National Governors Association Policy on Long Term Care

On June 1st, the National Governors association (www.nga.org) put out a policy paper on what they would like to see regarding Medicaid Reform. Here are some selected sections that really speak to Long-Term Care Issues:

16.2.2 Asset Policy. While Medicaid remains a vital source of long-term care coverage for many individuals who cannot receive that care elsewhere, there is growing concern that many individuals are utilizing Medicaid estate planners or other means in order to shelter or transfer assets and therefore qualify for Medicaid funded long-term care services. Medicaid reform must include changes that increase the penalties for inappropriate transfers, restrict the types of assets that can be transferred, and encourage reverse mortgages, as well as other policies that encourage individuals and their families to self-finance care rather than rely on Medicaid.

16.5 Slowing the Growth of Medicaid Long-Term Care. Medicaid has quietly over the years become the nation's largest payer of long-term care services, funding approximately 50 percent of all long-term care spending and nearly two-thirds of all nursing home residents. Several policies are needed to encourage greater reliance on long-term care insurance rather than Medicaid.

16.5.1 Tax Credits and Deductions for Long-Term Care Insurance. Tax credits and deductions for qualified long-term care insurance policies and the encouragement of public-private partnerships are likely to save money in the Medicaid program in the long-run, if not in the short-term.

16.5.2 Long-Term Care Partnerships. These partnerships, currently operated by four states, create incentives to purchase long-term care insurance by allowing consumers to access Medicaid and preserve their assets once the insurance policy has been depleted. The federal law restricting these partnerships to those four states should be repealed.

It couldn't be clearer - America needs long-term care insurance.

More on the test for Alzheimer's Disease

Would you want to know?

Would you want to know if, a decade from now, your brain will begin to deteriorate?Even if you can't do much to stop it?

The questions sound like a science-fiction brainteaser. But they became real with the announcement this week that researchers may be able to predict Alzheimer's disease nearly a decade before symptoms appear. Experts say predicting illness raises ethical questions for doctors and societal questions about insurance, workplace discrimination and privacy.

Jeanie Colp, a Phoenix writer who has authored several books, doesn't have to think in the abstract. She received her Alzheimer's diagnosis three months ago. Colp, 69, said she is glad she was blissfully unaware of the coming storm. "I was writing, working, playing," she said. "I was having a great time."

About 4.5 million people in the United States have Alzheimer's, and in the next 45 years, as the population ages, that number is expected to rise to 14 million. Researchers announced this week that a brain scan that shows decreased activity in the hippocampus seems to predict that 10 years later the patient will develop Alzheimer's. It is hoped the research will lead to interventions to slow or stop the disease.

The study will have to be replicated, and it could be years before the test would be available to the public.

Articulate and funny, Colp jokes about forgetting things like her PIN number but has few visible signs of the disease. She has moved into a smaller apartment, given up her car for fear she would hit someone or forget how to get home, and has been afraid to go back to her writing.

For the remainder of this article please go to: http://www.azcentral.com/arizonarepublic/news/articles/0622alzheimers.html?BMIDS=14883338-82ae3041-68070

More life expectancy statistics

Continuing from yesterday.

• In 2003, the preliminary age-adjusted death rate in the US reached a record low of 831.2 deaths per 100,000 population.
• Age-adjusted death rates declined for eight of the 15 leading causes of death. Heart disease and cancer, two leading causes of death in the US, saw declines of 3.6% and 2.2% respectively. Other causes of death that experienced declines were stroke (4.6%), suicide (3.7%), flu/pneumonia (3.1%), chronic liver disease and cirrhosis (2.1%) and accidents/unintentional injuries (2.2%).
• The infant mortality rate dropped slightly, from 7 death per 1000 live births in 2002 to 6.9 in 2003.
• The firearm mortality rate dropped 3% between 2002 and 2003.
• The preliminary age-adjusted death rate for HIV declined by 4.1% between 2002 and 2003.
• Age-adjusted death rates from alcohol dropped by 4.3% between 2002 and 2003. The rate for drug-related deaths fell by 3.3% during that same time period.
• Mortality rates increased for deaths caused by Alzheimer's disease, kidney disease, hypertension and Parkinson's disease.

Life expectancies reach record high

Life expectancies for Americans have reached record highs, according to the US mortality statistics released by the Centers for Disease Control and Prevention (CDC). The average life expectancy in 2003 was 77.6 years, up from 77.3 in 2002, according to the report, titled "Deaths: Preliminary Data for 2003."

There has long been a gap between life expectancies for males and females; in 1979 it peaked at a difference of 7.8 years. Since that year, however there has been a narrowing trend. In 2002, the gap had dwindled to 5.4 years. In 2003, it was 5.3 years.

Record life expectancies were reached for Americans of both genders, and for whites and blacks. White males can expect to live 75.4 years; for black males it's 69.2 years. White females have an average life expectancy of 80.5 years; for black females, the number drops to 76.1 years.

Friday Funny - Forgetting It

An 80 year old couple were having problems remembering things, so they decided to go to their doctor to get checked out to make sure nothing was wrong with them.

When they arrived at the doctor's, they explained to the doctor about the problems they were having with their memory. After checking the couple out, the doctor tells them that they were physically okay but might want to start writing things down and make notes to help them remember things.

The couple thanked the doctor and left. Later that night while watching TV, the old man got up from his chair and his wife asks, "Where are you going?"

He replies, "To the kitchen."

She asks, "Will you get me a bowl of ice cream?"
He replies, "Sure."

She then asks him, "Don't you think you should write it down so you can remember it?"

He says, "No, I can remember that."

She then says, "Well, I also would like some strawberries on top. You had better write that down cause I know you'll forget that."

He says, "I can remember that, you want a bowl of ice cream with strawberries."

She replies, "Well, I also would like whip cream on top. I know you will forget that so you better write it down."

With irritation in his voice, he says, "I don't need to write that down, I can remember that."

He then fumes into the kitchen. After about 20 minutes he returns from the kitchen and hands her a plate of bacon and eggs. She stares at the plate for a moment and says, "You forgot my toast."

Medicaid Spending Cuts

There was an article in the Courier Journal here in Louisville today about Medicaid spending cuts and shortfalls. I'm very worried when I read things like this. The reason is that there are so many people out there who think the government will take care of them when they need long term care. Hello, but there isn't enough money now? Where do you think it's going to come from in the future? If you have limited assets (less than $50,000 not including your home) and limited income, then long term care insurance is NOT for you. If you don't fall into this category, then it is CRITICAL that you get the information and quotes on long term care insurance.

The message I got loud and clear from the article is that you MUST provide for yourself, because the government is just not going to be there for you. You may chuckle at this and say, "The government has to take care of people without money." Well, they always have in the past, but what if the money just isn't there? Do you want to be one of the people that winds up in the government run "poor house" nursing home? I most certainly don't and I'm sure if you think seriously you don't either. If the government isn't there, then the burden will fall to your children, grandkids and other family members. Think hard for a minute, is this how you want to end up? Dependent upon your family for money, support and care? Forced upon your children because this is the only option? I think not.

If this sounds harsh and a little preachy then forgive me this one time. Move back from the land of denial and do what it takes to protect your family and future choices.

New test for Alzheimer's Disease

I saw an article in the newspaper today, but unfortunately didn't cut it out before our newspaper went in the garbage, so I'll try to remember the gist of it for you.

There may be a new test that they can do that will help predict if you will develop Alzheimer's disease in the next 9 years. Why would you want to know? Perhaps so you can watch for the signs and take medications to delay the symptoms you will experience.

The question in my mind, however, is will they use these sorts of tests in a negative way to deny you insurance? You never know. Hopefully, the information will only be used for the good.

The article also said that people who stay active mentally and are more sociable are less likely to develop Alzheimer's disease. As you age, if you live alone, you may want to consider moving to an independent living community so you have other people around you to stimulate you mentally.

Friday Funny - Hearing Aid

New hearing aid

Seems an elderly gentleman had serious hearing problems for a number of years. He went to the doctor and the doctor was able to have him fitted for a set of hearing aids that allowed the gentleman to hear 100%.

The elderly gentleman went back in a month to the doctor and the doctor said, "Your hearing is perfect. Your family must be really pleased that you can hear again."

To which the gentleman said, "Oh, I haven't told my family yet. I just sit around and listen to the conversations. I've changed my will three times!"

How much do you know about heart disease?

Your chest feels tight. You're finding it hard to breathe. You don't know whether you're going to be sick or pass out - or both. Are you having a heart attack?

Heart disease claims more than 493,000 women's lives a year in the US - nearly 1 death every minute. Most heart attacks and heart-related deaths occur in women over the age 65, but each year more than 9000 women under age 45 suffer a heart attack. Test your knowledge of heart disease by taking this quiz.

1. Heart disease is the leading killer of men. The following is the leading killer of women:
A. Stroke
B. Breast Cancer
C. Heart Disease
D. Ovarian Cancer

2. Women and men (always) suffer similar symptoms when it comes to heart attacks, including angina (squeezing chest pain), unusual fatigue, shortness of breath and nausea.
A. True
B. False

3. At the first sign of a heart attack, you should:
A. Chew and swallow acetaminophen (Tylenol)
B. Lie down with your hands above your head
C. A and B
D. None of the above

4. Which of the following are risk factors you can change?
A. Hypertension and high cholesterol
B. Diabetes
C. A and B
D. None of the above

ANSWERS:
1. C - Heart disease is the number one killer of both men and women. Fewer than half of American women, however, are aware that heart disease, not breast cancer, is their greatest health threat.
2. False - Women are more likely to experience atypical symptoms and may not have the classic chest pain. Instead, they may experience only shortness of breath or fatigue upon exertion. These symptoms may go unnoticed by busy, overworked women.
3. D - First, get help by calling 911. Then chew and swallow a whole aspirin and get to a hospital immediately.
4. C - Age and a family history of heart disease are two risk factors you cannot change, but high blood pressure and cholesterol can be controlled through diet, exercise and drugs when necessary. Diabetes can also be controlled to reduce your risk of heart disease. An estimated 45% of diabetic women develop significant coronary heart disease. Other risk factors you can change include smoking, obesity and physical inactivity.

Courtesy of the Johns Hopkins Medical Letter. Health after 50.

Underwriting for a Stroke or TIA

A Stroke (or CVA - Cerebral Vascular Accident) is the sudden onset of a neurologic deficit lasting longer than 24 hours. Stroke is usually caused by the occlusion of the cerebral arteries due to atherosclerosis. Less commonly, a stroke may be caused by a blood clot to the brain or bleeding within the brain. Strokes occur when blood flow to the brain is blocked for extended periods of time; irreparable damage to the brain often takes place resulting in loss of function or paralysis.

A Transient Ischemic Attack - TIA are episodes of temporary cerebral dysfunction of vascular origin, which resolve within 24 hours. TIAs occur when emboli or plaques temporarily block the arterial blood flow to the brain, resulting in temporary symptoms.

Numbness, weakness, dizziness, fainting, vision defects, or loss of speech (aphasia) are the typical signs. TIAs are often a precursor to more significant cerbrovascular events (ie. strokes).

When diagnostic tests show significant blockage or extensive ulceration or plaque in the carotid arteries, surgery (endarterectomy or stents) may be recommended to reduce the chance of stroke.

When underwriting for strokes and TIAs, insurance companies look at the amount of time that has passed, if there were multiple events or if there is a loss of function. If there is a combination of diabetes, heart attacks or heart surgery, smoking, peripheral vascular disease or aneurysms, the likelihood of being accepted diminishes. Not all companies will accept someone who has had a stroke or TIA. It is important to work with an agent with access to multiple companies to find the right fit for you.

Stopping a Stroke

Strokes strike fast, rendering millions of American's partially paralyzed or with vision, memory and speech problems. Often, there are warning signs, called transient ischemic attacks (TIAs), when a blood clot temporarily blocks an artery to the brain.

Unfortunately, many people ignore TIA symptoms, such as numbness or weakness on one side of the body, slurred speech, confusion, dizziness, headache and difficulty walking. But catching a TIA can prevent a future stroke.

British researchers found that 17% of stroke patients who had a TIA had it on the day of the stroke, 9% on the previous day, and 43% in the week before. "This confirms that warning signs shouldn't be taken lightly," says neurologist Larry Goldstein of the American Heart Association. If you have these symptoms, call 911 right away; doctors will likely run tests and give you medication to help prevent stroke.

Underwriting for Cancer

Based on experience, cancer is the fourth most common reason for admission to a long-term care facility. Metastatic cancer is most often encountered when cancer spreads to a distant organ via the lymph or circulatory system. Common sites for cancer of the elderly include the breast, lungs, prostate, colon, pancreas, lymph, brain and bone.

All normal tissues grow, live for a time and die, and all are replaced by new tissue. Cancer growth does not follow this orderly pattern, but rather has increased metabolism, growth and reproduction rate, and an increased blood supply. The growth process serves no useful purpose, but continues unchecked and is not controlled by the laws of normal growth. The tumor cells may invade locally or spread distantly, and always at the expense of the host.

Treatment of cancer may involve surgery, radiation therapy or chemotherapy. The treatment of choice is surgery where complete removal of the cancer is possible and inspection microscopically reveals no evidence of spreading outside the organ or to the lymph nodes.

Staging can be thought of as a system for describing cancers to determine the treatment for a given tumor and the prognosis for the patient. When staging a cancer, the doctor takes into consideration the size of the tumor, how deeply it has invaded into the surrounding tissue, whether it has spread to adjacent lymph nodes and whether it has spread to other organs.

An underwriter takes many factors into consideration: location, date of diagnosis, type of treatment and date of final treatment, complications, recurrence, staging, cancer type and persistence or change in tumor marker levels. Companies have widely varying guidelines on cancer which is why an agent with access to multiple companies is good to work with.

Friday Funny - Getting Old

You know you're getting older when...

• Everything that works hurts, and what doesn't hurt doesn't work.
• You feel like the morning after, and you haven't been anywhere.
• Your little black book only contains names ending in M.D.
• Your children are beginning to look middle-aged.
• Your mind makes contracts your body can't keep.
• You look forward to a dull evening.
• Your knees buckle and your belt won't.
• Your back goes out more than you do.
• You sink your teeth into a steak, and they stay there.
• You know all the answers, but nobody asks the questions.

Underwriting considerations for arthritis

Osteoarthritis (OA) is very common and if you have a "touch of arthritis", this is probably what you have. It is characterized by degeneration of joint cartilage and new bone formation at the joint margins. OA results from the aging process and trauma to the joint from wear and tear.

On physical exam, the joints are tender and may be inflamed. There is often joint enlargement, pain with weight bearing, and decreased range of motion. Surgical correction of the joint deformities can relieve pain and restore most function.

Considerations are use of narcotics to control the pain, major weight bearing surgery in the last 3-6 months, falls and fractures or if rheumatoid arthritis is present.

How do family caregivers fare?

http://ihcrp.georgetown.edu/agingsociety/pubhtml/caregiver3/caregiver3.html


Caregiving is often life changing and consuming, leaving some caregivers exhausted and depressed. Caring for a friend or relative, however, can also be a positive and rewarding experience. Many caregivers handle the stress well by turning to friends and family or prayer to help cope. This Data Profile provides an overview of physical, emotional, financial, and social experiences of primary family caregivers.

This Data Profiles series, Family Caregivers of Older Persons is supported by a grant from the AARP Foundation and a grant from the Mathers LifeWays. We are grateful for their support and hope you will find this Data Profile useful. It was prepared by Katherine Mack.

Underwriting Considerations for Hypertension

Hypertension is persistently high arterial blood pressure. It is an independent and important risk factor for coronary artery disease, stroke, congestive heart failure, peripheral vascular disease, and kidney disease. Its presence has a high potential for morbidity and disability.

Because of this, the underwriting concerns are that the blood pressure be well controlled. High blood pressure readings (over 180-110) within the last 6 months are of concern. The combination with other heart diseases, strokes and diabetes are looked upon unfavorably.

I often hear that people from people that are on 2 medications for high blood pressure that they are not concerned about it. The reason they are taking medication is because it was too high in the first place and the only way to get it under control was by medicating. It is good that the medication keeps it lower, but it doesn't cure the underlying issue.

Underwriting considerations for diabetes

I'm often asked about the underwriting for different diseases. While you have to be in pretty good health, it doesn't always have to be perfect. Let's take a look at a few different diseases and the underwriting considerations for long term care.

Diabetes Mellitus
Diabetes is a chronic disease of sugar metabolism where either the pancreas produces insufficient amounts of insulin or insulin is produced in sufficient quantity but cannot be fully utilized. Hyperglycemia (elevated blood sugar) is the result. Persistent hyperglycemia eventually damages virtually all organ systems.

There are two types of diabetes: Type 1 (insulin dependent diabetes) and Type 2 (non-insulin dependent diabetes). Diabetes is of increased significance when combined with obesity, high blood pressure, heart disease and other circulatory problems. These combination histories are underwritten very conservatively by most companies. The major underwriting considerations of this disease include the stability of the disease and the presence and severity of complications.

Friday Funny

A couple from Minneapolis decided to go to Florida for a long weekend to thaw out during one particularly icy winter. Because both had jobs,they had difficulty coordinating their travel schedules. It was decided that the husband would fly to Florida on a Thursday, and his wife would follow him the next day.

Upon arriving as planned, the husband checked into the hotel. There he decided to open his laptop and send his wife an e-mail back in Minneapolis. However, he accidentally left off one letter in her address, and sent the e-mail without realizing his error.

In Houston, a widow had just returned from her husband's funeral. He was a minister of many years who had been "called home to glory" following a heart attack. The widow checked her e-mail, expecting messages from relatives and friends. Upon reading the first message, she fainted and fell to the floor. The widow's son rushed into the room, found his mother on the floor, and saw on the computer screen...

To: My Loving Wife
From: Your Departed Husband
Subject: I've Arrived!

I've just arrived and have checked in. I see that everything has been prepared for your arrival tomorrow. Looking forward to seeing you then! Hope your journey is as uneventful as mine was.

P.S. Sure is hot down here!

Long Term Care and Retirement Security Act, HR4772 and S2492

Make sure you write your elected officials about the following acts. HR 4472 and S 2492. This is an important piece of legislature. It will allow a deduction to all individuals who purchase a qualified LTC plan to deduct 100% of the premium. Currently you need to itemize deductions and meet the 7.5% Adjusted Gross Income threshold to deduct this on your federal taxes. If you meet the 7.5% AGI threshold, then the amount you can deduct is based upon your age. Note: deductibility is different if you are self-employed or a business owner.

Screenings for Strokes

Men and women are different in many ways, including—according to new research—how often they get tested for stroke.

According to a study of nearly 400 stroke patients in southeast Texas, only 60 percent of women who suffered a stroke underwent carotid ultrasound examination of the neck arteries compared with 71 percent of men. Only 48 percent of women had an ultrasound examination of the heart looking for blood clots that could travel to the brain, compared with 57 percent of men. The research was reported at the April 2005 meeting of the American Academy of Neurology.

We recommend you get preventive screening. Lifeline screening has a great package of screenings that are very affordable. Call them at 894-9228 to find out when they will have one in your area. Tell them Allison from AM Warner Insurance sent you.