Should You Purchase Long-Term-Care Insurance?

Costs of long-term care are rising, and more seniors are finding themselves in positions where such care appears necessary or desirable. But is Long-Term-Care Insurance a reasonable and viable way of dealing with this problem? A recent article in the Wall Street Journal weighs the pros and cons of purchasing long-term care insurance. The article pits the arguments of George Mason University professor Mark Meiners against those of California Advocates for Nursing Home Reform senior staff attorney Prescott Cole.

While the two consider similar evidence to arrive at diverging opinions, they agree on certain important facts about long-term-care insurance. For one, both Meiners and Cole agree that the decision about whether to purchase long-term care insurance is most pressing to individuals with “mid-wealth” or mid-level savings - people who may identify with the middle-class income bracket. With more than $2000 of savings, these individuals do not qualify for Medicaid, but at the same time are not capable of financing their own long-term care using savings.

The two experts also agree that regardless of whether or not someone purchases long-term-care insurance, he or she should have additional savings set aside for the purpose of long-term care. This is because few, if any, long-term care policies offer 100% coverage of daily care in nursing homes. Even if you are covered under a long-term-care insurance policy, you will most likely have to pay a portion of the nursing home bills. This is especially significant given the “90-day rule” or policy that most insurance packages offer. Given that many long-term-care insurance policies do not kick in until after the insured has spent 90 days in a nursing home facility, individuals wind up bearing the financial responsibility for any stay under 90 days.

Prescott Cole points out that this 90-day rule, paired with the statistic that 67% to 70% of seniors who enter nursing homes leave before 90 days, means that regardless of whether or not a senior has long-term-care insurance, they will probably have to pay out-of-pocket for their stay at a nursing home. Cole applies this instance to a more general argument against long-term-care insurance: the cost (typically $3,500 per year) is extremely high, while the benefits are low. In addition, Cole argues that the risk associated with long-term-care is low; today, only 3.7% of seniors are currently living in nursing homes. As an alternative to long-term insurance, Cole suggests that a person might begin early on to set aside the amount he or she would otherwise pay for long-term insurance into savings specifically for that purpose. That way, the individual would have a sizeable fund on which to draw should the need for long-term care arise.

Meiners counters that this proposed method could be risky if the cost of long-term-care eventually exceeds the amount of savings. Yet, Meiner also acknowledges that even with long-term insurance coverage, an individual may outlive or outspend that coverage, thereby acknowledging that not even a long-term insurance plan is an entirely safe bet.

An added consideration – especially to seniors considering long-term care insurance – is that of insurance scams and fraud. If you suspect that you or a loved one has been the victim of long-term care insurance fraud in California, contact the Evans Law Firm for a free and confidential consultation at 415-441-8669 or 1-888-50EVANS (3-8264). Or contact the Evans Law Firm by email at info@evanslaw.com

Hospital Efforts To Keep Elderly Strong

A startling statistic has recently come to light: at least one-third and up to two-thirds of hospital patients over the age of 70 leave the hospital weaker than they were when they arrived. This information, previously disregarded as an inevitable effect of the natural aging process, is now leading experts to challenge the way most hospitals conventionally treat their elder patients. Because the hospitals focus mainly on treating whatever ailment or disease that afflicts the elder patient, caregivers at the hospital often overlook important practices that an elder patient needs to prevent frailty.

Examples of practices that inadvertently harm elder patients are bed confinement, un-nutritious food offerings, and uncomfortable surroundings. Instead, medical experts say that hospitals should encourage exercise and work to provide a more comfortable and pleasant experience for its elder patients. In two hospitals that have begun to implement changes, volunteers accompany patients on daily walking sessions of 15 minutes.

The benefits from improving daily life and activity also counteract the detriments of bed rest and immobility. Bed rest can raise chances for infection and contribute to rapid muscle loss. Plastic wrapping of food can be a significant problem for people with arthritis. While some hospitals around the country – notably the University of Texas Medical Branch in Galveston and Highlands Hospital in Birmingham, Alabama – have instituted elder-care units specifically to target these sorts of problems, most hospitals have not. It is essential that medical facilities begin to tailor their patient care to the needs of the elderly.

For more information on elder care and abuse in California, contact the Evans Law Firm for a free and confidential consultation.

Long-term care uncertainty is a growing issue

LA Times

As Americans age and the cost of long-term care increases, long-term care has become one of the biggest health insurance uncertainties for people aged 65 and older. Long-term care differs from other types of care because it constitutes care for people with disabilities or chronic illnesses. Long-term care exists to provide services that assist in activities of daily living – assistance that many seniors require as they age and become unable to rely completely on themselves. Yet, Medicare does not cover long-term custodial care at home or in nursing homes.  

The fact that Medicare does not pay for custodial care is a fact that many seniors are realizing – often too late. While Medicare does cover payments for acute illnesses and medical treatments, it will not help pay for a person to assist in feeding, bathing, dressing, or other daily activities. Thus, a senior who enters into a nursing home facility must pay an average cost of $70,000 a year without the help of Medicare. It is not until the senior’s funds have dwindled to a few thousand dollars that Medicaid or Medi-Cal kicks in to pay nursing home bills.

Yet, even qualifying for Medi-Cal coverage for long-term care is an extremely complicated process. The rules and necessities for qualifying are so convoluted that one consumer advocacy group uses a 12-page flowchart to help determine whether or not a person qualifies for Medi-Cal to pay for long-term care.

According to the LA Times, about 1,384,000 people in the United States live in nursing homes. A decade ago, approximately 1,456,000 seniors lived in nursing homes. A large part of this decrease is the increase in cost of care and living at nursing home facilities. As a result, millions of seniors who require help continue to live in their communities and are assisted by friends and family members who act as unpaid volunteer caregivers. While it can be comforting to rely on the assistance of family and friends, the increase in community-based caregivers has also given rise to the opportunity for caregiver fraud and abuse.

$1.3 Million Judgment Against Torrance Assisted Living Facility For Elder Abuse
Financial Content

In September 2011, the Greenpark Villa, Inc. assisted living facility in Torrance, California was ordered to pay over $1.3 million in a judgment of an elder abuse case. The plaintiff was a victim of elder abuse and a client of Garcia, Artigliere & Schadrack.  Among the allegations in the case were those of elder abuse and wrongful death.

Greenpark Villa is an assisted living facility for the elderly, and defined by California law as a voluntary housing arrangement for an individual 60 years or older. The living facility is expected and obligated by law to provide a certain amount of care and supervision to its patient.

Plaintiff Walters, an elderly woman suffering from Alzheimer’s, had fallen twice during her stay at Greenpark Villa, and was not sent to the hospital. After five months of severe pain and at her family’s insistence that she receive medical attention, it was found that she had fractured her hip in the second fall. Plaintiff also alleges that due to underfunding and understaffing, Walters’ Stage I pressure sore evolved into a stage IV pressure sore that became infected.

Elder care abuse and allegations of elder care abuse in assisted living facilities throughout California and the United States have grown alarmingly high. The country’s growing elderly population faces more risks today than ever before as elder abuse continues to be on the rise. Yet, support is available for those who have fallen prey to various forms of elder abuse. For a free and confidential consultation in California, contact the Evans Law Firm.

Charges of Elder Abuse, Negligence After Dementia Patient Dies of Exposure
Bay City News

The family of Kenneth Chin, an elderly dementia patient who died last February, filed a wrongful death suit against his conservator Jewish Family and Children’s Services and the transit agencies responsible for his transportation: MEDSAM Enterprises.  

After not returning home to his assisted living facility in San Francisco’s Richmond District on February 25, 2011, 73-year-old Chin was reported missing. His body was discovered on March 6 in Lincoln Park, and autopsy results indicated that he died from hypothermia.

Chin’s living relatives, represented by Ingrid Evans of the Evans Law Firm, gathered at a press conference on February 8, 2012. His niece Jennifer Chin said she remembered “lying awake at night, it was pouring and freezing… praying that he was indoors somewhere.”

Plaintiff alleges that the MEDSAM shuttle van negligently dropped Chin off at the wrong location, causing him to wander around San Francisco for days before succumbing to the elements in Lincoln Park. In addition, the conservator Jewish Family and Children’s Services did not notify Chin’s family that he was missing until three hours after the event – during which time it had grown dark, cold, and stormy. The family began a search immediately, but was significantly hindered by the delay and its consequences.

Chin says he brings this complaint in order to ensure that such wrongful negligence and tragedy never happen again.

Hundreds of Elder Abuse Cases in 2011
KULR-TV

Sarah Gravlee in Billings, Montana reports that the number of elder abuse cases is on the rise and will skyrocket over the next two decades. As the baby boomer generation enters into retirement, the number of senior citizens will rise, as will the number of senior citizens who fall prey to elder abuse.

These instances of abuse include physical and financial abuse. Examples of physical abuse include the refusal of family members or caregivers to pay for heat or electricity, leaving elder citizens cold and without power for months on end. In financial abuse cases, younger family members steal money from the elder’s Social Security checks.

According to this article, more than 1 million Americans over the age of 65 have been injured, exploited, or mistreated at some point by someone on whom they depended for care or protection.

While legal recourse is available for victims of elder abuse, a significant hurdle is the reluctance of victims to report the abuse. Denise Armstrong of Big Sky Senior Services says that only one in ten cases of elder abuse are reported; 90% are not. To respond to this crisis of secrecy, Big Sky Senior Services has begun educating the general public on issues of elder abuse. They have trained gatekeepers, bank tellers, meter readers, and mail carriers to detect and report instances of possible elder abuse. This new method of prevention provides allies in the community for potential victims of elder abuse, but does not diminish the importance of reporting abuse and seeking help. Instead, elderly victims should work with the community to report abuse in order to reduce the future number of abuses and victims.

Elder Abuse Pair Prepare for Hearing, Jury Trial in Bakersfield
Kern Valley Sun

In Kern County, 30-year-old Joseph McCoy and his 54-year-old mother Darlene Green took part in a Readiness Hearing at which they faced charges of causing harm or death to an elderly person. The person in question was Margaret Gray, Green’s mother and McCoy’s grandmother, who died on April 1, 2011.

On February 11, 2011 paramedics found Gray in her home suffering from bed sores and grade four ulcers, lying in her own bodily fluids with areas of her skin stuck to her bed sheets. Gray was then taken to the Kern Valley Hospital and treated in the emergency room for what the director, Dr. Manual Sacapano, called “the worst case of elder abuse I have ever seen.” Two months later, Gray died from cardio respiratory arrest, sepsis, and Alzheimer’s disease.

McCoy had been Gray’s primary caregiver since 1999. He and his mother are being held at the Lerdo pre-trial facility.

Deceptively passive in nature, neglect is one of the most harmful forms of elder abuse. To be designated a primary caregiver is to take on moral and legal responsibility for the healthcare and wellbeing of the elderly citizen. This and other tragic cases highlight the urgent necessity for legal recourse against caregiver abuse. With legal action, we can prevent further abuses and promote proper methods to ensure safety and comfort of the elderly. The Evans Law Firm in San Francisco, California represents elder victims of neglect and other physical and financial abuse.

Ohio Jewish Retirement Community Opens Elder Abuse Shelter
JTA

The Cedar Village Retirement Community in Mason, Ohio has opened the state’s first shelter for abused elderly. This shelter will allow abused seniors a stay of 90-120 days with access to medical care as well as to the retirement community’s activities. The shelter is called the Shalom Center for Elder Abuse Prevention opened on January 1, 2012.

This endeavor is not only exceptional as a service provided to the elderly, but it is also unique as a community-based response to elder abuse. The center does not treat the abused elderly as singled-out victims, but invites them to participate in the retirement community’s activities and provides access to medical care. The service is available to seniors from Hamilton, Warren, Butler, and Clermont Counties in Ohio. For information on elder abuse prevention and litigation in California, contact the Evans Law Firm for a free consultation.

Consumer complaints about long-term care insurance fraud have registered for several years now.  Many Americans choose to buy long-term care insurance fraud, to ensure that their care expenses in the future will be taken care of.  Unfortunately, many know little about how long-term care insurance works, or the extent that insurance company will go to in order to deny policyholders claims. 

According to estimates, approximately 7 million Americans own long-term care insurance.  Last year, the New York Times reported that many state governments are advising citizens to buy long-term care insurance in order to avoid excessive strain on Medicaid coverage.  However, while long-term care insurance has been aggressively promoted, little attention has been paid to the high potential for elder financial abuse through these schemes.

When most insurers began offering long-term care insurance, they believed it would be a potential gold mine.  However, they didn't bargain for the fact that the average elderly person lives for much longer now, even accounting for illnesses.  Some of these insurers have quickly found that long-term care insurance isn’t the goldmine they thought it would be.  Many of them have therefore hiked insurance premiums significantly, making it hard for policyholders to pay their premiums. 

Other companies have simply chosen to make processing claims as difficult for a policyholder as possible.  San Francisco long term care insurance fraud lawyers have come across several instances where claims have been delayed, leading to litigation.  In many cases, seniors don't have the energy or enthusiasm to continue fighting for years, and may die before any resolution of the case.  Some companies simply deny claims altogether for certain living facilities.

With such harassment, senior citizens who are already in frail health may be forced to endure severe stress and anguish due to such abuse.

What to look out for with Long Term Care Insurance

By Ingrid Evans, Attorney

The Evans Law Firm, www.evanslaw.com

For more information or to speak to an attorney, please contact info@evanslaw.com or call us toll free 888.503.8267 for a free and confidential consultation.

LONG-TERM CARE INSURANCE

Unscrupulous Agents Target Seniors for Improper Long-Term Care

Be careful of long-term facilities that do not meet your needs or are misrepresented. 

Insurers Raising Rates for Long Term Care Insurance So That It Becomes Cost Prohibitive and You are Forced to Lapse

Also, be careful of long term care insurance companies that are raising rates it cost prohibitive for you to continue owning a particular policy. 

Long-Term Care - What YOU Can do to Protect Yourself

There are a number of things you can do to protect yourself from fraud when selling your life insurance policy.

• Do Some Long Term Care Research
• Ask the financial professionals involved in your long term care policy about how long-term care works and how your settlement will help you. Make sure the policy is consistent with what the agent says. If the policy does not say it, then it does not exist and it will not help you.
• Ask for long term care consumer brochures.
• Ask the financial professionals involved in your long term care policy what their commissions will be.
• Consult an attorney if there is anything that seems suspicious or if your rates have been increased significantly, www.evanslaw.com or info@evanslaw.com
• Consult websites and resources related to senior financial planning to learn about long term care.
• Discuss your options with an independent financial planner.
• Always have a close friend or family member to consult with when making decision concerning financial products like life insurance. Most importantly, have a reputable financial planner review your long-term care policy to see if it is appropriate for you.
• Check Your Long-Term Care Insurance Agent's Credentials - Some resources you can use to research the broker:
  • State Departments of Insurance such as the California Department of Insurance
  • The internet - use any major search engine such as Google or Yahoo!

Watch out for life insurance agents who use phony certifications that misrepresent their actual qualifications. Sometimes more subtle tactics are used, but real scare tactics are effectively used because they motivate many seniors to buy coverage.

Long-term care policies pay the cost of the day-in, day-out care for a person with an acute or long-term illness or disability. Many seniors receive this care in nursing homes, but more effective and less expensive care at home and at adult day-care centers is growing in popularity, because it is less expensive and still provides the security of a longstanding home. That is the theory, but in practice long-term care policies are often riddled with loopholes that do not adequately protect a senior's life savings. Some policies have such strict disability criteria that many policyholders who need help do not qualify for benefits. Add to this cauldron of conflict the insurance company's sales commission structure. Insurance agents are loath to disclose policy pitfalls when it means risking the loss of a commission equal to life insurance commissions of 30 percent to 65 percent of the first year's premium, far more than the typical 10 percent commission many auto insurance agents earn.

Helpful Hits to Consider Before Purchasing a Long-Term Care Policy

• Always check with several companies and agents
  It is wise to contact several companies (and agents) before you buy. Be sure to compare benefits, the types of facilities you have to be in to receive coverage, the limitations of coverage, the exclusions, and, of course, the premiums.
• Take your time and compare outlines of coverage
  Never let anyone pressure or scare you into making a quick decision. Do not buy a policy the first time an agent comes calling. Ask the agent to give you an outline of coverage. The outline of coverage summarizes the policy's benefits and highlights important features. Compare outlines of coverage for several policies.
  • Understand the policies
  • What qualifies you for benefits? Some insurers say you must be unable to perform a specific number of the following activities of daily living: eating, walking, getting from bed to a chair, dressing, bathing, using a toilet and remaining continent.
  • What type of care is covered? Does the policy cover nursing home care? What about coverage for assisted living facilities that provide less client care than a nursing home? If you want to stay in your home, will it pay for care provided by visiting nurses and therapists? What about help with food preparation and housecleaning?
  • What will the benefit amount be? Most plans are written to provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
  • What is the benefit period? It is possible to get a policy with lifetime benefits but this can be very expensive. Other options for coverage are from one to six years. The average nursing home stay is about two and a half years.
  • Is the benefit adjusted for inflation? If you buy a policy prior to age 60, you face the risk that a fixed daily benefit will not be enough by the time you need it.
  • Is there a waiting period before benefits begin? A 20 to 100 day period is not unusual.
• Do not be misled by advertising or endorsements by celebrities
  Most of these people are professional actors who are paid to advertise. They are not insurance experts.
• Accurately disclosing your medical history is extremely important
  Make sure you fill out the application completely and accurately. If an agent fills out the application for you, do not sign it unless you have read it and made sure that all of the medical information is correct. If information about the state of your health is misstated, incomplete, or wrong, the company will refuse to pay your claims and cancel your policy. For that reason you should always fully and completely explain the full extent of your medical condition.
• If you are unsure about any particular item be sure to state - Do not recall
  And as a catch-all to protect yourself, always refer the carrier to your doctors' records of the care provided to you and list the names and address of your doctors.
• Pay premiums automatically
  It may be a good idea to have premiums automatically deducted from your bank account and paid electronically by your bank. Should an illness delay or prevent paying your statements on time, your coverage will not lapse.

Keep the policy in a convenient place where you or anyone else can readily find it, and tell a trusted friend or relative where it is.

If you believe you have been a victim, consult an attorney.

For more information or to speak to an attorney, please contact info@evanslaw.com or call us toll free 888.503.8267 for a free and confidential consultation.

About The Evans Law Firm

The Evans Law Firm is a plaintiffs’ firm concentrating on elder abuse (physical and financial), consumer fraud class actions involving, particularly insurance and banking claims,  consumer product liability and personal injury/wrongful death cases, particularly asbestos-mesothelioma, pharmaceutical product liability, negligence personal injury claims, as well as qui tam (whistleblower/false claims) and employment discrimination litigation.

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