and advocates for choice and care at the end of life -- improving pain and palliative care, enforcing living wills and advance directives, and legalizing aid in dying)

The difference between a living trust and a living will (Lauren Rickert, Helium)

Preparing for a Loved One to Die at Home (Susan Seliger, NY Times, 1-14-13) Here's what specialists say are the most common kinds of equipment and preparations you may need.

You Are Going to Die (Tim Kreider, Anxiety, 1-20-13). "Because of all the stories we’ve absorbed, we vaguely imagine that our lives will take the shape of a narrative ...But life is not shaped like a story; it’s an elongate and flattened bell curve, with an attenuated, anticlimactic decline as long as its beginning. Friends have described seeing their parents lose their faculties one by one, in more or less the reverse order that their young children are acquiring them."

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What you need to know about long-term care insurance


Long-Term Care Insurance: The Risks and Benefits (Joseph Matthews, Nolo). Is long-term care insurance (LTI) a good investment? An excellent overall explanation--of the odds such a policy will pay off. " this kind of insurance is expensive, and it often provides only limited benefits -- with many restrictions and conditions -- that may end up covering only a small percentage, or nothing at all, of your total long-term care costs. Spells out the odds of your having a long-term nursing home stay and how well that LTI will perform in covering your expenses. (Not well.)
Combine Long-Term Care With Life Insurance? Do the Numbers First (Paul Sullivan, Wealth Matters, NY Times, 12-9-16) "THE market for long-term care insurance, which covers the costs of some in-home health care, has had a rough month. One provider announced that it would not sell any more policies; another is headed toward insolvency, with billions of dollars in liabilities needing to be assumed by someone else.... John Hancock, one of the largest providers of this insurance, announced that it would stop selling new long-term care policies this month. And two subsidiaries of Penn Treaty American Corporation, with billions of dollars in obligations, are set to be liquidated next year....New hybrid policies offer both long-term care and life insurance. Are these newer policies any good? Like most types of insurance, they are only as good as the consumer’s understanding of them — and that may not be as deep as it should be.

Long-term-care insurance policyholders face sharp premium hikes: ‘When do these increases end? There is no ceiling’ (Steve Jordon, Live Well Nebraska, Omaha World Herald, ) Donna Olesh doesn’t accept her insurance companies’ explanations of why, after several years of low rates and no rate changes, her long-term care insurance company has raised the rates sharply. "Rather, she thinks they started with low premiums to attract customers and now intend to raise rates indefinitely until customers drop out or agree to lower benefits." One of the best articles about long-term care insurance I've seen. Must-read before you invest in this insurance. See especially side-bar along the left side, of Long-term care insurance basics, such as
» Consider “combination” products that include elements of life insurance, annuities and long-term care, as well as straight long-term care coverage.
» Consider “partnership” policies, which can shield assets while qualifying for Medicaid assistance.
» Look for discounts for good health, for making annual premium payments or other features.
» Shop around. Rates for the same coverage vary as much as 40 percent among insurers.

Special Kiplinger report on long-term care insurance (Kiplinger). Kiplinger published several articles on this complex and fear-provoking topic, starting with Twelve reasons you will go broke in retirement (Stacy Rapacon, a slide show), then 4 Secrets to Buying Long-Term-Care Insurance (Policies are rising in price, while benefits are getting skimpier. Here's how to get the best deal for you.). Then 10 Things You Should Know About Long-Term Care (quiz, updated Jan. 2015), 3 Ways to Lower Your Long-Term-Care Insurance Premiums (Can't afford higher premiums for long-term care insurance? Consider various options to trim your benefit instead.), and Paying Long-Term-Care Premiums With HSA Money (Kimberley Lankford, 7-8-14) The amount you can withdraw from a health savings account tax-free to pay premiums depends on your age.
One more chance to decide on federal long-term care insurance (Michelle Singletary, WaPo, 9-30-16) When federal long-term health care insurance premiums jump from $285 a month to over $560, or $136 to $400, some feel lowballed by previous premiums. Many people with privately obtained long-term care insurance policies have received similar notices of steep jumps in premiums.

High nursing home bills squeeze insurers, driving rates up (Matthew Craft, AP, Pittsburgh PostGazette, 3-29-15) The people who need it the least can afford long-term care insurance; for others, it is increasingly unaffordable. But nursing home bills are rising.
Dodge the Long-Term Care Insurance Mess (William Baldwin, Forbes, 3-29-13). Do read this one before buying a policy. "From the buyer’s perspective, LTC insurance has three defects, at least when you compare it to the conspicuous alternative, a longevity annuity. The latter is an investment that pays out a fixed monthly sum beginning when the buyer reaches some advanced age, like 80."

Long-Term Care Insurance Can Baffle, With Complex Policies and Costs (John F. Wasik, Retiring, NY Times, 12-18-15) Premiums have increased sharply, and comparisons are difficult, which helps explain why only 20% of those over 65 own a policy. Experts advise consulting an elder law attorney and fee-only financial planner who doesn’t make money from recommending the policies. That’s the best way to receive an objective — and nuanced — evaluation on whether this product makes sense for you.

Must Suspicions About Personal Health Be Shared With an Insurer? (Kwame Anthony Appiah, The Ethicist, NY Times Magazine, 5-4-16) A person says they suspect they have Parkinson's but haven't seen a doctor about it. Must they share what they fear with a long-term care insurer? The answer is VERY good at explaining how insurance works and why it's not working so well now that people are living longer.)

Insured for old age? An economist explains the dangers of long-term care insurance (Lewis Mandell, PBS Newshour, 1-15-14) "The most critical thing to realize is the total amount that such a policy will pay you if you remain in a nursing home for the three full years (after your first 90 uncompensated days): just $164,250, unadjusted for inflation. That’s $150 a day times 365 days in a year times three years. Therefore, if you have that amount in liquid assets per person (money not needed to fund core expenses), you can self-insure for that three-year period." "In spite of paying expensive premiums for many years, some individuals who are “covered” by long-term care insurance policies are surprised to find their claim denied by their insurance company....carefully consider whether its likely benefits are worth the costs."

Mistakes to Avoid When Shopping for Long-Term-Care Insurance (Anne Tergesen, WSJ, 4-13-14). How to Pick the Best the Policy for Your Needs and What to Avoid

Understanding Long-Term Care Insurance (AARP)

Hybrid Long-Term Care Policies Provide Cash and Leave Some Behind (John F. Wasik, NY Times, Retirement/​Insurance, 3-4-16) A hybrid policy for long-term care works by keeping a certain amount of cash within the policy. Some plans combine nursing care with an annuity, offering monthly payments to the policyholder and a death benefit to survivors. The pros and cons and whys and why nots of such a policy.

Long-Term Care Insurance Can Be Costly but Effective (John F. Wasik, Retiring, NY Times, 12-25-15) Part 2 of a two-part series. "Long-term care insurance isn’t for everybody, but it can be useful for people who are interested in preserving their estate for their heirs and for families determined to provide high-quality home care or a superior nursing home for aging loved ones...one of the major requirements is to make sure the policy has adequate protection against rising health care costs." Buy early and when you are in good health, but study options "because of the myriad benefits and pricing options" various policies offer.

Premiums Rise for Long-Term Care Insurance. Keep It or Drop It? (Ann Carrns, Your Money, NY Times 3-21-14) Despite increases of 50% in premiums on old policies, many holders of long-term care insurance are not letting their policies lapse.
Do retirees need long-term care insurance? (Rodney Brooks, USA TODAY, 9-10-14) Another helpful, albeit discouraging, look at the numbers.

An Alert When the Policy Lapses (Paula Span, New Old Age, NY Times, 6-12-14). See sad related story: The Policy Lapsed, but No One Knew (Paula Span, 1-31-14).
Preventing Lapses in Long-Term Care Policies (Ann Carrns, Your Money, NY Times, 6-13-13)

ElderLaw Answers (What to Look for In a Long-Term Care Insurance Policy, When Should You Purchase Long-Term Care Insurance? How Much Insurance Should You Purchase?, Which Spouse Should Get Coverage?,Long-Term Care Insurance and Medicaid Planning, Partnership Policies, The Tax Deductibility of Long-Term Care Insurance Premiums, The Taxation of Benefits, Consult With a Qualified Agent, Books on Long-Term Care Insurance)

The Retirement Crisis Nobody Talks About: Long-term Care (Penelope Wang, Money, 6-20-14) If you become disabled, you may face huge bills for daily help. And, no, Medicare doesn't cover it. A review of the numbers.

What does long-term care cost in your state
FAQs about long-term care insurance (Honey Leveen) What is and isn't covered by Medicare, for example.
Long-Term Care Insurance and Our Collective Denial (Ron Lieber, Your Money, NY Times, 10-17-11)
The Coming Caregiver Crunch and Why This Gerontologist Owns Long Term Care Insurance by Ken Dychtwald, Huffington Post, 11-16-09
A New Way to Pay for Long-Term Care (Paula Span, New Old Age, NY Times, 10-9-13) Two small companies are offering to buy life insurance policies at a percentage of face value. A new option to consider if you're going to let your life insurance lapse after years of paying into it.
Do retirees need long-term care insurance? (Rodney Brooks, USA TODAY, 9-10-14) Another helpful, albeit discouraging, look at the numbers.
A Winding Road to Benefits From Long-Term Care Insurance (David Segal, The Haggler, Your Money, NY Times, 3-23-13)
Expense and Emotions in Preparing for Long-Term Care (Ann Carrns, Your Money, Your Money NY Times, 3-25-13)
Fine Print and Red Tape in Long-Term Care Policies (Tara Siegel Bernard, NY Times, Your Money, 6-7-13) Long-term care insurance policies aren't like common insurance policies, and that can lead to unexpected requirements, mountains of paperwork, and denied claims. If you need to file a claim on behalf of a loved one, it helps to know why claims are denied and where filers tend to get tripped up (surveyed in this article). Practices vary from company to company and state to state, whether you can trust the company depends on regulation in that state, and most states have limited regulation.
Long-term care rate hike stuns retirees (Victoria Colliver, SFGate, 2-25-13)
Not Interested in Long-Term Care Insurance? How About Short-Term Care Insurance? (Howard Gleckman, Caring for our Parents blog). "One financial planner who specializes in middle-market clients . . . says these policies are 'like buying a stuffed bear.' They may make you feel better, but they won’t provide any real financial security."

Parsing the New Law on Long-Term Care (Paula Span,New York Times, Prescriptions blog, 5-3-10)
Paying for long-term care (sidebar to WNET special, Before I Die)
Long-Term Care Insurance: The Essentials (free PDF from MetLife, an insurer)
J.K. Lasser's Choosing the Right Long-Term Care Insurance by Benjamin Lipson
Long-Term Care: Your Financial Planning Guide by Phyllis Shelton
J.K. Lasser's Choosing the Right Long-Term Care Insurance by Benjamin Lipson
Veterans Benefits for Long Term Care (Debra A. Robinson, ElderCare Matters)
National Clearinghouse for Long-Term Care Information (U.S. Dept of Health & Human Services)
Diane Rehm program on long-term care insurance . Listen and/​or read the transcript. Speakers were former Social Security Administrator Ken Apfel, Families USA executive director Ron Pollack, and Kiplinger’s Personal Finance columnist Kim Lankford, and Howard Gleckman, author of Caring for Our Parents
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Long-term care, long-term care insurance, and public policy


A new vision for long-term care (Howard G. Gleckman, Urban Institute, 7-15-15) This links to a full report; click through to read such articles as Roadblocks Ahead for Seniors Who Don't Drive and Placing Diagnosis Errors on the Policy Agenda

Fine Print and Red Tape in Long-Term Care Policies (Tara Siegel Bernard, Your Money, NY Times, 6-7-13) “With all of the hurdles, trying to get a claim paid can be like an Olympic event,” Mr. Rosenfield said. “The bottom line is that practices vary widely from company to company and state to state. And whether you can trust the company depends on regulation in that state — and most states have limited regulation.”

No Easy Answers on Financing Long-Term Care (Judith Graham, New Old Age, NY Times, 9-19-13) "The federal Long-Term Care Commission published its full report on Wednesday, but it did little to change the perception that substantial relief for caregivers will be a long time coming." Geriatrician Joanne Lynne "believes that it’s a mistake to separate long-term care from broader reforms of Medicare and the health care delivery system." " The two primary financing options considered by the commission share “some commonalities,” said the commission chairman, "including agreement on the need for strong public programs and a role for the private sector." “If you look carefully at these two perspectives, you can begin to see a way forward.”

The Challenge of Financing Long-term Care (Judith Feder, Urban Institute, 6-3-15). Click on link under Journal Citations to get to full article (PDF).

Medi-Cal Long-Term Care: Safety Net or Hammock? (PDF of report from Pacific Research Institute with Center for Long-Term Care Reform)

How to Fix LTC Insurance (Michael Kitces, Financial Planning, 1-21-15)

Changing Family Caregiver Dynamics Ramp Up the Importance of Long-Term Care Planning (Jamie Hopkins, Forbes, 7-28-14) "Men typically need long-term care services for 2.2 years and women for 3.7 years. “Recently, insurers have come to understand that women are a higher risk for care claims, and in 2013 most introduced gender-specific rates with premiums for women being priced substantially higher than those for men,” says Newman. ...Clients need to understand the limitations on Medicare long-term care coverage and the asset requirements to qualify for Medicaid covered services."

Pitfalls Seen in a Turn to Privately Run Long-Term Care (Nina Bernstein, NY Times, 3-6-14) At least 26 states are rolling out mandatory programs that put billions of public dollars into privately managed long-term care plans, in hopes of keeping people in their homes longer, and expanding alternatives to nursing homes....hidden pitfalls as the system of caring for the frail comes under the twin pressures of cost containment and profit motive. In many cases, care was denied after needs grew costlier — including care that people would have received under the old system." "Like many advocates, he originally supported managed long-term care, seeing it as a way to break the stranglehold of nursing home lobbies that opposed shifting more Medicaid money to home and community-based care. But now he says too high a price is being paid by very debilitated people denied care when they need it most."
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