In this blog-post the author discusses changes in rates and underwriting practices soon to impact LTCI.

Articles include:

- Long Term Care Product Design: Two Common-Sense Recommendations
- Conducting a Long-Term Care Experience Study
- Solving the LTC Crisis in 20 Minutes
- 500 LTCI Producers Gather to "Focus Forward"
- Touch-Screen Technology
- Stay the Course
- Winning Strategies for a Changing Game
- First-Principles LTC-Survivorship
- A Voluntary Lapse Rate of 12.6 Percent for LTCI? Not Really
- Change Is Constant

This Focus intends to provide readers with an overview of the current status of public and private LTC insurance in selected countries. It will also clarify the basic aspects of product design.

This article is featured on page 26 of the September 2012 SOA Long Term Care Newsletter. Other articles in this issue include:

The Future of Genetic Testing is Now
Aspirin, Not Morphine
LTC Dashboard - Key Accessory to High-Octane Performance
Opinions and a Conversation on LTC Financing
Independent Providers: A Long-Term Care Insurance Conundrum
AGGIR, the Work of Grids
Thoughts of a Landscaper

As a veteran long-term care insurance (LTCI) specialist in California, I have been witness to the turmoil surrounding the availability of this insurance. Following are some of my perceptions relating to provider/pricing stability.

The 2012 Long Term Care Insurance Survey is the 14th consecutive annual review of long term care insurance (LTCI) published by BROKER WORLD magazine. The survey compares products, reports sales distributions and analyzes the changing marketplace.

Carriers providing long-term care (LTC) insurance have historically invested significant resources in risk management activities designed to ensure that policies are properly priced and that premiums can remain relatively stable for consumers. An important focus of such risk management activities has been the medical underwriting process and more specifically dementia screening.

Alan Monheit, the editor of Inquiry, is asking whether the U.S. private long-term care insurance (LTCI) market is sustainable.

2012 is the perfect year to start selling long-term care insurance (LTCI). More than ever before in my 30-plus years of experience in the industry, consumers are now asking for LTC solutions.

The wax and wane of pre-funded Long Term Care (LTC) insurance products is a complex story to tell fully. One contributor to the recent Chartered Insurance Institute (CII) conference, “Who cares? The Future of Long-Term Care Funding”, may have oversimplified it when stating, “they just did not sell”. Campbell (2009)5 provides a more subtle analysis of the decline in pre-funded LTC policies. Whatever the background story, just 15,000 such policies remained in force at the end of 2010. More recently, Immediate Care Annuities have been more in vogue but even this market has remained relatively small with around 1,500 new policies being sold each year. In order to bring fairness, order, sustainability and affordability to this complex arena, Dilnot makes a number of key proposals:

Topics covered include:

- The Impact of Obesity and Diabetes on LTC Disability and Mortality
- Living at Home Brings Peace of Mind
- Industry Check-Up
- A Tale of Two Countries

Gastrointestinal complaints are very common in the general population and very often co-occur with common mental disorders. We aimed to study the prospective impact of gastrointestinal complaints on long term sickness absence, and address the contribution from co-occurring common mental disorders and other somatic symptoms.

The average annual cost of a private room in a U.S. nursing home has increased to $77,745 this year, up 3.4% from the 2010 average.

For more in-depth information, check out Genworth's Cost of Care Across the United States to learn a state’s or region's median cost of care by type of care and read key findings.

Report on the most recent Living to 100 Symposium from Douglas Doll, FSA, MAAA, consulting actuary with Towers Watson.

Estimates are based on household interviews of a sample of the civilian, noninstitutionalized U.S. population aged ≥80 years.

There is already well established evidence that individuals with functional impairments and dementia face a higher risk of mortality than those who are not impaired.1,2,3,4,5,6,7,8 What is less well-known, however, is the association between the very earliest stages of cognitive decline—having mild cognitive impairment— and subsequent mortality experience.

The purpose of this research is to analyze the relationship between being classified as cognitively impaired by two alternative cognitive screens and mortality rates among long-term care (LTC) insurance applicants.

Karine Peres presents the current trends of disability worldwide from an epidemiological perspective with a focus on dementia.

Susan Coronel provides an exhaustive picture of the market for long-term care insurance in the United States. She discusses the current environment and the future challenges to come.

The "pre-dementia" state has been conceptualized in a number of different ways usually described as Mild Cognitive Impairment (MCI) with subjective memory complaints (SMC) a consistent part of the criteria along with measurable impairment, preservation of functional ability and not meeting the criteria for dementia. This edition of Gen Re's LTC Quarterly explores the question of SMCs and the value of obtaining information of this type at underwriting stage.

This edition of Gen Re's LTC Quarterly considers whether the generation known as the Baby Boomers is likely to enter later life with better or worse age-specific rates of morbidity and disability than earlier cohorts.

A 55-year-old couple purchasing long-term care insurance protection can expect to pay $2,350-per-year (combined) for about $338,000 of current benefits ($169,000 each) which will grow to about $800,000 of combined coverage for the couple when they turn age 80.

The data comes from the 2011 Long-Term Care Insurance Price Index published by the American Association for Long-Term Care Insurance that analyzed rates for 11 long-term care insurance policies.

Report on a joint study sponsored by LIMRA and The Society of Actuaries.

MetLife Inc. says it will no longer sell new long term care insurance policies in either the individual or group markets after the end of the year.

The move will not affect coverage for the company’s existing LTC insureds, the company says.

The cost of private-room nursing home care is averaging $83,585 this year, up 4.6% from the 2009 average, and the average annual cost of staying in an assisted living facility increased 5.2%, to $39,516 per year.

The MetLife Mature Market Institute, Westport, Conn., an affiliate of MetLife Inc., New York (NYSE:MET), has published those figures in a summary of results from a long term care market survey.

New findings on health care reform, long-term care, microinsurance and more.

This issue looks at cognitive problems which have proved the most difficult risk to assess and manage.

Older men may be at risk of developing mild cognitive impairment (MCI), often a precursor to Alzheimer’s disease, earlier in life than older women, according to a study appearing today in Neurology.

Primarily funded by the National Institute on Aging (NIA), part of the National Institutes of Health, the study raises the question of whether there may be a gender difference in the development and progression of MCI.

This recently released study includes consumer perceptions and cost trends by state and key metropolitan areas, and an interactive mapof the US showing cost data.

Individual long term care insurance sales were 13% higher in the first half than they were during the comparable period in 2009.

The research team found an association between tobacco industry affiliation and the conclusions of individual studies that fail to link the association. Industry-affiliated studies they noted indicated that smoking protects against the development of AD, while independent studies showed that smoking increased the risk of developing the disease.

According to the American Association for Long-Term Care Insurance (AALTCI), there are about 24 million people in the world living with dementia, with 4.6 million new cases coming forward every year.he study by Boston University School of Medicine (BUSM) published online in the journal Annals of Neurology, confirms the inverse association of increasing BMI with lower brain volumes in older adults and with younger, middle-aged adults.

New research shows seniors with higher levels of vitamin D demonstrate more youth and vitality as they enjoy longer life spans. A limited number of studies have pointed to the possibility that optimal intake of vitamin D (the “sunshine” vitamin) might help keep our muscles strong and preserve physical function. To help understand this diet-health association, researchers at Wake Forest University studied the relationship between vitamin D status and physical function in a group of relatively healthy seniors living in Memphis, TN and Pittsburgh, PA.

Topics covered include:

• Alzheimer’s Disease—Will It Become An Epidemic?
• The Fight for Bettering LTC
• Mental Health Issues of Particular Groups: The Dichotomies of Caregiving: Mental Health Challenges of Informal Caregivers
and more.

The health bill package includes provisions that could have a big impact on long term care insurance sales, industry experts say.

More women receive privately paid for care at home for lingering health issues with more obtaining this care at older ages than men according to a new report from the American Association for Long-Term Care Insurance. Nearly 60 percent of those receiving care were women with over 80 percent age 75 or older the study found.

The older population is becoming more racially and ethnically diverse as the overall minority population grows and experiences great longevity. In fact, the percentage of older persons, which was 16 percent of the older population in 2000, is expected to grow to 24 percent by 2020. This section provides information on minority elders in the United States.

Presentations from the 2009 Forum include:

• DRA Partnerships - Three Perspectives
• Fibromyalgia - Causes, Consequences and Future Directions - Wickersham
• Challenges Adjudicating the Younger Claimant
• Cardiovascular Disease - LTC Underwriting Perspective - Mastropolo
• Cardiovascular Disease - LTC Underwriting Perspective - Margolis
• Three Perspectives for Spotting Fraud and Keeping It Off the Books

The cost of home care appears to be increasing far less rapidly than the cost of nursing home care, according to Genworth Financial Inc. (NYSE:GNW). Nursing home rates have climbed at an annual median rate of 4.5% for private nursing home rooms over the past 5 years, while the annual median increase has been just 1.7% for licensed home health aides and 2.4% for licensed homemaker services over that same period, according to Genworth, Richmond, Va.

Americans are living longer, but how will that extended lifespan affect your clients’ plans for retirement? By 2050, about 20 percent of Americans will be 65 or older, U.S. News and World Report writes - that’s about 90 million people. Of those, 11 percent will be 75 or older, and 9 percent will be between 65 and 74. The magazine highlights some trends that will shape seniors retirements.

The Society of Actuaries' Long–Term Care Insurance Section and the ILTCI Conference Association research report exploring functional and cognitive trends among assisted living facility residents. The report, authored by Jessica Miller, Marc Cohen, and Xiaomei Shi of LifePlans, Inc., examines data on long-term care policyholders to gain insight into these trends.

Research published in the Journal of Alzheimer Disease reported on a study of women with Down Syndrome, who are known to have an early onset of menopause. The results of the research can be translated to apply to the general population.

Individuals purchasing long-term care insurance in 2009 tended to be slightly older and selected less costly policy features according to the American Association for Long-Term Care Insurance (AALTCI) annual study. The organization’s research was based on an analysis of 155,000 individual placed policies.

In this guest editorial for The Geneva Association's Health and Ageing newsletter, Howard Gleckman reviews the current long-term care financing model in the U.S., as well as several potential alternatives, including the CLASS Act.

Presentations from the 2009 Forum include:

• DRA Partnerships: Three Perspectives
• Fibromyalgia - Causes, Consequences and Future Directions Wickersham
• Challenges Adjudicating the Younger Claimant
• Cardiovascular Disease LTC Underwriting Perspective - Mastropolo
• Cardiovascular Disease - LTC Underwriting Perspective - Margolis
• Three Perspectives for Spotting Fraud and Keeping It Off the Books

According to government data, some 7.5 million individuals currently receive extended periods of care at home because of acute illness, permanent disability, or long-term health conditions. The nation’s annual cost for care in 2010 is projected to exceed $59 billion.

Understanding long term care insurance terminology is often the cause of great confusion and frustration for advisors as well as consumers.

Much of the benefits terminology was derived from the long term disability industry, where it also bewildered applicants. Today, many LTC policies use simpler and more understandable concepts, but assessing the terms carefully is still essential, because terms differ between contracts and they may involve tradeoffs from traditional comprehensive LTC insurance.

The American Academy of Actuaries told state regulators it will be developing long term care morbidity tables.

Members of the Accident and Health Working Group at the National Association of Insurance Commissioners, Kansas City, Mo., heard about the LTC insurance valuation morbidity tables project early this week during a working group teleconference.

Long-term care specialists—including consumer advocates, providers, public officials, and policy experts—who participated in a national survey generally agreed on the need for long-term care reform. Despite some differences, key constituent groups supported the establishment of government-sponsored financing strategies, a shift toward home- and community-based care, offering payment incentives to improve quality, and more effective regulation of nursing homes, home health care agencies, and assisted living facilities.

Broad health care reform legislation being considered by Congress would effect a major change in the way the United States finances long-term care. The Community Living Assistance Services and Supports (CLASS) Act would create a voluntary national long-term care insurance program. As lawmakers debate the potentially far-reaching proposal, they may learn from the experiences of other developed nations and from recent experiments in the U.S.

A series of publications provide a history of the generations born since the early 1900s. The profiles provide a snapshot of four generations. They look at demographics and, perhaps more importantly, the events occurring during their teen and young adult years that influenced their values and their viewpoints.

Newsletter of the SOA's Long Term Care section.

The recession may be depressing prices for some goods and services, but the cost of nursing home care, home health care aides and assisted living services is still going up.

During 2003-07, among adults aged ≥65 years, the poorest (<100% of the poverty threshold) were approximately twice as likely to need help with ADLs as the least poor (≥300% of the poverty threshold). Older adults were more likely to have 3-6 ADLs than 1-2 ADLs, except for the poorest group where the difference was not statistically significant.

The latest issue looks at:

• Underwriting the Elderly - Findings From a U.S. Survey
• Beyond Containment but Well Into the Guessing Game - The Novel A/H1N1 Influenza Pandemic
• Evidence-based Underwriting - Rheumatoid Arthritis

A 55-year-old individual considering long-term care insurance protection can expect to pay $723-per-year for a base level of protection if they are married or $1,060 if they are single according to the 2009 Long-Term Care Insurance Price Index published by the American Association for Long-Term Care Insurance. Across various age groups, costs for coverage increased about two percent from the prior year.

With the flowering of “financial services,” life insurers are now seriously questioning the appropriateness of cumbersome, time-consuming and blatantly customer-unfriendly screening tests.

Some 400,000 individuals purchased long-term care insurance protection in 2008 according to a just-released report. The overwhelming majority (84%) of individual buyers in 2008 were younger than age 65 and three-fourths (76%) selected a more affordable approach to this protection by opting for coverage for a specific number of years.

The annual study conducted by the American Association for Long-Term Care Insurance, the industry's professional trade organization, analyzed data on 215,000 buyers of individual long-term care insurance protection.

Presentation by Transamerica Reinsurance's David Wylde at the 2009 MUD Group meeting.

As 2008 came to an end, many of us found ourselves wondering what the adjective 'long-term' means in the context of wildly gyrating stock markets and the day-to-day uncertainty this turbulence has created for countries around the globe."

http://www.towersperrin.com/tp/showdctmdoc.jsp?country=global&url=Tillin...

John Hancock has announced the results of an in-depth study of the 2008 costs of long-term care (LTC), which found that LTC costs have been increasing in line with inflation in recent years.

Presentation from SOA Annual Meeting in Orlando, October 2008.

The Pension Protection Act of 2006 includes some important tax rules affecting combination plans that feature life or annuity plans coupled with long-term care insurance (LTCI). Many of these rules will become effective Jan. 1, 2010. In some cases, the rules will be applicable to policies on the books prior to that time. Among the benefits resulting from these new rules, the most notable would seem to be the clarification of tax treatment of annuity/LTCI combination products.

Price rollbacks throughout the U.S. economy during the past year did not apply to long-term care service providers, according to the 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs. Private room nursing home rates rose 3.3% to $219 per day or $79,935 per year, while assisted living also rose 3.3% on average to $3,131 per month. Home health care aides now cost an average of $21 per hour, a 5% increase; adult day services run $67 per day, a 4.7% increase.

...from the Long Term Care International Forum.

It is no secret that the long-term care insurance (LTCI) industry is having trouble offering products with a convincing and an attractive value proposition. In a recently released report, Conning Research & Consulting, Inc. reminds us that from an economics point of view, in order for a consumer to purchase a product, the product must 1) satisfy a perceived need or a want for which the consumer is personally responsible and 2) have an acceptable price. It appears that there are large gaps between LTCI consumers and insurers in both of these areas. (link updated)