Chronically Ill Older Adults Rely On Others For Care

According to a new report, a majority of those who are married have spouses with at least one chronic illness that can affect their ability to provide support. The findings the importance of health care professionals directly addressing the roles that family members play in the care of their aging parents or other relatives.

The study looked at U.S. residents who were age 51 or older with chronic health problems who participated in the 2006 Health and Retirement Study, a national longitudinal study conducted at the University of Michigan’s Institute for Social Research and funded by the National Institute on Aging.

Researchers found that 93 percent of the chronically ill older adults had adult children, but for half of them, the children lived more than 10 miles away.

Roughly 19 million older chronically ill Americans have adult children living at a distance, explains Jesse Slome, executive director of the American Association for Long-Term Care Insurance. “Even when a spouse is available, the vast majority struggle with their own chronic medical needs and functional limitations,” Slome adds.

University of Michigan staff are working to develop telephone monitoring systems that involve family members in a relative’s care through e-mail alerts or automated phone calls. The “CarePartners” program has been developed for patients with heart failure, diabetes, depression, and cancer chemotherapy.

The program is being studied as part of randomized trials and community demonstration programs throughout mission as well as internationally.

New, Low Cost Way to Predict Alzheimer’s Disease

According to scientists a low-cost behavioral assessment can clue someone in to Alzheimer’s disease at its earliest stage. The experts report the ability to detect changes in the progression of mild cognitive impairment (MCI).

MCI is a condition that affects language, memory, and related mental functions. It is distinct from the ordinary mental degradation associated with aging and is a likely precursor to the more serious Alzheimer’s disease. Both MCI and Alzheimer’s are linked to a steady decline in the volume of the hippocampus, the area of the brain responsible for long term memory and spatial reasoning.

MRIs (magnetic resonance imaging) are a reliable and direct way to detect hippocampal atrophy and diagnose MCI. But for many, the procedure is unavailable or too expensive according to Jesse Slome, executive director of the American Association for Long-Term Care Insurance.

Researchers created a much cheaper alternative, based on a memory test, that correlates with hippocampal degradation. From a computer model of an atrophying hippocampus, the researchers determined how to estimate capacity with a statistical measure of how quickly tasks are completed. Applying this analysis to a memory test for people with MCI, the researchers were able to gauge their hippocampal capacity and compare it to the progression of their ailment.

The researchers gave this test to five groups of participants: college students, healthy middle-aged adults, healthy elderly individuals, people with diagnosed cases of MCI, and a control group of age-matched individuals without MCI. The first three groups each had 100 members and the last two each had 50.

They analyzed the response times for the tasks and the number of items that were recalled, with and without additional cues. The MCI group showed the greatest sensitivity to added cues — the additional input either substantially helped or inhibited their performance. But like the computer model, estimates of capacity highlighted the greatest cognitive difference between the MCI group and the others.

Self Administered Tests Could Screen Early Dementia Risk

The handwritten self-assessment takes less than 15 minutes to complete and is a reliable tool for evaluating cognitive abilities. Findings confirming the validity of the tool are reported in the current issue of the journal Alzheimer Disease and Associated Disorders.

“This is great news for adults in their 50s and early 60s who can still qualify for long-term care insurance,” explains Jesse Slome, director of the American Association for Long-Term Care Insurance. Dementia and alzheimer’s are the most costly conditions among aging seniors. “Once a cognitive condition is diagnosed, there’s no way an individual will qualify for insurance,” Slome notes.

Ohio State University Medical Center medical experts developed the Self-Administered Gerocognitive Examination (SAGE) to help identify individuals with mild thinking and memory impairments at an early stage. The research shows four out of five people (80 percent) with mild thinking and memory (cognitive) issues will be detected by this test, and 95% of people who are normal thinking will have normal SAGE scores.

Many of the assessment tools for cognitive disorders being used today, while accurate, have aspects that deter their use. Other diagnostic tests require the patient to use a computer, which can add heightened anxiety to some older adults who may be infrequent users of technology.

The SAGE self-assessment is a practical tool for a busy primary care office said the test developer who makes the tests available free of charge to healthcare personnel. It only takes a paper, pen and a few minutes to take the test and because it’s self-administered, it doesn’t necessarily take time away from the appointment. “They can take the test in the waiting room while waiting for the doctor,” said Scharre.

The study involved 254 study participants, 59 years of age or older, who took the SAGE self-assessment. Sixty-three (63) individuals were randomly selected to have a one-day clinical evaluation utilizing a battery of physical, neurological and cognitive tests.

SAGE scores compared favorably with the mini-mental state examination (MMSE), a brief questionnaire test that is commonly used in medicine to screen for cognitive impairments and dementia.

Small Business Owners Unaware of Long-Term Care Tax Deductions

The majority of small and mid-sized business owners are not familiar with the tax deductible benefits available when offering long-term care insurance plan to employees. According to one insurance company executive, tax-deductible long-term care insurance remains the best-kept secret and employers are missing out on billions of dollars of potential tax savings.

Federal and a growing number of states now offer tax deductions and tax credits for the purchase of long-term care insurance. The cost of coverage may be fully tax deductible to the business and a great deal of flexibility can be offered when initiating a plan. In addition, corporate pricing breaks of 5 percent to 10 percent, in addition to substantial spousal or couples discounts, are the norm.

According to the 2009 edition of A Business Owner’s Guide To Long-Term Care Insurance, any form of business ownership can enjoy deductions for a long-term care insurance premium. Benefits received are, as a rule, always tax-free. Premiums might be considered imputed income to an employee depending on how the company is held.

Insurers offer various forms of long-term care insurance plans designed specifically to meet the needs of either small or large employers. Policies can be personally owned but company-paid, thus staying with the insured after he or she leaves a company or retires.

Long-term care insurance offers great design flexibility for employers. For example, employers can pick and choose who participates in a plan. Properly done, there are no ERISA issues, unlike group health insurance, according to tax experts. These plans are often called “carve-outs” which allow employers to be “selective” when determining who would be covered under a long-term care insurance benefit.

Policy design provisions enable employers to pay premiums for fixed periods of time, at which point the policy is paid up for life. One of the significant benefits is that policy benefit amounts keep increasing under inflation protection options with no risk of future long-term care insurance rate hikes.

According to American Association for Long Term Care Insurance experts, policies available to employers may allow two spouses to share one benefit pool. This has the potential to double the benefit any single insured might have and eliminates much of the problem as it pertains to the benefit period chosen. At the death of one spouse, the other typically inherits the other remaining benefits free of charge.

Why do consumers perceive long-term care insurance is expensive?

Simple: The media has told them so. Reporters love numbers for their articles and industry-focused entities have gladly shared "average" premiums which have historically been in the $2,000 range. Compounding the matter, couples perceive a joint cost of $4,000 -- "expensive". Overcoming perceptions isn't easy. But an effective way to show that costs can indeed be affordable - is to show the actual range that consumers at very specific ages are paying for coverage. Thankfully, the New York State Partnership program does an ongoing study of what consumers pay. The 2009 numbers will be contained in the 2010 Sourcebook (2008 ranges are in the 2009 Sourcebook, page 44).

Here is 2009 data for key age ranges:
Ages 50 - 54 $ 694 - $9,650 (Mean: $2,236)
Ages 55 - 59 $ 794 - $8,824 (Mean: $2,373)
Ages 60 - 64 $1,011 - $8,187 (Mean: $2,935)

It is the tremendous range that creates an average (or mean) amount that is misleading. Again, these are real numbers of what real people paid for coverage in the State of New York in 2009.

I Have Read About Rate Increases ...Should I Be Concerned?

It's hard to give a complex answer in just a few words, but let me try. The policies you are reading about in some news stories typically were issued 10 to 15 years ago when Long-Term Care insurance was still relatively new and conditions and policy pricing was very different. Just one example of what's charged. Interest rates paid on investments used to be 10% in 1985 and about 7% in 1995. Long-Term Care insurance is very interest rate sensitive. So, declining interest rates are great when you are looking to refinance your mortgage but lousy for an LTC insurer with older policies. But that was then; and this is now. Policies issued today in most states are governed by new regulations issued by the National Association of Insurance Commissioners and adapted by most states. These regulations mandate that policies are priced fairly and accurately based on everything that;s been learned. So, while no one can guarantee the future ... not even me ... there are many more safeguards in place today to protect you.

I Am 57 and Married, How Much Does Long-Term Care Insurance Cost?

What you pay is determined by your age, your health, and how much protection you select when you apply. But, you want a bottom line. A Price Index is done every year and someone age 55 who qualifies for preferred health and spousal discounts may pay $709 per year if they are married for what I would call a base plan of protection today. That about $115,000 in current benefits. With inflation protection coverage, that will grow to over $305,000 in 20 years. That's taking advantage of spousal and preferred health discounts.