WHAT IS LONG-TERM CARE?WHAT IS LONG-TERM CARE?

A wide range of services designed A wide range of services designed to to manage limitationsmanage limitations caused by a caused by a chronic condition and to chronic condition and to minimize minimize further deteriorationfurther deterioration of physical of physical and mental healthand mental health..

A chronic condition that limits a A chronic condition that limits a person’s ability to perform person’s ability to perform AActivitiesctivities ofof DDailyaily LLivingiving (ADLs) (ADLs)..

WHAT IS FUNCTIONAL WHAT IS FUNCTIONAL IMPAIRMENT?IMPAIRMENT?

AACTIVITIES OF CTIVITIES OF DDAILY AILY LLIVINGIVING

BathingBathing DressingDressing EatingEating ToiletingToileting TransferringTransferring ContinenceContinence

WHAT IS COGNITIVE WHAT IS COGNITIVE IMPAIRMENT?IMPAIRMENT?

COGNITIVE IMPAIRMENTCOGNITIVE IMPAIRMENT is a is a disability due to a deterioration in disability due to a deterioration in mental capacity, which requires mental capacity, which requires continued supervision. continued supervision. Alzheimer’s Alzheimer’s DiseaseDisease and other forms of and other forms of dementiadementia are examples of cognitive are examples of cognitive impairment.impairment.

WHERE IS LONG-TERM WHERE IS LONG-TERM CARE PROVIDED?CARE PROVIDED?

• HomeHome

• CommunityCommunity

• Assisted LivingAssisted Living

• Nursing HomeNursing Home

HOME AND COMMUNITY-HOME AND COMMUNITY-BASED SERVICESBASED SERVICES

• Adult Day Health CareAdult Day Health Care

• Chore ServicesChore Services

• Emergency Response SystemEmergency Response System

• Home Delivered MealsHome Delivered Meals

• Home Health AideHome Health Aide

HOME AND COMMUNITY-HOME AND COMMUNITY-BASED SERVICESBASED SERVICES

• Homemaker ServicesHomemaker Services

• Respite CareRespite Care

• Visiting Nurse ServicesVisiting Nurse Services

• TherapiesTherapies

Charge Per Visit

Charge Per Hour

Skilled Nursing VisitSkilled Nursing Visit

Registered NurseRegistered Nurse

LPNLPN

Home Health AideHome Health Aide

Physical TherapyPhysical Therapy

Occupational TherapyOccupational Therapy

Speech TherapySpeech Therapy

$139 --- --- $63 --- $53 --- $32 $135 --- $138 --- $138 ---

AVERAGE HOME HEALTH AVERAGE HOME HEALTH RATES IN CONNECTICUTRATES IN CONNECTICUT

Charge Per Day

Charge Per Hour

Adult Day CareAdult Day Care

Chore ServicesChore Services

Companion ServicesCompanion Services

Homemaker ServicesHomemaker Services

Home Delivered MealsHome Delivered Meals

(Charge Per Meal)(Charge Per Meal)

$81 --- --- $22 --- $19 --- $19 --- --- $7.00

AVG. COMMUNITY-BASEDAVG. COMMUNITY-BASED SERVICE RATES IN CTSERVICE RATES IN CT

USE OF HOME CAREUSE OF HOME CAREIN CONNECTICUTIN CONNECTICUT

• The average length of stay The average length of stay is more than is more than 4 years4 years

• About About halfhalf transition to a transition to a nursing facilitynursing facility

• About About 35%35% die at home die at home

ASSISTED LIVING OPTIONSASSISTED LIVING OPTIONS

• Congregate HousingCongregate Housing

• Assisted Living FacilitiesAssisted Living Facilities

• Residential Care HomesResidential Care Homes

• Continuing Care Retirement Continuing Care Retirement Communities (CCRCs)Communities (CCRCs)

Average Daily Rate $381

$139,000

5.6%

NURSING FACILITY RATESNURSING FACILITY RATESIN CONNECTICUTIN CONNECTICUT

Average Annual Rate

Average Annual InflationRate (1988 – 2012)

COST OF AVERAGECOST OF AVERAGE NURSING FACILITY STAY NURSING FACILITY STAY

IN CONNECTICUTIN CONNECTICUT

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

MediMediCARECARE

Federal Health Insurance forFederal Health Insurance for People age 65 years or olderPeople age 65 years or older People with permanent kidney People with permanent kidney

failurefailure People under 65 with certain People under 65 with certain

disabilitiesdisabilities

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

MedicMedicAIDAID

Who Pays for Long-Term Care?

Out-of-Pocket 21.6%

Private Insurance 11.6% Medicaid 62.3%

Other Gov. Programs 4.6%

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.

INCOME TAX CLARIFICATION INCOME TAX CLARIFICATION FOR INDIVIDUALSFOR INDIVIDUALS

Premiums can count as an Premiums can count as an unreimbursed medical expenseunreimbursed medical expense

Out-of-pocket payments for Out-of-pocket payments for “qualified” long-term care services “qualified” long-term care services can count as an unreimbursed can count as an unreimbursed medical expensemedical expense

““Qualified” insurance benefits paid Qualified” insurance benefits paid will not count as taxable incomewill not count as taxable income

INCOME TAX CLARIFICATION INCOME TAX CLARIFICATION FOR EMPLOYERSFOR EMPLOYERS

Premiums can be deducted in same Premiums can be deducted in same manner as health insurancemanner as health insurance

Employers can select or carve out Employers can select or carve out groups of employeesgroups of employees

Insurance benefits received by the Insurance benefits received by the employee are not taxableemployee are not taxable

WHY LONG-TERM CARE WHY LONG-TERM CARE INSURANCE?INSURANCE?

(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

UNIQUE ASPECTSUNIQUE ASPECTS

State certificationState certification

Medicaid asset protectionMedicaid asset protection

Greater affordabilityGreater affordability

Guaranteed discountGuaranteed discount

Enhanced standardsEnhanced standards

Public EducationPublic Education

How Asset Protection WorksHow Asset Protection Works

• If you continue to need care after your If you continue to need care after your Partnership policy has paid benefits, Partnership policy has paid benefits, you may apply for assistance from you may apply for assistance from Medicaid.Medicaid.

• When determining eligibility, the Dept. When determining eligibility, the Dept. of Social Services will of Social Services will disregarddisregard or or ignoreignore any assets you have any assets you have up toup to the the amount the Partnership policy has amount the Partnership policy has paid in benefits.paid in benefits.

Guarantees ofGuarantees ofMedicaid Asset ProtectionMedicaid Asset Protection

1.1. Asset protection is a life-long Asset protection is a life-long promisepromise

2.2. Payments granted asset Payments granted asset protection before a policy lapse protection before a policy lapse will still be honored by Medicaidwill still be honored by Medicaid

3.3. The State of Connecticut The State of Connecticut cannotcannot recover protected assets from a recover protected assets from a person’s estateperson’s estate

4.4. Asset protection can Asset protection can accumulate anywhere the policy accumulate anywhere the policy pays benefitspays benefits

Guarantees ofGuarantees ofMedicaid Asset ProtectionMedicaid Asset Protection