Louisville Medicine Volume 61, Issue 12 | Page 42

Speak Your Mind If you would like to respond to an article in this issue, please submit an article or letter to the editor. Contributions may be sent to [email protected] or may be submitted online at www.glms.org. The GLMS Editorial Board reserves the right to choose what will be published. Please note that the views expressed in Doctors’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine. Better Win Buckets at the Track Mary G. Barry, MD T Louisville Medicine Editor [email protected] hat’s about the extent of a lot of folks’ long term care planning – not the most cheerful topic for the lovely month of May, but as we enter the Triple Crown of racing, think about what you would have to win to provide for your parents’ care as they finally become feeble - or your own future care. Be forewarned: my husband says that this is so grim that I should tell you up front, “Abandon all hope ye who enter here.” The national statistics are daunting, to say the least. The average cost per year nationally to live in a private room in a nursing home is about $95,000, and in a double room it’s still $83,000. But these costs are rising between 3 and 4 percent per year depending on where you live in this country. The average daily cost right now for an in-home caregiver provided by a local agency in Kentuckiana is about $20 an hour. Nationally, it is about $30,000 a year and has been rising at about 1.3 percent per year. If you can send yourself or your loved one to adult day care, that costs about $20,000/ year, and that cost is rising at a lower rate of about 1.3 percent/year. The John Hancock website quotes Mr. Michael Doughty, an executive vice president: “The cost of long-term care continues to be one of the most significant uninsured financial risks that an individual can face.” If you want to have nightmares, use this website at www.johnhancockltc.com/coc to figure current and inflationary costs. 40 LOUISVILLE MEDICINE Some people are completely uninsurable for long-term care because of pre-existing conditions. For instance, everyone with post polio syndrome, which includes a sadly large chunk of baby boomers, will never be able to get long-term care insurance. Those who have significant mental illness, most neurological conditions including multiple sclerosis, muscular dystrophy, Parkinson’s disease or dementia of any type or severity, are not eligible to apply for long term care insurance. Those with most cancers, rheumatological illness or even chronic osteoarthritic or orthopedic problems that require they use a multipronged cane or walker, need not apply. Anyone who requires oxygen or wheelchairs, or already needs assistance with any activity of daily living, may not apply. HIV, autoimmune hepatitis, Non-A, Non-B, or Hepatitis C, chronic kidney disease, cirrhosis of any cause, hemophilia or cystic fibrosis or any other significant childhood illness with adult consequences - all knock you out of the running immediately as well. A May 2012 article from the Society of Actuaries’ Long Term Care News compared standards of underwriting for various pre-existing problems. The actuaries’ trademarked motto is “Risk is Opportunity,” which I figure is about as cold-blooded as their typical professional behavior. About half of insurers list a maximum acceptable weight for a man of 5’10 as 285 lbs, although a third set it under 265 lbs. For a woman below 5’4, this was set at less than 230, and was raised as height increased. Minimum weights also applied; I presume this screens for undeclared illnesses or frailty in general. The severity of some illnesses renders them a rating of insurable or not. Angina, smoking, alcoholism, certain skin cancers, osteoarthritis, inflammatory bowel diseases, sleep apnea, depression, amputation, COPD, TIA and stroke are unacceptable if severe. Definitions of “mild or moderate” for these ailments vary. Especially if judged to be moderate, having these conditions simply raised one’s rates as opposed to made one uninsurable. If the actuaries assigned you to a “mild” category, there was quite a diversity in the rate –setting, some barely raising rates at all. Some of these judgments were made through telephone interviews. If the applicant is 70-years-old, face-to-face assessments are universally required to screen for cognitive impairment. Some insurers require a face-to-face interview for every applicant. Insurers use MIB Group data extensively. The MIB Group services many different insurance companies by collecting and compiling health and insurance-use data on anyone who has applied for any individual life, critical illness, disability, long term care or health policy in the previous seven years. After seven years, the data is removed (I daresay the NSA could find it). Most insurers also conduct prescription drug searches on all applicants. The average “affordable” policies involve a daily benefit payout lasting less than five (continued on page 42)