Agent Training Handout

1
WHAT IS LONG-TERM CARE?
A wide range of services designed to manage
limitations caused by a chronic condition and to
minimize further deterioration of physical and
mental health.
2
WHAT IS FUNCTIONAL IMPAIRMENT?

• A chronic condition that limits a persons
  ability to perform Activities of Daily Living
  (ADLs).

3
ACTIVITIES OF DAILY LIVING

• Bathing
• Dressing
• Eating
• Toileting
• Transferring
• Continence

4
WHAT IS COGNITIVE IMPAIRMENT?

• COGNITIVE IMPAIRMENT is a disability due to a
  deterioration in mental capacity, which requires
  continued supervision. Alzheimers Disease and
  other forms of dementia are examples of cognitive
  impairment.

5
WHERE IS LONG-TERM CARE PROVIDED?

• Home
• Community
• Assisted Living
• Nursing Home

6
HOME AND COMMUNITY-BASED SERVICES

• Adult Day Health Care
• Chore Services
• Emergency Response System
• Home Delivered Meals
• Home Health Aide

7
HOME AND COMMUNITY-BASED SERVICES

• Homemaker Services
• Respite Care
• Visiting Nurse Services
• Therapies

8
AVERAGE HOME HEALTH RATES IN CONNECTICUT
Charge Per Hour
Charge Per Visit
Skilled Nursing Visit Registered Nurse LPN Home
Health Aide Physical Therapy Occupational
Therapy Speech Therapy
139 --- --- 63
--- 53 --- 32 135
--- 138 --- 138 ---
9
AVG. COMMUNITY-BASED SERVICE RATES IN CT
Charge Per Hour
Charge Per Day
81 --- --- 22
--- 19 --- 19 ---
--- 7.00
Adult Day Care Chore Services Companion
Services Homemaker Services Home Delivered Meals
(Charge Per Meal)
10
USE OF HOME CAREIN CONNECTICUT

• The average length of stay is more than 4 years
• About half transition to a nursing facility
• About 35 die at home

11
ASSISTED LIVING OPTIONS

• Congregate Housing
• Assisted Living Facilities
• Residential Care Homes
• Continuing Care Retirement Communities (CCRCs)

12
NURSING FACILITY RATES IN CONNECTICUT
381 139,000 5.6
Average Daily Rate
Average Annual Rate
Average Annual Inflation Rate (1988 2012)
13
COST OF AVERAGE NURSING FACILITY STAYIN
CONNECTICUT

• With the average cost for nursing facility care
  at over 138,000 per year and an average length
  of stay of about 2 1/2 years, the average cost
  for a nursing facility stay could be more than
  345,000.

14
MediCARE

• Federal Health Insurance for
• People age 65 years or older
• People with permanent kidney failure
• People under 65 with certain disabilities

15
MedicAID

• The state and federal health insurance program
  for those with limited resources or, in some
  cases, extremely high medical expenses.

16
Who Pays for Long-Term Care?
Other Gov. Programs 4.6
Out-of-Pocket 21.6
Medicaid 62.3
Private Insurance 11.6
Note Out of pocket expenditures include
payments made by patients and families. Source
National Spending for Long-Term Services and
Supports (LTSS), 2011 National Health Policy
Forum at George Washington University February
1, 2013.
17
INCOME TAX CLARIFICATION FOR INDIVIDUALS

• Premiums can count as an unreimbursed medical
  expense
• Out-of-pocket payments for qualified long-term
  care services can count as an unreimbursed
  medical expense
• Qualified insurance benefits paid will not
  count as taxable income

18
INCOME TAX CLARIFICATION FOR EMPLOYERS

• Premiums can be deducted in same manner as health
  insurance
• Employers can select or carve out groups of
  employees
• Insurance benefits received by the employee are
  not taxable

19
WHY LONG-TERM CARE INSURANCE?
20

• (1) Risk is high
• (2) Cost is high
• (3) MediCARE and health insurance do not pay for
  long-term care
• (4) While MedicAID pays for long-term care, you
  have to be poor and eligibility rules are
  restrictive
• (5) Potential tax benefits for individuals and
  employers

(6) Partnership for Long-Term Care
21
UNIQUE ASPECTS

• State certification
• Medicaid asset protection
• Greater affordability
• Guaranteed discount
• Enhanced standards
• Public Education

22
How Asset Protection Works

• If you continue to need care after your
  Partnership policy has paid benefits, you may
  apply for assistance from Medicaid.
• When determining eligibility, the Dept. of Social
  Services will disregard or ignore any assets you
  have up to the amount the Partnership policy has
  paid in benefits.

23
Guarantees ofMedicaid Asset Protection

• 1. Asset protection is a life-long promise
• 2. Payments granted asset protection before a
  policy lapse will still be honored by Medicaid

24
Guarantees ofMedicaid Asset Protection

• 3. The State of Connecticut cannot recover
  protected assets from a persons estate
• 4. Asset protection can accumulate anywhere the
  policy pays benefits