Archive for February, 2010

Long-Term Care in America — Part 2

Last week we noted that there is a high risk of needing long-term care (LTC) at some time in our lives (68% for those 65 and older), the cost is high, and it is an especially important issue for women. There are four options to provide the care:

  1. Self-insure (use your own assets, including retirement funds)
  2. Family (spouse, children, siblings)
  3. Government (Medicare [very limited] and/or Medicaid)
  4. Transfer some of the risk to an insurance company

What is LTC insurance?

LTC insurance pays for LTC services. Policies vary in terms of what they will cover, and insurance companies require that applicants qualify for the coverage through an underwriting process.

Do you need LTC insurance?

LTC insurance is not appropriate for everyone. The poor should not buy it because they will likely qualify for Medicaid. The independently wealthy may want to self-insure. Middle-class Americans may want to consider LTC insurance for peace of mind and to protect their family, their retirement assets, and to maintain their quality of life, independence, and control.

What are the types of LTC insurance?

  • A reimbursement policy reimburses you for the actual costs of specific, defined services up to the selected benefit.
  • A cash policy pays the full selected benefit regardless of services provided.
  • Combination of the two.

Are LTC insurance premiums tax deductible?

  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides a tax incentive for individuals to take financial responsibility for their long-term care needs.
  • A portion of tax-qualified plan premiums may be deducted as a medical expense on Schedule A of the federal form 1040.
  • Some states allow tax credits for premiums not deducted on a federal return.
  • Premiums may be paid for from Health Savings Accounts (HSAs).
  • There are specific deductions for business owners and self-employed individuals. Please consult with your

What does Partnership mean?

Partnership-qualified policies can further help middle-class Americans protect their assets. In addition to preserving assets that would have been spent for LTC services, a partnership-qualified policy provides dollar-for-dollar asset disregard should you ever need to apply for Medicaid. Every dollar spent from a LTC policy for your care will protect a dollar of your assets from needing to be spent down in order to qualify for Medicaid.

More information can be found at The National Clearing House for Long-Term Care Information at

NEXT WEEK:  When should you buy LTC insurance, what are the benefits, and what does it cost?

Pat O'Neill

Pat O’Neill is an independent long-term care insurance specialist. She works with individuals, businesses, and associations. You can visit her Web site at’Neill and download her booklet, Dignity for Life, or you can reach her at 703 534 3255 and

Long-Term Care in America — Part 1

Pat O'Neill

Pat O’Neill is an independent long-term care insurance specialist. She works with individuals, businesses, and associations. She will be enlightening us on long term care in America in a three-part series.

Former First Lady Rosalynn Carter said,
There are four kinds of people in the world:
Those who have been caregivers
Those who currently are caregivers
Those who will be caregivers
And those who will need caregivers.

Rosalynn Carter

What is long-term care?

Long-term care (LTC) is for people with a prolonged illness, a disability, or a cognitive impairment (such as Alzheimer’s disease). Care may be provided at home, adult day care, nursing home, and assisted living community. LTC includes both skilled care and personal care. Up to four generations can be affected by a LTC need.

The need for LTC can start gradually, or it may come on suddenly due to an accident, stroke, heart attack, or major illness. You may need care for a short time or for many months, years, or the rest of your life.

Leading causes of LTC:

  • Alzheimer’s Disease and Related Dementia – 31% of LTC claim dollars
  • Circulatory Disease and Hypertension Related – 16%
  • Parkinson’s and other Central Nervous Systems Conditions – 14%
  • Stroke – 9%
  • Broken Hips and Related Injuries – 9%

Who may need LTC?

  • Today, about 63% of people needing LTC are over 65. However, 37% are 64 years of age or younger.
  • The longer you live, the greater chance you will need assistance due to chronic conditions.
  • For people ages 65 and older, there is a 68% lifetime probability of needing LTC at some point in their lives.
  • About 44% of people reaching age 65 are expected to enter a nursing home at least once in their lifetime.
  • LTC is an especially important issue for women.

How much does LTC cost?

The cost depends on the amount and type of care you need and where you get it. Below are national average annual costs for care provided in different settings as of 2009. You can learn the current average cost for your area by going here.

  • Nursing Home – national average cost was about $219 per day for a private room, or $79,935 annually.
  • Assisted Living Facility – national average of $3,131 per month (for a one-bedroom unit) or $37,572 per year, including rent, meals, and most other non-medical fees. Costs can be higher if more care is needed.
  • Home Care – The national hourly rate for home health aides was $21. Yearly costs vary widely depending on the amount of care needed.

Who pays for LTC?

  • Personal resources (income and assets) of individuals or their families
  • Long-term care insurance
  • Some assistance from Medicaid for those who qualify (must have low income and very little assets)
  • NOT – Medicare, Medicare supplement insurance, and health insurance usually will not pay for LTC.

NEXT WEEK:  What is long-term care insurance and do you need it?

You can visit Pat O’Neill’s Web site at’Neill and download her booklet, Dignity for Life, or you can reach her at 703 534 3255 and

Video Games and Aging

Previously, I did a post on the Nintendo Wii. Now, according to  Jason Allaire, an associate professor of psychology at North Carolina State University and co-director of its Gains Through Gaming Lab, “There’s a growing body of evidence that suggests playing video games actually can improve older adults’ reflexes, processing speed, memory, attention skills and spatial abilities.”  Wii can even provide physical exercise.

In an article on, reporter Dennis Thompson says, “One study found that a Wii bowling game boosted the heart rate of players at a senior center in Pensacola, Fla., by about 40 percent. The game required that the players, who were in their 60s, 70s and 80s, hold the controller like a bowling ball and swing it to hit the pins in a virtual bowling alley.”

In July of last year, reported that California State University, Northridge, researchers say that a Nintendo video game, Brain Age 2, is helping to reverse mental aging among the elderly. They have seen some seniors in their 80’s improve their brain age to the 20’s. Giovanni Sosa, the CSUN psychology professor who heads the program, said the game helps stimulate the brain through tasks like solving simple math problems, counting currency, drawing pictures on the Nintendo DS touch screen and unscrambling letters. “The game is designed to help work your brain and increase blood flow to the prefrontal cortex,” according to Sosa.

In order to play Brain Age 2, it does require that you also have Nintendo DS Lite. Click here for more information on the Nintendo DS Lite and click here for Brain Age 2.

Since writing the post on the Wii, we have received it as a gift from our boys and their families and it has brought us many hours of fun and challenges. Although you can play with others, the goal is to always better your own score so basically you are competing with yourself. Hence, if one person is much better than you are, it does not matter.

What are your experiences with Brain Age or Wii Fitness?

Coping with Bereavement through Writing

Urmilla Khana, left, and workshop leader Joanne Glenn talk about writing. (Photo courtesy of Betty Baumgartner)

Here, retired pediatrician and former caregiver Urmilla Khana shares what writing means to her. Urmilla took to writing after being the primary caregiver to her husband Kris, who had Parkinson’s Disease for fourteen years and died from a massive heart attack in 2003, when they were taking a cruise. At first, her writing was mostly about her life growing up in India. Later, her thoughts fixated upon her life with Kris …and her writing took another direction.

I had led such a busy life, even after I was retired, taking care of Kris, doing all the things we wanted and loved to do. When he passed away, there was such a void. I was looking for something to fill up my life—knitting, watercolor, movie clubs. One day, when I was visiting my cousin in England, playing around on the computer and practicing how to type, I started writing. It felt good, and somehow I got stuck on the word “word painting.” Word painting was better than painting—which would have taken too much room, too much space, too much equipment.

At the time I did not think of writing as a coping strategy. When Kris was sick, there was no time for writing, that’s not your priority. I feel that as a caretaker you’ve just got to enjoy every moment with that person. But I did record events and get things down—maybe that was the extent of my writing for coping. You may not have time to write, but putting memories down is another matter.

I started writing about PD later. It helped me settle my thoughts. When I’m sitting gathering all the details and thinking of the words to write, and what aspects of the story to write, it hits me again and again that I wouldn’t do anything differently. That gives me a lot of comfort. Sometimes I feel that maybe if I can write or express my story properly, maybe it would help other people. For example, it’s only in hindsight that I’m developing an awakening about my husband’s initial mental symptoms being a forerunner of Parkinson’s.

I am being more comforted by writing now than by not writing at all. If I didn’t write our story, how would I get it out of my system? Now, by writing, I can reminisce in a pleasant way. And it helps me understand my own life, and our life together.

If you are interested in giving yourself the gift of sanity—the chance to make sense of your life, to write, alone and with others—consider attending the “Writing Workshop for Caregivers” on February 20, 2010, from 10 A.M. – 2 P.M. We’ll meet in the welcoming environs of the Fireplace Room in Hollin Hall, a lovely historic home on the grounds of Mt. Vernon Unitarian Church in Alexandria, VA. Or share this information with another caregiver, someone who may need or want a chance to write her story. For details, please email Joanne Glenn or call 703.721.2088.