iLoveBenefits: Industry News Blog

What are the long term implications to longevity

1 in 3 Adults Have Not Planned for Long-Term Care Needs

The Associated Press recently published their 2016 Long-Term Care Poll on attitudes and preparedness for long-term care. Here are some key findings from the report:

·         4 in 10 American adults over age 40 expect to rely on Medicare to pay for their long-term care needs.

·         One-third say they have done no planning at all for their own long-term care needs.

·         More than three quarters would prefer to receive care for themselves in their own home.

·         67% would prefer for their loved ones to receive care in a home setting.

·         Half of older Americans support government-administered long-term care insurance programs.

·         72% support state paid family leave programs to help Americans providing care to a loved one.

Source: Associated Press, June 1, 2016

How long do patients remain in hospice care

Lenths of Stay for Patients Receiving Hospice Care in The U.S. in 2012

<7 Days – 35.5%
8-29 Days -27.0%
30-89 Days – 17.4%
90-179 Days – 8.8%
180+ Days -11.5%

Source: Managed Care, March 2014
Data Souce: National Hospice and Palliative Care Organization: NHPCO’s Facts and Figures, 2013

Top 25 Most Expensive Markets for Long-Term Care Coverage

Top 25 Most Expensive Markets for Long-Term Care Coverage


Nursing Home Private Room Annual Rate

Bridgeport-Stamford-Norwalk, CT


Anchorage, AK


New York-Northern New Jersey-Long Island, NY-NJ


Poughkeepsie-Newburgh-Middletown, NY


Hartford, CT


Boston-Worcester-Lawrence, MA


Rochester, NY


San Diego, CA


Seattle-Tacoma-Bremerton, WA


San Francisco-Oakland-San Jose, CA


Philadelphia-Wilmington-Atlantic City, PA-NJ-DE


San Jose-Sunnyvale-Santa Clara, CA


Albany-Schenectady-Troy, NY


Portland, ME


Honolulu, HI


Washington-Baltimore, DC-MD


Sacramento-Yolo, CA


Boise, ID


Milwaukee-Racine, WI


Manchester-Nashua, NH


Miami-Fort Lauderdale, FL


Buffalo-Niagara Falls, NY


Los Angeles-Riverside-Orange County, CA


Detroit-Ann Arbor-Flint, MI


Portland-Salem, OR


Source: New York Life Insurance Company

Care transitions are critical junctures in the health care system

ONC unveils HIT Web page for long-term care providers
The ONC has launched a new Web page that gives long-term care providers information about federal health IT initiatives that could be beneficial to them. These providers don’t qualify for the EHR incentive initiatives, although they do contribute to enhanced care transition processes. One initiative mentioned on the site is the Beacon Community programs that promote patient data sharing between nursing facilities and health information exchanges with or without the use of EHRs. Health Data Management (6/20)

What happens after you are in the hospital

Distribution of Hospital Stays by Discharge Status, 2009





Long-Term Care and Other Facilities


Home Healthcare


Another Short-Term Hospital


In-Hospital Deaths


Against Medical Advice


Publication Source: HealthLeaders Media Thomson Reuters Factfile
Data Source: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, HCUP Facts and Figures, 2009, exhibit 1.4a

About 4 in 10 Residential Care Facilities had one or more residents who had some or all of their long-term care services paid by Medicaid

Data from the 2010 National Survey of Residential Care Facilities

  In 2010, residential care facilities (RCFs) totaled 31,100, with 971,900 beds nationwide.
  About one-half of RCFs were small facilities with 4-10 beds. The remainder comprised medium facilities with 11-25 beds (16%), large facilities with 26-100 beds (28%), and extra large facilities with more than 100 beds (7%).
  One-tenth of all RCF residents lived in small RCFs and about that percentage (9%) lived in medium facilities, while the majority resided in large (52%) or extra large (29%) RCFs.
  About 4 in 10 RCFs had one or more residents who had some or all of their long-term care services paid by Medicaid.
  Larger RCFs were more likely than small RCFs to be chain-affiliated and to provide occupational therapy, physical therapy, social services counseling, and case management.

Source: NCHS Data Brief, Number 78, December 2011, National Center for Health Statistics,

Can for profits and not for profits mix when it comes to ACO’s?

Nursing home and hospital provider groups have asked the Internal Revenue Service for clarification and guidance regarding the participation of nonprofit providers in accountable care organizations. Many nonprofit groups are concerned that collaborating with for-profit partners will cause them to lose their exempt status, the Bureau of National Affairs reports.

Read more here:

New Long Term Care Plan

Editor’s note: As with so many things, it is all about the details. For example, as the government sought to close the drug benefit donut hole, they have opened another one. This time it is in the coverage for Long Term Care. Keep reading to discover that if you are 53 or older this plan will have little, if any, benefit for you.


Proponents of health care reform might consider President Obama’s signature on the historic law a class act, but advocates of long-term care (LTC) insurance are busy studying the literal translation of a key provision known by the same name.

A Kaiser Family Foundation comparative analysis of the Community Living Assistance Services and Supports (CLASS) Act noted that the legislative language remained unchanged between the House and Senate bills became the White House and congressional leadership reconciliation bill. Lawmakers have proposed a January 1, 2011 effective date for the voluntary public LTC insurance program, but several details still need to be ironed out.

So far, the proposal stipulates a daily cash benefit of no less than $50 after a five-year vesting period that would be paid for through payroll deductions. The plan would supplement traditional payers of LTC such as private insurance or Medicaid, helping people with functional limitations buy services needed to maintain personal and financial independence.

Jesse Slome, executive director of the American Association for Long-Term Care Insurance, says that while the CLASS Act could serve to spark enormous awareness of the LTC risks Americans face and the need to plan ahead, he fears that employers will wait to implement voluntary LTC plans until several critical areas are defined. 

“Because there is a five-year plan participation requirement, whatever benefits CLASS ultimately offers will really only have value for those employees who are currently age 53 or younger,” he explains. “As a result, a significant segment of American workers – those currently between 53 and 65 – will fall through the donut hole and fail to have long-term care protection.” 

Congress must decide on the cost to plan participants, benefit levels and requirements imposed on employers, which Slome says may not be available until 2012 and not applicable until the 2013 benefit plan year.

When Medicaid Will Pay for Long-Term Care

Many people still expect that government programs, such as Medicare and Medicaid, will pay for their long-term care needs. Unfortunately, these programs provide limited assistance for long-term care needs.


Medicare, the program for those 65 and older, has restricted coverage for stays at long-term care facilities. The coverage generally is only for brief periods of rehabilitation after surgery or injuries. Medicare pays only about 15% of national nursing home expenses. It does not pay much of the cost for those in assisted living facilities or receiving home health care.


Medicaid offers extended long-term care coverage and pays about 45% of total nursing home expenses. But to receive the coverage you must meet the Medicaid asset limits. This generally means you must be impoverished by Medicaid standards. There are strategies people use to qualify for Medicaid, but they became less practical after changes in the law about 10 years ago and even less practical after a 2005 law. Now, it is difficult to qualify for Medicaid without impoverishing yourself long before any coverage is needed.


Medicaid is a joint federal-state program. There are umbrella federal rules, but the states are allowed to add to them by making eligibility more restrictive. You have to know not only the federal rules but any modifications your state makes. This post reviews the federal rules and some state variations.

November 23, 2009 | Categories: healthcare | Tags: , , , , | Comments (0)