C. Lawrence “Larry” Thomas

C. Lawrence “Larry” Thomas

C. Lawrence “Larry” Thomas began working with long-term care and Medicare programs in the mid- 1980s. He is currently associated with Insurance 101 Services to provide long- term care solutions to seniors and those approaching. Larry can be reached at (949) 374-3316 or ltinsurance@me.com.
CA Insurance License # 0C79256.

Tragically, the term “See Something, Say Something” and its call to action are focused these days on defending ourselves against acts of terrorism right here, where we live. But the concept the term expresses applies to other things against which we must defend ourselves, our friends, neighbors, and loved ones. One such thing is the growing problem of Elder Abuse.

Elder Abuse takes many forms. It can be physical, emotional, sexual, or financial and can include neglect, abandonment and criminal activities such as swindles and cons. Much elder abuse is a combination of several of these forms. The results can be devastating to the victim.

As a person ages, and becomes more physically frail and dependent on others, they are less likely to be able to defend themselves or even recognize that the abuse is occurring. Couple their increasing frailty with hearing loss, poor eyesight, and a loss of mental sharpness and vulnerability greatly increases. The abusers can be strangers, but it is more likely that they are friends or relatives of the abused elder. Some are professional criminals.

According to the National Center for Elder Abuse, “an estimated 1.2 million older Americans are victims of physical, psychological, or other forms of abuse and neglect. Those statistics may not tell the whole story. For every case of elder abuse and neglect that is reported to authorities, experts estimate that there may be as many as five cases that have not been reported. Recent research suggests that elders who have been abused tend to die earlier than those who are not abused, even in the absence of chronic conditions or life threatening disease.”

Abuse can be somewhat minor looking or go unnoticed such as a caregiver raising their voice to control behavior or threatening to or actually withholding something the elder needs, or neglecting the elder by leaving them alone for long periods. Many times abuse occurs when the caregiver and elder are alone.

Many people who hear “elder abuse and neglect” think about older people living in nursing homes or about elderly relatives who live all alone and never have visitors. But elder abuse is not just a problem of older people living on the margins of our everyday life. Often it occurs in our midst, out in the open.

Financial abuse and exploitation is an example of a form of abuse that usually occurs in the presence of others.

An actual occurrence here in Orange County is a case in point. A very nice lady, let’s call her Mrs. Jones was a long-time regular customer of a bank. The staff knew her well and she visited the bank often. Mr. Jones passed away over a year ago and Mrs. Jones was coping with the loss very well, her grief had subsided and her normal happy demeanor was reemerging.

Then on day she was accompanied to the bank by a man and a woman in their forties. She did her normal banking, nothing unusual, and introduced them as her new caregivers. The bank staff was concerned at first but there was no reason to assume wrongdoing. But as time went on the male half of the couple seemed to increase his control and eventually did most of the talking to the bank staff with Mrs. Jones simply agreeing. The bank staff got more suspicious when checks were processed, written to pay her usual bills, but the signature was slightly different. Then on day a very large check came through payable to the male caregiver and deposited into his account. The bank called Mrs. Jones who said it was a loan to him and told the bank to pay the check. She seemed tense, not herself. The bank contacted the Orange County Council on Aging elder abuse hotline and reported the incident. It turned out that the couple was attempting to gain title to Mrs. Jones’ assets, including her home and car. Luckily for Mrs. Jones, the couple was not far enough along to do much damage and disappeared. Mrs. Jones had no children but a niece was contacted who came to her rescue. Mrs. Jones sold her home and moved to a very nice independent living facility. She is still there and is very happy all because her bank’s staff saw something and said something.

Bankers, insurance professionals, stock brokers, and financial planners all receive continuing education training in elder abuse so that they can recognize the red flags that indicate the possibility of such abuse. “By increasing awareness among physicians, mental health professionals, home health care workers, and others who provide services to the elderly and family members, patterns of abuse or neglect can be broken, and both the abused person and the abuser can receive needed help,” says the National Center for Elder Abuse.

All of us can help by being observant and recognizing the signs that elder abuse might be present. A great deal of information is available at http://www.elder-abuseca.com/index.html. If you see something, say something to Adult Protective Services (24-hour hotline) at (800) 451-5155.

When a person retires they have three pots of money to be concerned about. Each of these pots has a dedicated source of funds. They are:

  • The Living Money Pot: This pot contains the income needed for basic living expenses such as food and shelter, utilities, transportation, clothing, and the like. This money typically comes from Social Security, a pension, an annuity, distributions from retirement accounts, and, perhaps, a part-time job.
  • The Lifestyle Money Pot: This pot is for the things we want; things that make us happy, things that are nice but not as essential as the needs funded by the Living Money Pot. Things like golf expenses, hobbies, travel, a golf cart that looks like a Rolls Royce, and so forth. The Lifestyle Money Pot also funds Long-Term Care should it be needed. Let’s face it, if you need long-term care assistance, your golf and travel will probably be limited and the money for it diverted to long-term care expenses. This money comes from savings and investments. It is not a good idea to take money from a source, such as an IRA, that is needed for the Living Money Pot.
  • The Legacy Money Pot: This is the money that we pass on to our heirs. Sometimes it is after we are gone; sometimes we want to do something while we are here like fund a grandchild’s education. This pot is usually funded from investments, an owned business, real property assets, and life insurance.

Long-term Care expenses can be paid by selling an asset from the Lifestyle Money Pot, the Legacy Money Pot, or by buying an insurance policy designed to pay for this care. Some long-term care insurance policies have a feature that returns the premiums paid in if the coverage is never needed.

Another innovation is a life insurance policy, paid for out of the Lifestyle Money Pot, with a death benefit that can be used for long-term care expenses. Any portion of the death benefit that still remains when the insured passes is paid to the heirs (so it becomes part of the Legacy Money Pot).

Long-term care is assistance with the acts of daily living such as eating, dressing, bathing, transferring (i.e., from a bed to a chair), continence, and toileting. Neither Medicare nor Medicare supplemental insurance covers this care. The only government assistance for long-term care is through MediCal, a program for impoverished persons.

For further information regarding the long-term care financing options available, please call. There is never a charge for such consultations.

One of the questions I am most often asked is this one: what is the best age to buy long-term care (LTC) insurance?

A number of years ago Consumer Reports studied this and came up with the following:

LTC diagram

While I think this is, for the most part, still true, I have refined my advice to a range from 55 to 65 years old (the younger the better) as the best age to buy. I came to this conclusion partly for the reasons outlined above and because folks in this age range really feel the need to add LTC in order to protect the assets they have worked so hard for: to save them for a comfortable retirement lifestyle and to pass on to their kids and grand kids. Additionally, today there are policies available with guaranteed premiums.

Also according to Consumer Reports Money Advisor “not everyone needs long-term-care insurance: only people with assets between $200,000 and $2 million should be perusing policies. Retirees with assets of $2 million or more should be able to pay for the full cost of care. And those with a net worth below $200,000 to $300,000 (not including a house) won’t be able to comfortably afford pricy premiums and will probably rely on government programs (MediCal, in California) if they need assistance with long-term care coverage.”

I would add another consideration to the above, even people with over $2 million in assets (excluding home equity) want to save money to transfer to children, grandchildren, other heirs, the arts, universities, and charities. Long-term care coverage can do that and even more. There are long-term care policies available now that actually increase the size of the policyholder’s estate if long-term care is never needed.

According to the U.S. Department of Health and Human Services over 70% of Americans over 65 will need some long-term care services either at home, in an assisted living facility, or in a nursing home. Without long-term care insurance, the last years of life can be financially devastating for seniors and their families.

The good news is that there are a range of LTC coverage products that can lift this burden and allow for aging with more independence and dignity and less reliance on the kindness of family and friends. More information, without cost or obligation, is just a call away.

Please pass this article on to family or friends, especially those in their fifties.

That is one of our most frequently asked questions. The short answer is - possibly.

Before the question can be answered we need to drill into your parent’s specific situation. We will ask some questions to determine some factors that influence the final answer. Eventually, your parents will need to be directly involved in answering these questions.

  1. Do you understand what services are paid for under long-term care coverage?
  2. Does one or both of your parents currently require substantial assistance with two or more of the six Activities of Daily Living (called ADLs which are eating, bathing, dressing, continence, transferring, and toileting)?
  3. Does one or both of your parents need assistance to protect him-or-herself and/or others because of a mental deterioration (such as Alzheimer’s Disease)?
  4. What medical conditions are present and what medications are currently being administered?
  5. What surgeries or hospital stays have occurred in the past 5 years (brief details and diagnosis for each)?
  6. What are the ages of the parents?

The answers to these six questions will determine if coverage is possible. If your parents are not approvable for coverage we will let you know. In some cases the insurance company may have further questions.

Assuming that we get a green light, next come the design of the coverage and the preparation of a quotation.

There are lots of options in this stage, which means more questions. Among them are:

  1. Where do the parents want to receive long-term care (at home, in a facility, day care, etc.)? It is common that this care starts at home and eventually moves to a facility when a high level of services is needed.
  2. What are the financial constraints? Consumer protection regulations require the collection of financial information so that we can insure that this coverage is “suitable.” Financial information is submitted as part of the coverage application.
  3. Are their special requests or requirements that need to be considered? This may include considerations such as insuring that a specific facility or luxury level is planned for.

At this point we have enough information to provide an initial quotation. This quotation may change with the details of the plan that change as a result further discussion and clarification.

Once the coverage is settled and the quotation is approved, the detailed application is prepared and submitted to the insurance company for underwriting. The length of the approval process depends on the details of the medical history. It can take as much as thirty days to get the final approval. The time required depends on the completeness of the application and how fast medical service providers respond to the underwriter’s requests.

While somewhat lengthy, working through the details will insure that you and your parents get the coverage you need at a cost that is appropriate.

The last question: How about your long-term care coverage? Buying it earlier in life is less expensive and, chances are, disqualifying medical issues are less likely. There are policies available that guarantee your premium will not increase.
Call us for more details. There is never a charge for consultation.

There is a lot of misunderstanding regarding long-term care. Some people confuse it with medical services and think that it is at least partially paid for by Medicare. It is not.

Long-term care does not include medical care. Rather, it is assistance with the “acts of daily living” (called ADLs) such as eating, bathing, dressing, continence (inability to control one’s bowel or bladder function), transferring (getting in or out of a chair or bed), and toileting.

Assistance with these activities does not require a medical professional such as a nurse, medical technician, or physician. Further, long-term care may be provided at the person’s home, in a facility such as a “nursing home,” or in a “day-care” setting.

In many families assistance with ADLs is taken care of by a family member until the assistance requires physical strength beyond the caregiver’s (such as lifting or carrying person needing assistance). At that point the person needing assistance can be better cared for by professionals, either at home or in a facility.

In many cases the person needing assistance does not want their spouse or their child to attend to these duties. They do not want to impose or “be a burden” on their loved ones. Paying a professional caregiver for these services preserves their pride and independence.

Usually the need for long-term care services starts gradually and can easily be done at home. It is not unusual for a family member provide the care during the early phase when the person needing care is ambulatory and can handle many of the ADLs without assistance. As the need intensifies, a professional caregiver is added. Eventually the professional caregiver’s assistance is required for most of the care, perhaps in a facility.

As the foregoing progression occurs, so does the cost of the care. In Orange County the average daily rate for a nursing facility runs between $190 and $220 per day and is growing at 3.2% per year. It is, therefore, very important to plan for this eventuality.

The fact is statistics show that 75% of us will need at least some long-term care.

Some folks believe that they will never need long-term care. The fact is statistics show that 75% of us will need at least some long-term care.

This care is generally paid for in one of three ways: the person needing assistance spends from their estate; long-term care insurance is purchased to finance the care; and, if the person needing care is impoverished (has reduced their assets and has low income), MediCal (California’s Medicaid program) may cover their long-term care needs in a contracted facility.

For the people who think they may not need long-term care, there are policies available s that cover these expenses if needed and have a life insurance feature so that if long-term care is not needed, the long-term care pool of money left over is passed to heirs.

There are many options available for financing long-term care needs. We are prepared to assist you in understanding your choices at no cost or obligation to you. Just call (949) 374-3316.

One of the questions I am most often asked is this one: what is the best age to buy long-term care (LTC) insurance?

A number of years ago Consumer Reports studied this and came up with the following:

LTC diagram

While I think this is, for the most part, still true, I have refined my advice to a range from 55 to 65 years old (the younger the better) as the best age to buy. I came to this conclusion partly for the reasons outlined above and because folks in this age range really feel the need to add LTC in order to protect the assets they have worked so hard for: to save them for a comfortable retirement lifestyle and to pass on to their kids and grand kids. Additionally, today there are policies available with guaranteed premiums.

Also according to Consumer Reports Money Advisor “not everyone needs long-term-care insurance: only people with assets between $200,000 and $2 million should be perusing policies. Retirees with assets of $2 million or more should be able to pay for the full cost of care. And those with a net worth below $200,000 to $300,000 (not including a house) won’t be able to comfortably afford pricy premiums and will probably rely on government programs (MediCal, in California) if they need assistance with long-term care coverage.”

I would add another consideration to the above, even people with over $2 million in assets (excluding home equity) want to save money to transfer to children, grandchildren, other heirs, the arts, universities, and charities. Long-term care coverage can do that and even more. There are long-term care policies available now that actually increase the size of the policyholder’s estate if long-term care is never needed.

According to the U.S. Department of Health and Human Services over 70% of Americans over 65 will need some long-term care services either at home, in an assisted living facility, or in a nursing home. Without long-term care insurance, the last years of life can be financially devastating for seniors and their families.

The good news is that there are a range of LTC coverage products that can lift this burden and allow for aging with more independence and dignity and less reliance on the kindness of family and friends. More information, without cost or obligation, is just a call away.

Please pass this article on to family or friends, especially those in their fifties.

Some conversations are really hard to have. Especially those related to our, or a loved one’s, end of life. Most people are hesitant to have the “talk.” I call these “3D” conversations as they are subject to denial, delay, and deflection. Let’s have one.

In the vast majority of couples there will be a survivor, one who lives longer than the other. The survivor probably has been a caregiver for the other half of the couple: possibly the primary, if not only, caregiver. If she is the last one standing, how will she get the care she needs?

That is the dilemma for many families; dad has passed and mom needs care that was never adequately planned or prepared for. If there are children, caregiving becomes their responsibility (either to give the care or pay for care by professionals).

To jog our memories, we are talking about long-term care, which is assistance with the “activities of daily living” (eating, bathing, dressing, transferring from bed to chair, toileting, and continence). This care may be at home or in a facility.

Medicare does not pay for long-term care beyond a few weeks in a skilled nursing facility after an inpatient hospital stay and if there is a medical necessity for skilled nursing and the patient is improving. MediCal (California’s version of Medicaid) does have a long-term care program for impoverished persons as a “safety net.” Qualifying for MediCal benefits essentially eliminates the recipient’s estate.

Well, now that we are depressed having identified the problem, let’s talk solutions.

The first solution is to plan early (your 50’s is not too early, 70’s is not too late) by starting with the needs of the survivor and working backwards through the needs of the couple together. In today’s world there are various forms of long-term care insurance that can be purchased individually or jointly by couples. The earlier this coverage is acquired, the less expensive it is. Additionally, the younger the applicant is, the healthier they tend to be, so qualification for the coverage is usually easier.

As an aside, it is not unheard of for a person in their 30s to purchase long-term care coverage. Why? The premiums are comparatively low. Plus, a significant portion of the long-term care benefits paid out are to policy-holders who are under 65 and have suffered a medical condition (i.e., car accident or early stroke) which requires long-term care for a period of time.

Back to the issue at hand: what if the couple is older or one of them has already passed? There are still things that can be done, depending on the individual’s situation. There is a program in California that protects some assets from MediCal “spend down” requirements called the California Partnership for Long-term Care. That may be an option. There is also a special long-term care annuity that may be suitable.

The best way to proceed is to contact a long-term care coverage professional and discuss your personal circumstances. If this doesn’t apply to you, but you know someone who might need some advise, pass this on to them. In our case, there is never a charge for these consultations.

In my three decades of focusing on long-term care coverage, I have seen it many times. The woman of the house – who did the majority of the child raising, managing the house, and caring for her aging husband (probably an income earner too) – never was planned for and had very limited resources when she needed care. It is no one’s fault, really. Families are just used to thinking of mom as the rock that will always be there.

Usually the kids help as much as they can, if they live close enough and they find time while raising there own families. Sometimes mom moves in with one of the kids. Sometimes she wants to stay at the family home, where she made most of her memories and have the kids and grand kids visit her there. She might decide on an independent living facility so she can socialize with folks she relates to. She can have the family come there to see her.

Sometimes she is alone, no children, few relatives, and would really prefer to be in a facility where she can interact with people. She is not interested in staying home.
What almost all of these women have in common is: they don’t want to be a burden on their families, they don’t want their kids helping them with very personal things (like changing their diapers and bathing them), and they want to leave something from their estate to their kids and grandkids. In short, they want independence for as long as possible, dignity, security, and a little fun. I’ll bet they earned all those things.

What do you do? The best thing is to lay out a strategy early and lock it in. Waiting is costly. Planning isn’t the end of the process; it is the beginning.

People think that programs like Medicare cover long-term care, they don’t. The only program in California that does help with long-term care is MediCal. It is designed for impoverished people who need substantial assistance with the acts of daily living (i.e., dressing, bathing, toileting, and so forth).

Financing long-term care is up to the individual. There are tools available to assist the family with mom’s long-term care.

For example, there is coverage available that can take care of all of mom’s long-term care needs, in any setting (home, a facility, an adult day care center, etc.) and, if she use all the long-term care benefits, there is a life insurance feature that passes the remainder to her beneficiaries. In fact, this coverage can be purchased jointly with dad and it can provide long-term care benefits to each or both, for a lifetime (as well as the life insurance benefit if the long-term care benefit isn’t used up).

Long-term care insurance coverage should be purchased as early as possible. The closer the insured person is to possibly needing the care, the more expensive it becomes.
Many of the families I meet with tell me they have been through taking care of an aging relative. They say that they want to secure long-term care coverage so their kids or relatives do not have to go through that with them.

If you have questions, need additional information, or want to refer a friend or relative, please call. There is never a charge for consultations and we will do our best for anyone you refer.

The short answer is, well, maybe. While it depends on why a person is not qualified for long-term care (LTC) insurance, there is an option, a, single premium, fixed, deferred annuity that is designed with built-in long-term care benefits.

The advantages of this option are that it is easier to qualify for than insurance, has long-term care benefits, and if you don’t need long-term care, the money in the annuity can be used as income or passed on to heirs.

What is a fixed annuity? Simply stated it is a long-term, tax deferred, insurance contract designed for retirement. With a fixed annuity the retiree creates a stream of income for his or her lifetime or a certain number of years, their choice. The money placed in the annuity grows by a fixed and guaranteed interest rate. Taxes are deferred until the money is taken out.

The annuity option discussed here also features LTC benefits. These benefits are accessed in much the same way as the other forms of LTC coverage. To start the benefits, the covered person must need substantial assistance with two of the six activities of daily living (eating, bathing, dressing, continence, transferring, and toileting) or have a severe cognitive impairment. A medical professional must certify these conditions.

Once LTC payments are approved, and after a waiting period, the benefits are paid tax-free. Some of these annuities also have an optional feature that continues long-term care benefits for up to 9 years (conditions apply). The continuation payments are also tax-free.

One or two persons, called annuitants, can purchase these annuities. The LTC benefits can be paid to either annuitant individually or both at the same time.

Long-term care insurance is medically underwritten. Generally an insurance applicant must be in average-or-better health to qualify. The annuity option is also medically underwritten, but the applicant’s state of health can be “fair” and still qualify. Medical underwriting is, of course, very specific to the applicant’s personal situation.

This is a single premium annuity. That means that the annuitant(s) must deposit a large sum into the annuity which grows at a fixed rate of interest over an extended, contract period, say ten years. If the decision is made to take the money out early, a “surrender charge” may apply. However, authorized LTC benefits are immediately available, tax–free, and with no surrender charge.

The source for the funding of an annuity like this is usually money that is set-aside for a rainy day. Answering the question: “what would I need to liquidate if I needed long-term care tomorrow?” may put the source in focus. It may be another annuity or a CD.

There are lots of details that you must understand before you select this option. Please give us a call for a personalized illustration and Outline of Coverage. There is never a charge for consultation.

Long-term care (sometimes referred to as LTC) can be confusing and there are lots of misconceptions regarding what it actually is and who pays for it. While it is impossible to cover everything about LTC in these few words, we can get a good start.

What is Long-term Care (LTC)?

Simply put, LTC is services and assistance to an individual who has severe limitations in his/her ability to function independently and will require assistance and care over an extended period of time.

Long-term Care is not medical care and is not provided by medical professionals such as nurses and therapists or their assistants. Long-term care is custodial in nature and can be provided at home or in a facility (there are several types) licensed to provide such care.

The above term “ability to function independently” is measured by a person’s ability to do the “activities of daily living.” These activities, frequently called ADLs, are eating, bathing, dressing, continence (inability to control one’s bowel or bladder), transferring (getting in or out of a bed or a chair), and toileting. This is a universally accepted list, which is used to determine when a person is qualified to receive LTC coverage benefits.

One additional measure of qualification for LTC Coverage benefits is “severe cognitive impairment.” This is defined as an individual needing supervision and/or assistance to protect himself/herself or others because of mental deterioration caused by Alzheimer’s disease or other organic mental diseases.

What does long-term care cost?

According to the California Department of Health Services, the 2014 average daily private pay rate for a nursing facility in California is $260 per day. Further the average annual increase in this rate for the most recent 5-year period has been 3.2% per year. Other studies indicate that Orange County’s costs are somewhat less that the statewide average (currently in a range of approximately $190 to $220 per day). Generally speaking, less is spent on care delivered at home, depending on the quantity of care needed and how much of the care can be handled by friends and relatives with no “out-of-pocket” costs.

How is LTC paid for?

There are typically three ways that LTC is paid for: First, self-funding, the individual spends his or her assets and/or has financial assistance from children or other relatives and friends. Second, purchased LTC coverage (traditional LTC insurance and California Partnership-certified LTC insurance, or one of the newer, more innovative “hybrid” LTC policies). This transfers all or part of the risk of a person needing long-term care to the insurance carrier. Third, qualify for MediCal LTC benefits by spending down personal assets for LTC services first and when the MediCal level is reached, apply and move into a facility that accepts MediCal reimbursement (MediCal is California’s version of the Federal Medicaid safety-net program). Please note that neither Medicare nor private health insurance pay for LTC services.

Long-term care is custodial in nature and can be provided at home or in a facility (there are several types) licensed to provide such care.

What are the LTC coverage options?

Today’s options are far better than they ever have been: First, traditional LTC insurance. This coverage is much like other forms of insurance, the customer pays a premium and, if LTC is needed, a specific list of benefits, limitations, and exclusions apply. Second, California Partnership (State Certified) LTC insurance which is traditional LTC insurance with mandated benefits. This coverage protects certain assets from “spend-down” in order to qualify for MediCal.

Third is what is known as “asset-based” or “hybrid” LTC coverage. This is a combination of either Life Insurance and LTC Coverage or an Annuity and LTC Coverage. These options can be paid for with premiums over time, a single investment, trading an obsolete life insurance policy, or using “qualified” money such as within an IRA. The advantage is that the “death benefit” can be used for LTC (much like traditional coverage) but any of it not needed for LTC transfers to beneficiaries upon the passing of the insured.

This is, of course the “tip of the iceberg.” For additional questions, please call. There is never a charge for providing information and consultation.

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Battling the Isolation Crisis with ALYCEMates

When one contemplates the term “health crisis,” images from the 1995 medical disaster movie Outbreak come to mi...

Unique Boutique: Doheny Clothing Exchange

Business Showcase Sorbet Mag

Unique Boutique: Doheny Clothing Exchange

Certain things in life I am very grateful for. These things include chocolate, wine, soul music ...

THE ART OF FALSETTO

Entertainment Sorbet Mag

THE ART  OF FALSETTO

“The gypsy cri-i-i-ied…” Lou Christie – The Gypsy Cried Was the voice you heard a high pitched female alto, a ...

Segerstrom Center for the Arts and Attila Glatz Concert Productions Proudly Announce Salute to Vi…

Entertainment Sorbet Mag

Segerstrom Center for the Arts  and Attila Glatz Concert Productions  Proudly Announce  Salute to Vienna New Year’s Concert

Celebrate the arrival of 2018 in spectacular style with Salute to Vienna New Year’s Concert at Segerstrom Cente...

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