Thursday, September 27, 2018

Most Affluent Seniors Want to Age In Place Including Relying on and Compensating Family For Long Term Care

McKnight's Long Term Care News, reports the results of a new survey of wealthy seniors which suggests that many of nursing homes’ potential residents would prefer to receive long-term care at home, and would be willing to pay their own family members for it.

The Harris Poll, conducted on behalf of the Nationwide Retirement Institute, conducted a survey that gathered responses of more than 1,000 U.S. adults, age 50 or older, with an annual household income of $150,000 or more.  The survey found that about seventy-one percent (71%) of seniors would prefer to rely on a family member for long-term care. More, seventy percent (70%) of those surveyed would not expect that help, unless they were able to pay relatives.

Only one percent (1%) stated that they preferred to receive skilled care in a nursing home. The majority of respondents (56%) said that they “would rather die” than live in a nursing home, and just less than half of the respondents (47%) said they worry about becoming a burden to their families.  Reasons for those worries included loss of control of their lives (68%), detachment from the community (32%) and seeing family less often (30%).

The overwhelming majority of respondents (77%) said, if needed, they’d most prefer to receive long-term care at home.  

More details from the seventh annual survey can be found on Nationwide’s website here.

Tuesday, September 25, 2018

Alzheimer's Association Launches Program to Connect Dementia Care Experts with Assisted Living Communities

According to an Alzheimer's Association press release, the Association is launching an innovative pilot program aimed at enhancing the care people living with Alzheimer’s and other forms of dementia receive in assisted living facilities. Modeled after Project ECHO® (Extension for Community Healthcare Outcomes) – a “telementoring” program that uses videoconferencing technology to share information – the new pilot will connect dementia care experts with leaders from assisted living communities across the country. The six-month program will combine bi-weekly presentations with interactive case studies to help enhance person-centered, high quality dementia care in community-based settings.  Go here to see a video describing how Project Echo® works. 

“The Alzheimer’s Association is excited about leveraging the ECHO model™,” said Morgan Daven, senior director, health systems, Alzheimer’s Association. “It allows us to create an ongoing dialogue between dementia care experts and those on the front lines providing care to individuals living with Alzheimer’s and other dementias. Project ECHO provides not only an opportunity for dementia experts to share their insights, but also a forum to explore real case studies from the field to better address the common challenges facing communities providing dementia care.”

Project ECHO, developed by the University of New Mexico in 2003, was first used to train primary care clinicians in rural communities to treat patients with hepatitis C. Subsequent studies found that hepatitis C care provided by Project ECHO trained community providers resulted in outcomes equal to those provided by specialists at a university. Since then, the model has been used to educate providers and improve care for other complex conditions, including: HIV, tuberculosis, chronic pain, endocrinology and behavioral health disorders. This will be one of the first models used to improve quality dementia care in long-term and community-based settings.

“The ECHO model has a proven track record of success,” Daven said.  “It will enable us to disseminate the latest and greatest research and recommendations for dementia care to communities in a timely and efficient manner. Communities will be able to use this information to improve care for people living with dementia. Ultimately, we would like to expand this pilot program across the country.

The six-month pilot program will consist of 12 sixty-minute sessions. Designed specifically for leaders and staff from assisted living communities, the sessions will examine content areas put forth in the Alzheimer’s Association Dementia Care Practice Recommendations released earlier this year. The recommendations, developed by dementia care experts, emphasize person-centered care and are based on a comprehensive review of current evidence, best practice, and expert opinion. Key topics addressed in the sessions, include: 

  • Fundamentals of person-centered dementia care
  • Detection and diagnosis for nonphysicians
  • Person-centered assessment and care planning
  • Co-morbidities and medical management for nonphysicians
  • Information, education and support needs of individuals living with dementia and caregivers
  • Evidence-based nonpharmacological practices
  • Progressive support for activities of daily living
  • Building and supporting the workforce
  • Supportive and therapeutic environments
  • Interventions for transitions in care
  • Evaluating person-centered practices

The Alzheimer’s Association is partnering with the New York Academy of Medicine (NYAM) to evaluate the initial pilot. NYAM created the first-ever evaluation toolkit and resource guide for users of the ECHO model in 2016. The evaluation will assess key areas including process, impact and sustainability. The Alzheimer’s Association will use the evaluation to inform and enhance future offerings of the program.

In addition to having ongoing engagement with dementia care leaders, pilot participants will have open access to resources provided during the program and will receive a certificate upon completion. Sixteen assisted-living facilities are participating in the initial pilot, they include: Affinity Living Group (Ahoskie House), Brandywine Living (Pennington), Brightview Senior Living (Canton), Brookdale Senior Living (Westlake, Ohio Clare Bridge Alzheimer’s and Dementia Care Program), The Chelsea at Tinton Falls, Forest Hills of DC/Forest Side Memory Care, Genesis Healthcare (Granite Ledges of Concord), Juniper Communities (Brookline’s Wellspring Memory Care Community), The Kendal Corporation (The Admiral at the Lake), HCR Manor Care (Arden Courts of Winter Springs), Senior Lifestyle (Liberty Heights), Senior Resource Group (Maravilla Santa Barbara), Senior Star (Dublin Assisted Living and Memory Support), Silverado (Kingwood Memory Care Community), St. Paul Elder Services Inc., and Sunrise Senior Living (Brighton Gardens of St. Charles).

The pilot program is offered free of charge to participants. Individual donors Bill and Susan Thomas and Robert and Jill Thomas are funding the assisted living pilot program.  

A companion pilot aimed at health care providers is also being launched. It will focus on resources and information relevant to clinical practice and is aimed at helping primary care clinicians not specialized in dementia care, better diagnose, care and support individuals living with Alzheimer’s and other forms of dementia.

Thursday, September 20, 2018

VA Rule Changes to Aid & Attendance Effective 10/18/2018

The Veteran's Administration has published new rules regarding Aid and Attendance eligibility.  These rule changes were long anticipated, but now become effective October 18, 2018, thirty days after publication which occurred on September 18th, 2018.  Applications and transfers prior to that date are governed by the old rules.

THE NEW RULES

Three-Year Look-Back For Asset Transfers: Beginning October 18, 2018, there will be a 3-year look back on asset transfers for less than fair market value. Previously you could transfer assets in one month, and apply for benefits the next month with no look back at all. The 3-year look back has eliminated the option of last-minute planning with immediate benefits. Note however, that any transfer prior to October 18, 2018 will be protected and not subject to the new laws; however, the transfers need to be made strategically in the right way.


Penalty for Asset Transfers: Transfers made during the look-back period will be subject to a penalty period (a period of ineligibility) that can last up to 5 years. The penalty is calculated by using a set amount as a divisor (the monthly MAPR for a veteran with one dependent, which is currently $2,169.00 per month for Improved Pension with Aid & Attendance), regardless of whether the application is for a surviving spouse or a qualifying veteran. Once determined, the penalty period begins on the first day of the month that follows the last asset transferred.


Net Worth Test: The prior “asset test” was “sufficient means” which was generally around the $80,000 mark. Under the new regulations, the asset limit is now set at $123,600 for 2018 and increased each year with inflation. The asset test takes into account all assets (minus the primary residence and personal belongings like cars) plus annual gross income, minus permissible medical expenses. Be sure to check with an experienced attorney who is also accredited agent by the VA to determine whether your assets are countable or exempt under the new laws.


Allowable Medical Expenses: The changes now allow qualified veterans and widows to deduct Independent Living Facilities expenses as a deductible medical expense as long as a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist says that the person EITHER needs assistance with 2 ADLs (Activities of Daily Living) OR supervision due to cognitive or physical limitations. Previously only home care, assisted living and nursing home care costs were allowed as deductions.

CALL TO ACTION!


If you are a Veteran or Widow(er) of a Veteran and want or need help paying long term care costs, you should:
  • Contact a VA  Elderlaw Attorney as soon as possible to determine if you would benefit from VA Benefits Planning.
  • Complete ALL asset protection planning before the October 18th deadline. All transfers that occur prior to October 18th will not be penalized under the new rules, even if an application for benefits is filed after that date. To be protected from the impact of the new rules, all planning should be completed by October 18th.
If you provide services for Veterans, you and your team need to know about these new rules. Contact our office to find out about upcoming educational workshops and training opportunities on the VA’s updated rules or to refer your clients directly to us as time is of the essence.

Read the new rules and a discussion of the changes here: Net Worth, Asset Transfers, and Income Exclusions for Needs-Based Benefits.

Read the following prior articles published on this blog regarding the changes:

Monday, September 3, 2018

Must-Know Statistics About Long-Term Care

Christine Benz, Morningstar's director of personal finance, has penned an excellent article regarding long term care.  In it, she collects the most fascinating array of statistics regarding long-term care, caregiving, and the financial consequences of both.  

Ms. Benz describes the issue of what to do about long term casts later in life as the "single unsolved problem in the retirement plans for many middle- and upper-middle-income adults."  

She warns against the wealthy being too cavalier about their ability to pay the cost of long-term care: 
"[v]ery high-income, high-net-worth people can plan to self-fund long-term care costs, though I'd advise them to do the math on long-term care cost inflation before getting too comfy with the idea that they'll have enough to do so. 
Meanwhile, she warns that most people without significant financial assets will need to rely on Medicaid-provided long-term care; Medicaid and other government programs cover the majority of the long-term care costs in the U.S.

For those in the middle, she describes the choices as "stark and rather unappealing:" 
Sandwiched in the middle are people with some, even significant, financial assets--just not necessarily enough to comfortably fund a $300,000 (or more) long-term care outlay at the end of their lives. For them, the choices are stark and rather unappealing. They could purchase traditional long-term care insurance and risk premium hikes. Alternatively, they could purchase one of the increasingly popular hybrid life/long-term care products and face an opportunity cost, as discussed here. Or they could forego insurance altogether, planning to self-fund care or use nonportfolio assets, such as a home sale, to cover any long-term care costs.
Add to these unappealing choices the surprises that often await long-term care recipients, including, but not limited to state resource recovery laws and filial responsibility- and the choices are worse than "stark;" they are potentially devastating.  

Every year, Ms. Benz compiles facts and figures regarding long-term care in an effort to aid in decision making and planning.  These statistics follow organized by subject matter.  
Usage of Long-Term Care
  • 52%: Percentage of people turning age 65 who will need some type of long-term care services in their lifetimes. 
  • 47%: Estimated percentage of men 65 and older who will need long-term care during their lifetimes.
  • 58%: Estimated percentage of women 65 and older who will need long-term care during their lifetimes.
  • 2.5 years: Average number of years women will need long-term care.
  • 1.5 years: Average number of years men will need long-term care.
  • 14%: Percentage of people who will need long-term care for longer than five years.
  • 10%: Percentage of Americans over age 65 who have Alzheimer's dementia. 
  • 33%: Percentage of Americans over age 85 who have Alzheimer's dementia. 
  • 64%: Percentage of Americans with Alzheimer's dementia who are women.
  • 123%: Percentage increase in the number of people who died from Alzheimer's dementia, 2000-2015.
  • -11%: Percentage decrease in the number of people who died from heart disease, 2000-2015.
  • 22%: Percentage of individuals over 65 in the highest income quintile who will have a long-term care need of two years or longer.
  • 31%: Percentage of individuals over 65 in the lowest income quintile who will have a long-term care need of two years or longer.
  • 45%: Percentage of people requiring significant long-term care help (assistance with two or more activities of daily living) who are under age 65.
  • 8%: Percentage of people between the ages of 40 and 50 who will have a disability that will require long-term care services.

Paying for Care
  • $30 billion: Long-term care expenditures in the U.S., 2000.
  • $225 billion: Long-term care expenditures in the U.S., 2015.
  • 57.5%: Percentage of individuals turning 65 between 2015 and 2019 who will spend less than $25,000 on long-term care during their lifetimes.
  • 15.2%: Percentage of individuals turning 65 between 2015 and 2019 who will spend more than $250,000 on long-term care during their lifetimes.
  • $341,840: Estimated lifetime cost of care for someone with dementia. 
  • $18,200: Median annual cost for adult day care (five days/week), 2017.
  • $45,000: Median annual cost for assisted-living facility, 2017.
  • $85,775: Median annual nursing-home cost, semiprivate room, 2017.
  • $97,455: Median annual nursing-home cost, private room, 2017.
  • $215,770: Average annual nursing-home cost, private room, Manhattan, 2017.
  • $51,100: Average annual nursing-home cost, private room, Monroe, Louisiana, 2017.
  • $23,394: Median annual income from all sources for individuals who are 65 or older.
  • $39,823: Median annual income for households headed by people 65 or older.
  • 3.8%: Five-year annual inflation rate in nursing-home costs, private room, 2017.
  • 5.5%: One-year annual inflation rate in nursing home costs, private room, 2017.
  • 19%: Percentage of long-term care costs that were paid out of pocket, 2013.
  • 8%: Percentage of long-term care costs that were paid by private insurance, 2013. 
  • $263,200: Median household wealth for adults age 65 or older with no disabilities. 
  • $94,200: Median household wealth for adults age 65 or older with limitations on two or more activities of daily living. 
Caregiving 
  • 34.2 million: The number of Americans who have provided unpaid care to an adult 50 or over in the past 12 months.
  • 16.1 million: The number of caregivers for someone with Alzheimer's or other dementia. 
  • $470 billion: The estimated dollar value of long-term care provided by unpaid caregivers, 2013. 
  • 65%: The percentage of caregivers who are female.
  • 33%: Approximate percentage of caregivers to people with Alzheimer's/other dementias who are daughters.
  • 25%: Approximate percentage of caregivers who are "sandwich generation" caregivers, providing care to children as well as older adults. 
  • 34%: The percentage of caregivers who are age 65 or older.
  • 33%: The percentage of people providing care to people age 65 or older who describe their own health as fair or poor. 
  • 83%: Percentage of care provided to older adults that is delivered by friends or family members. 
  • 65%: The percentage of older adults with long-term care needs who rely exclusively on friends and family members to provide that assistance.
  • 34.7: Average number of hours worked by unpaid caregivers who have jobs in addition to caregiving. 
  • 70%: The percentage of caregivers who suffered work-related difficulties due to their caregiving duties.
  • 36%: The average percentage of caregivers for people age 50 or older who said they were experiencing high levels of financial strain.
  • 10%: The estimated percentage of older adults who have suffered from some form of elder abuse. 
  • 7%: The estimated percentage of elder-abuse cases that are reported to authorities.
State and Federal Funding 
  • 51%: Percentage of long-term care services and supports that were provided through Medicaid, 2013.
  • 20%:  Percentage of long-term care services and supports that were provided through other public sources, 2013.
  • 62%: Percentage of nursing home residents whose care is provided by Medicaid. 
  • 20%: Percentage of Medicaid funding that went to pay long-term care costs in 2016. 
  • 50%: Expected increase in Medicaid spending for long-term care between 2016 and 2026.
  • $123,600: Maximum amount of assets that a healthy spouse can retain for the other spouse to be eligible for long-term care benefits provided by Medicaid, 2018. (Actual amounts vary by state.) 
  • $3,090: Maximum amount of monthly income that a healthy spouse can receive for the other spouse to be eligible for long-term care benefits provided by Medicaid, 2018. (Actual amounts vary by state.) 
  • 100: Days of care in a skilled nursing facility ("rehab") covered in full or in part by Medicare following a qualifying hospital stay.
Long-Term Care Insurance 
  • 125: Number of insurers offering standalone long-term care policies, 2000. 
  • Fewer than 15: Number of insurers offering standalone long-term care policies, 2014. 
  • 380,000: Number of individual long-term care insurance policies sold, 1990.
  • 129,000: Number of individual long-term care insurance policies sold, 2014. 
  • 72,736: Number of hybrid life/long-term care policies sold to individuals, 2009.
  • 305,068: Number of hybrid life/long-term care policies sold to individuals, 2013.
  • 4.5 million: Number of individuals with long-term care insurance coverage, 2000. 
  • 7.25 million: Number of individuals with long-term care insurance coverage, 2014. 
  • $1.98 trillion: Maximum potential benefit of all long-term care policies in force today.
  • $1.87 billion: Annual claims on long-term care insurance policies, 2000.
  • $9.2 billion: Annual claims on long-term care insurance policies, 2017.
  • $1,677: Average annual premium, long-term care policies being sold, 2000.
  • $2,772: Average annual premium, long-term care policies being sold, 2015.
  • 99%: Percentage of new long-term care policies that cover both nursing home and in-home care.
  • 0.5%: Percentage of all businesses offering long-term care insurance to their employees.
  • 20%: Percentage of businesses with 10 or more employees offering long-term care insurance to their employees. 
  • 13.9%: Percentage of applicants ages 50-59 denied long-term care coverage due to health issues. 
  • 44.8%: Percentage of applicants ages 70-79 denied long-term care insurance due to health issues. 

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