Cost of Long Term Care


A lot of people incorrectly assume that health insurance and Medicare will cover long term care. They cover medically necessary care for up to 100 days, or until you stop improving or stablize. After that, you’re on your own.

The majority of Americans over 60 do not have long term care insurance yet 70% will need care. So, why do people not buy insurance?

Most will say the cost of the policy. An average policy, depending on age, health and benefits chosen, will cost $1,000-$3,000 per year per person.

But what about the fact that the same people who say they will “self-insure” for long term care will never “self-insure” a parking meter… they always put money in the meter, even though they could easily afford and “self-insure” the parking fine.

We make decisions based mostly on emotion. That’s what causes people to buy stocks when they are high and sell when it crashes, the opposite of what seasoned investors do.

What if you “self-insure” for long term care, how much will it cost you? The national average for nursing home care is $89,000/year with some areas over $140,000/year. Home care and assisted living average $50,000/year. See how much care cost in your state: download the Cost of Care brochure.

For every $1,000 of monthly retirement income you want to generate from your own savings, you will need about $230,000 in assets, according to the Schwab Center for Investment Research. For example, if you want only $3,000 a month, or $36,000 a year, you would need savings of $690,000. That’s a conservative estimate, assuming that you earn 5.2% on your investments and live off the earnings without dipping into the principal.

If you cannot afford a long term care insurance policy, how are you going to afford paying out of pocket? The other option is spending all your cash for your care. This includes anything of cash value: savings, investments like stocks, bonds, life insurance, annuities. Medicaid allows you can keep only $2,000.

There are 30 states with filial laws that allow the state to make your children repay Medicaid for your care expenses, although this is rarely done. Fifteen years ago the #1 reason people bought long term care insurance was they did not want to be a burden on their family. Today, the #1 reason is people do not want to outlive their money (and end up on Medicaid-Welfare Health Care).

Some people will buy long term care insurance for asset protection. Most states have a Partnership program that will protect assets from Medicaid if you own a Partnership long term care insurance policy.

You have five options to pay for long term care:

1. Self-insure.

2. Long term care insurance and Partnership.

3. Life insurance with long term care rider.

4. Annuity with long term care rider.

5. Medicaid.

The life insurance and annuity do not qualify for the Partnership (neither do group LTC policies). The life/LTC or annuity/LTC are often bought because: the person’s health will not qualify for traditional LTC insurance, or the person has too many cash assets and they’d never spend down to qualify for Medicaid. An old life policy or old annuity can be converted to one with long term care benefits without paying capital gains.

You can continue down the same road, uninsured, until either a diagnosis or a serious change of health, like a stroke, will disqualify you from insuring. Then you will only qualify for state assistance. At that point you would have to have used, sold or given away your assets 5 years before applying for Medicaid. Who has the ability to see 5 years into the future?

*  The best age to insure: the age your health will still insure you.
*  The best benefits to get: enough to cover what you cannot afford to pay out of pocket.

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When Will We Have an Alzheimer’s Vaccine?

Scientists are working on a vaccine to delay or reduce Alzheimer’s disease. Researchers say they are close to testing the vaccine on humans.

In spite of all the research and money spent, no reliable Alzheimer’s treatments are available yet. But researchers believe they may be able to cut down the number of Alzheimer’s sufferers half.     

At the University of Texas Southwestern Medical Center, a team of scientists has developed an experimental vaccine that is designed to reduce two proteins in the brain, beta-amyloid and tau, that are associated with Alzheimer’s Disease. Buildup of these proteins prevents the brain from functioning normally. In mice, the vaccine reduces beta-amyloid protein by up to 40 percent and tau by up to 50 percent.

If the vaccine has the same effect on humans, it could delay the onset of Alzheimer’s by five years, or cut in half the number of people affected.

The main problem with animal studies is that human diseases and immune systems don’t always work the same way. Another problem is that proteins can build up in the brain for 20 years before a patient will have symptoms. So patients would have to agree to taking the vaccine long before they know if they are susceptible to the disease. At this time, tests that show who is at risk for Alzheimer’s are expensive.

The vaccine may be tested for safety on monkeys before trying it on humans, so it will probably be 10 years or more before it is available.

At this time, around 5 million Americans have Alzheimer’s disease. The Centers for Disease Control and Prevention estimate that by 2060 there will 14 million. The National Institute of Health will spend 2.3 billion on Alzheimer’s research this year.

Read more about Alzheimer’s and Dementia: Link

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Nursing home patients’ response to music opens new avenues for diagnosis and therapy

A nursing home in California began playing music for residents suffering from dementia, and got responses from patients once considered unreachable.

There are thousands of nursing homes participating in an international music and memory program.

At Villa Coronado, a nursing home in San Diego, 10 residents with traumatic brain injury were given an iPod to listen to music. Over 4,500 residents in 300 California nursing homes are taking part in a statewide experiment. One of the aims of the study is to find out whether music can replace antipsychotic drugs and restraints for agitated patients. With some patients, it seems to work.

This patient population receives little or no therapy, and are mostly bedridden, isolated from the world around them. Researchers are looking to see if the music program can reduce aggressive behavior.

For some people, music brings back memories. It can help dementia patients become more aware of their surroundings. Music will bring a smile to some patients, and can calm those who are agitated. Some patients listening to the music will smile, move rhythmically, and be more responsive to their loved ones.

Music is said to activate more parts of the brain than any other stimulus. New research suggests music therapy could help people in a coma or in a vegetative state.

The patients’ response to music may even help physicians to diagnose consciousness. Studies show there is a high rate of misdiagnosis in vegetative patients, where it is important to determine a patient’s chance of recovery. Observing these patients leads some workers to conclude that rather than a steady state, there is a spectrum of consciousness, and patients drift in and out.

Caroline Schnakers is an associate clinical professor in the Department of Psychiatry at UCLA. Her research indicates there is a 40 to 50 percent error rate in diagnosing a patient’s consciousness. Some patients appear to be unconscious, and yet have some signs of consciousness and awareness of their surroundings.

A patient in a minimally conscious state (MCS) is considered to have more chance to recover than a patient in a vegetative state. If a patient is observed to be sometimes conscious, there is more hope of recovery. The diagnosis of a patient determines medical treatment and end-of-life decisions, so it’s important to diagnose correctly.

Some patients thought to be in a vegetative state are actually in a minimally conscious state, and they respond to the music. One nursing home activities director was excited to see how music affected the residents, saying they just come alive.

Researchers at UC Davis plan to have the initial results of their nursing home study by the end of this year. But regardless of whether music is able to replace medication, it’s worth giving patients music to improve their quality of life.

For more information on the care of dementia patients: Alzheimer’s on Guide To Long Term Care.

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Diabetes drug doing double duty as Alzheimer’s therapy

A drug developed for treating diabetes now shows promise for Alzheimer’s patients, according to scientists at England’s Lancaster University. The drug is described as a triple receptor agonist, or TA. It combines hormones glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and Glucagon, activating these three receptors at the same time. The new study is published in the journal Brain Research.

A group of mice with Alzheimer’s-related symptoms were tested in a spatial water maze. The TA drug was injected once a day for two months. The mice who were treated with the drug remembered their path better than the control group.


In addition to the memory improvement, other symptoms were improved: the accumulation of plaque in the brain was reduced; brain nerve cells were protected from deterioration and loss; and chronic nerve inflammation was reduced, as well as oxidative stress in the cortex and hippocampus. Increased levels of synaptophysin indicated protection from synaptic loss that occurs in Alzheimer’s. An increase of doublecortin positive cells showed improved neurogenesis.

Other diabetes drugs have shown promise for Alzheimer’s patients. The two diseases are known to be related, and type 2 diabetes increases the risk of Alzheimer’s disease. Clinical trials are proceeding to investigate the neuroprotective effects of extendin-4 and liraglutide.

Alzheimer’s cases are expected to triple in the next forty years, requiring more long term care. The increase in patients will bring financial challenges as well as medical ones. For more information on supporting Alzheimer’s and dementia patients, see the Alzheimer’s Section on Guide To Long Term Care.


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The rate of dementia among seniors is going down

The rate of Alzheimer’s and other forms of dementia among seniors has declined significantly over the last ten years, according to a new study.

The Einstein Aging Study followed 1400 men and women age 70 and older from 1993 through 2015. When they entered the study they did not have dementia. Carol Derby, research professor at the Albert Einstein College of Medicine in New York City, analyzed the data. The report was published in JAMA Neurology.

Of 369 people born before 1920, 73 ended up with dementia. Of 285 born 1920-24, 43 developed dementia. Of 344 born 1925-29, 31 developed dementia. Of 350 born after 1929, only 3 got dementia. Similar declining rates have been found in Europe.

Researchers say the reasons for the decline in dementia cases are not known, but there is also a declining rate of stroke and heart attack from one generation to another (though diabetes is increasing).

Efforts to prevent cardiovascular disease in recent decades may be paying off; the incidence of stroke has declined. Since dementia risk is correlated with the health of blood vessels in the brain, it makes sense that the rate of dementia is falling alongside the rate of strokes. A recent study found that healthy lifestyles, including exercise, good diet, no smoking, and proper treatment of chronic medical conditions could prevent 35% of dementia cases.

Although the rate of dementia is going down, the actual number of people with dementia is increasing dramatically as the baby boomer generation ages, inflating the percentage of elderly people in the U.S. population.

Around the world, more than 47 million people suffer from dementia, and 7 million new cases develop each year. The number of cases of dementia is projected to double every 20 years. The number of people with Alzheimer’s disease is expected to reach 106 million by 2050.

Dementia is one of the most expensive health conditions, costing patients and families in medical fees and caregiving time. Long term care insurance can help pay for the costs. You must insure before the diagnosis! For more information see the Guide To Long Term Care – Alzheimer’s.


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Dancing Benefits The Aging Brain

Doctors have long recommended physical exercise to reduce or delay the onset of dementia as people age. But a new study indicates that dancing may give even greater benefits than other forms of exercise.

Dr. Kathrin Rehfeld compared the effects of different kinds of exercise on volunteers with an average age of 68. Over 18 months, participants took part in either traditional fitness training with repetitive exercises like cycling or Nordic walking, or dance lessons which featured something new each week.

The study measured changes in the hippocampus, the area of the brain that is connected with learning, memory, and balance, and is affected by Alzheimer’s and similar diseases. In both groups, the hippocampus region of the brain increased. The dancers had a noticeable improvement in balance.

The dance routines varied and included jazz, square dance, line dance, and Latin. The study was published in the journal Frontiers in Human Neuroscience.

Other studies have found similar benefits to dancing:

A study at the Albert Einstein College of Medicine found that brain-stimulating activities such as reading, writing, and doing puzzles lowered the risk of dementia by 47 percent. This study did not find that regular bicycling, swimming, or team sports lowered the risk of dementia significantly. But ballroom dancing reduced the risk of developing dementia by 67 percent!

A study from Korea found that seniors who learned to dance the Cha Cha improved their memory and cognitive function over six months when compared to controls. A study from Canada found that seniors who danced the tango twice a week improved their cognitive scores.

The challenge of constantly learning a variety of new things may be one of the keys to the success of dance in improving mental ability. Dance requires a combination of mental and physical activity – dancers must remember the steps and executive them in rhythm. Also, dance is usually accompanied by music, and music has also been found to benefit people with Alzheimer’s and dementia. Music stimulates memories and positive emotions, and body response to rhythms; music can also have the effect of making people more outgoing and sociable.

For more information on Alzheimer’s and dementia, see the Alzheimer’s Section of Guide To Long Term Care.

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Nine lifestyle changes can reduce dementia risk

Nine factors that contribute to the risk of dementia

  • Mid-life hearing loss – responsible for 9% of the risk
  • Failing to complete secondary education – 8%
  • Smoking – 5%
  • Failing to seek early treatment for depression – 4%
  • Physical inactivity – 3%
  • Social isolation – 2%
  • High blood pressure – 2%
  • Obesity – 1%
  • Type 2 diabetes – 1%

These risk factors – which are described as potentially modifiable – add up to 35%. The other 65% of dementia risk is thought to be potentially non-modifiable.


Note: Insure before the diagnosis. Once diagnosed insurance is no longer available.


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