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.

Life insurance is sold to needs. For the past few decades, most life insurance consumers bought coverage to protect their income from the risk of dying early. However, as the traditional customer base grows older, consumers are now concerned about living too long.

These changing needs, as well as other factors affecting life insurance sales, have led life insurers to seek new sources for growth. More and more carriers are turning to living benefits, specifically long term care (LTC) riders. While companies had limited success with LTC as a standalone product, recent changes in the tax code may enable carriers to answer the LTC need and, at the same time, find a new source of growth for their life insurance and annuity products.

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.

Asia, too, is faced with demographic change. Family sizes are decreasing, longevity is increasing and relying on filial piety solely as a means for taking care of one’s self in old age is no longer possible. Singapore has put a sustainable solution in place with "ElderShield". Munich Re provides support in the product design and promotes cooperation between the State and the private insurance sector.

For people free of dementia, abnormal deposits of a protein associated with Alzheimer’s disease are associated with increased risk of developing the symptoms of the progressive brain disorder, according to two studies from researchers at Washington University in St. Louis. The studies, primarily funded by the National Institute on Aging (NIA), part of the National Institutes of Health, linked higher amounts of the protein deposits in dementia-free people with greater risk for developing the disease, and with loss of brain volume and subtle declines in cognitive abilities.

A study published in Archives of Neurology reports that a new spinal fluid test can predict with 100 percent accuracy those patients suffering memory loss who will eventually develop Alzheimer’s disease.

This breakthrough offers new hope to victims of the disease and their families, who heretofore could only know for sure that Alzheimer’s was the cause of their suffering after an autopsy was performed.

Presentation from the SOA '10 Health Meeting, held on June 28–30, in Orlando, FL.

Researchers report that seniors have six times the risk of developing dementia if they live with a spouse who has been diagnosed with the condition, according to the study.

Falls and fall prevention are a concern for the elderly and people with osteoporosis, according to data from trhe American Association for Long-Term Care Insurance. Osteoporosis is an increasingly common chronic disease that causes weak and fragile bones.

The American Association for Long-Term Care Insurance has come out with a consumer guide, which offers new data on the duration of LTCI claims as well as other findings related to LTCI. The data come from a study conducted for the group by Milliman, Inc.

Medicalnewstoday.com is reporting on new research which suggests that neurons, or the brain’s nerve cells, may be created even in old age. Prevailing scientific belief held that most neurons are lost shortly after birth, with the loss slowing but continuing throughout one’s life.

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

A Washington Post article recently compared the U.S. Medicaid system unfavorably to the long term care systems for the elderly and those with disabilities employed in France and the United Kingdom. Going back 20 years, most of the developed world relied on a system similar to the one the United States uses: Poor enough and sick enough and you received some assistance; middle class and you were on your own (until your resources became so depleted that you no longer qualified as middle class.)

Most developed countries determined that this approach was unnecessarily cruel and fiscally unwise, and revamped their systems to address the need for long term care, often in arrangements that combine government assistance with private long term care insurance. The U.S. response was to encourage its citizens to purchase private long-term care insurance.

According to new research published in the latest issue of The Journals of Gerontology Series A: Biological and Medical Sciences, individuals with higher midlife body mass index (BMI) scores had significantly lower general cognitive ability and significantly steeper decline than their thinner counterparts over time.

The study provides an in-depth look at Americans born 1952 - 1958. The Baby Boomer generation, typically, has been characterized as a bloc of people who think and act as one monolithic generation, when it actually comprises three separate cohorts. This study found that there are distinct differences between these Middle Boomers and their older and younger generation mates.

Premiums for long term care insurance rose about 2% to $723 a year for a base plan for a 55-year-old married individual, according to a study by the American Association for Long Term Care Insurance.

For a single individual in that age range, base protection would cost $1,060 annually, according to the annual Long Term Care Insurance Price Index published by the AALTCI, Westlake Village, Calif.

A proposal in the House and Senate healthcare reform bills, the CLASS Act, establishes a federal long-term care (LTC) program financed from participant premiums without any federal subsidy. The new LTC program is subject to guaranteed issue, and that, combined with its voluntary nature, subjects the CLASS Act to considerable adverse selection risk. This paper by Al Schmitz examines this risk while considering other likely consequences.

Industry insider Jesse Slome opines on LTCI's future - good and bad.

From 2000 through the first half of 2009, sales of long-term care (LTC) insurance plunged—a phenomenon that would seem to defy demographic trends that show an increasing number of Americans turning 60 each year. Rate hikes, product uncertainties, and an intractable reluctance by consumers have made LTC insurance a difficult sale. But a number of market and regulatory factors have come together to spur innovation in combination products that pair LTC with an annuity or life insurance. Could this next generation of hybrid products be the solution that consumers and insurers have been seeking?

Survey shows while vast majority are aware of the significant likelihood of needing long-term care, 83% have no plan for dealing with it.

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.

The Geneva Association's April 2009 Information Newsletter spotlights long-term care and aging issues from a global perspective. The guest editorial by Christopher Ball and Ross Campbell discusses instruments that produce the right information for underwriters and claim managers to better insure long-term care risks. Housing, Medicare and long-term care insurance are also examined.

When it comes to buying long-term care insurance protection, there are some significant differences between those purchasing group (employer-sponsored) coverage with those purchasing on an individual basis (typically through an insurance professional).

Presentation at Institute of Actuaries Australia 2009. (Audio, slides and synopsis available.)

The 2009 Long-Term Care Insurance Sourcebook, a compendium of the most current relevant research and data regarding long-term care and insurance products, has been published by the American Association for Long-Term Care Insurance (http://www.aaltci.org).

Despite the experience of Penn Treaty Network America in Allentown, Pa., which was recently put into rehabilitation, experts say reinsurance is available for long term care carriers.

After a promising start in 2008, individual long-term care insurance (LTCI) premium fell 23 percent in the fourth quarter, ending 2008 down seven percent, according to LIMRA’s Individual Long-Term Care Sales survey.

When working with an older client in the planning process, the individual’s health may be a critical component of the underwriting equation. Right from the start, there are certain issues that should be taken into consideration.

A form of screening to identify persons who are likely to need complex health care, who are at risk of adverse health outcomes, and who will benefit from care management programs.

Presentation at the SOA Annual Meeting & Exhibit, October 2008.

A follow-up to the article originally published in the May 2006 edition of Product Matters!, the newsletter of the SOA Product Development Section.

Changes in longevity, biological perspectives, mortality trends and more.

Potential testing options in underwriting people over age 65 are on the move. (link updated)

Handouts from the Living to 100: Survival to Advanced Ages International Symposium for sessions such as:

• Distinguishing Health Status For Advanced Ages - Faye S. Albert, John M. Bragg, James C. Brooks, Dr. Bob Gleeson, Steven K. Holland, Ashely Thomas
• Demographic Implications of Aging Populations Internationally - Robert L. Brown, Roberto Ham–Chande, Steven G. Prus, N. V. Subramanyan
• Quality of Life of Elderly - Beverly J. Orth, Anna M. Rappaport,Eric Stallard