Episode Transcript
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Speaker 1 (00:02):
The other day. I think we're gonna be okay, folks.
The rain is supposed to stop. We've had enough of it,
and we are now looking for some sunshines afternoon, So
a sun sighting for this afternoon. Get ready for that,
and this morning, get ready for a show that's gonna
take you deep into the New York State legislature, into
the long term care world, into long term care insurance.
(00:25):
What's happening. The budget is now, we'll see exactly where
it is, but I think it's done. And we're going
to talk about a new piece of legislation that has
been proposed for New York State. We're going to talk
about existing insurance plans available in New York State, and
we're gonna talk about what's going on around the country
in Washington. This is a long term care show. You
(00:47):
need to know this, folks, because it will affect you.
But it doesn't today. And we were just talking before
the show, and everybody has their story. Oh yeah, I
just went through it with my mother. She went to rehab,
she's coming out. We don't know how to get services,
how do you pay for those services? What's the cost
of care for long term care? And if you haven't
(01:08):
heard about what those costs look like. Let me just
tell you. If you need to go to a nursing
home in New York State today, the cost is about
sixteen thousand dollars per month. So get your calculators out.
Sixteen thousand times twelve. You're up around two hundred thousand
dollars a year. And you may think, well, I'm never
going to go to a nursing home. A lot of
(01:29):
people think that and they put their head in the
sand and say, I'm not going to worry about it
because that's not going to be me. Well, what if
you want to stay at home and you want to
be taken care of in your own home, and you
want to go out and hire help to do that.
The going rate right now for a private home health
aid is about thirty five dollars an hour. Again, get
your calculators out. Thirty five times twenty four times three
(01:50):
sixty five. Now you're at two hundred and fifty thousand
dollars a year. So what's going on around the country
and the state to help defray this. I'm gonna introduce
some guests right now we have with us for today
this morning. To start out Senator Shelley Mayer. Good morning, Senator,
Good morning, lou how are you. I am doing well.
(02:11):
I'm going to introduce mister Bob Vandy for our listeners.
You may know Bob. He has been a frequent guest
and past host of Life Happens Radio. Good morning, Bob.
Heylu good to be with you, and all the way
from Florida. We have my good friend and colleague, Howard Crooks,
who is a past president of the National Academy of
Elder Law Attorneys, past president of the New York State
(02:32):
Bar Elderlaw Section, the Florida Bar Elderlaw Section, and one
of the most knowledgeable people on elderlaw and long term care.
Good morning, Howie.
Speaker 2 (02:40):
Good morning lou So.
Speaker 1 (02:42):
Senator Mayor, Let's start off with you, because the budget
has just been actively negotiated and I think it's pretty
well put to bed. But where does it stand today.
Speaker 3 (02:54):
Well, you're absolutely right, it's finished and it's been signed.
We finished on Thursday night. The Senate and Assembly passed
all the remaining bills. The governor signed them yesterday. So
the budget unfortunately late, but it is done and it
has some good.
Speaker 2 (03:10):
Things and some not so good things.
Speaker 3 (03:12):
As most budgets do, and that's where the budget stands.
The New York State budget for the next fiscal year
has been enacted.
Speaker 1 (03:20):
So from your perspective, what are some of the highlights
and maybe a low light.
Speaker 3 (03:25):
Well, I'm chair of the Senate Education Committee, so my
primary focus is ensuring that every public school gets some
additional money over last year, and every school district in
the state is getting at least two percent more than
they got last year. Some districts are getting more than
that as we continue to alter what's called the Foundation,
(03:49):
a formula by which schools get paid. And there's a
lot of other things that matter in many districts, including
additional money for career and technication, which is so important
to ensure that kids have really have access in schools
can provide the kind of training they need in the trades,
and all kinds of things that are you know, where
(04:11):
there are good paying jobs out there and schools have
not been able to do all they should do. So
there's a lot of good there some disappointing things, certainly
in the CD paths because we're talking about people who
have disabilities. At some point, that's a program that is
not working well, and we did not fix it in
(04:31):
this budget to meet.
Speaker 2 (04:32):
That's very unfortunate, okay.
Speaker 1 (04:34):
And CDPATH for those that don't know, is the Consumer
directed Personal Assistance Program, something that has been changed in
a very very major way over the last year. And
we're going to talk a little bit about that and
a lot about that on Thursday, And Senator Mayor is
going to be one of our panelists on Thursday on
(04:54):
a panel talking about another topic CDPAP related, which is
long term care fine financing. Medicaid is the program, as
most of you know, let's listen to this show that
finances a good portion of long term care. About seventy
five percent of nursing home beds are paid for it
by Medicaid, and there is a growing number of people
that want to take advantage of the Medicaid home care program.
(05:17):
And part of Medicaid home care is having to hire
aids that are consumer directed that you are managing. And
one of the reasons is we have a tremendous shortage
of aids and of healthcare workers in New York State,
and that workforce Shortage Center is driving a lot of
the dynamics right now in New York.
Speaker 3 (05:37):
Oh absolutely, I mean, we don't have enough people to
provide the care, and then we don't pay them enough
to be able to live in the communities we represent.
You know, that's true throughout the state. These are some
of the lowest paid people and at the same time
we're desperate to have their services. So it is, it
is truly a crisis.
Speaker 1 (05:56):
And last week we had on the show Al Cardillo,
the head of the Home Care Association of New York State,
and Rebecca Prevy, who is the head of the Area
Agencies on Aging in New York State, and they talked
about all of these topics. This Thursday, just for those
of you that would like to check in on it,
it's the Elder Law Forum. It's a full day of
(06:17):
discussion from federal perspective, Congressman Paul Tonko, from the state perspective,
Senator Mayor and some of her colleagues and the state legislature,
along with none other than Bob Vandy and Howard Crook's
our guests today on Life Happens, and a whole host
of other people dissecting this issue and these issues and
looking at solutions and center. Mayor, let's get right to it.
You have proposed some legislation to take a burden off
(06:40):
of Medicaid and put it where it kind of should be,
which is in some type of insurance program. So tell
our listeners what that legislation is.
Speaker 3 (06:51):
Well, that is a bill called the Long Term Care
Trust Act that is modeled after what they have in
the state of Washington, where instead of depending on Medicaid
or on giving up your assets in order to be
eligible for Medicaid, it is a funded program through very
modest contributions by employees, allowing somebody to get a long
(07:16):
term care benefit that somebody can come and care for
you in your own house up to a certain number
of hours, provide the care you need, usually not medical care,
but support care. Someone to help you take a shower
and do your laundry and get your dinner ready, and
that that part would be paid for up to a
certain number of hours, and it would avoid it allowed
(07:38):
people to remain at home, to have care that they
choose and the amount they want up to a certain point,
and allow these people to be paid at a living wage.
It is really not a perfect but a good solution
to a problem that you've identified.
Speaker 1 (07:54):
There, and it's a payroll deduction similar to Medicare deduction
off of your payroll.
Speaker 3 (08:02):
And yes, it is a modest payroll deduction for employees,
no burden to employers.
Speaker 1 (08:09):
And that's voluntary or is that mandatory.
Speaker 3 (08:12):
It is mandatory in order to create a fund that's
big enough to provide basically the equivalent of an insurance product.
Some people buy, as you know, long term care insurance.
That is not a perfect solution. You have to pay
a lot and then you have to keep it going,
and some people don't keep it going when the premiums
go up. And also it may not provide everything that
(08:34):
people need. And it's only a modest percentage of the
population has that long term care insurance.
Speaker 1 (08:41):
And we're going to talk a lot about that in
the second half of the show. And we have mister
Vandy here who is one of the leading experts in
that long term care marketplace. With regard to the legislation,
this has been tried at the federal level part of
the Affordable Care Act, which was called the Class Act,
which was a similar type of program. Every program has
its own unique details and payroll deduction and praying it
(09:03):
in right now, Medicaid is paid for from the general fund, correct, Correct?
So this is targeting dollars, pulling it out of the
Medicaid program and targeting long term care dollars directly towards
those costs.
Speaker 3 (09:17):
Well, that's true that it would ultimately be a saving
to the Medicaid program, but it also would be an
opportunity for many people who don't go on Medicaid to
get the care they need at home. And I'm sure
that many of your listeners, you know, they give up
their job to take care of an elderly parent or
a disabled person at home, and this way they would
(09:42):
be able to continue to have some short term or
long term modest amount of home care without the person
having to move to a nursing home. And that's what
really encouraged me at the beginning. People want to stay
at home if they can, and we want people to
be able to stay at home with the amount of
care they need.
Speaker 1 (10:00):
And what would be the benefit that would be derived
if you do participate in.
Speaker 3 (10:04):
There'd be a lifetime benefit benefit of seventy three thousand dollars,
and so there would be a certain number of hours
per week that you would be able to get. You
have to have paid in for ten years during the
lifetime near retirees, so people who can't pay in ten years,
they were to get a partial benefit, but there would
(10:27):
be a certain number of hours per week that the
beneficiary would get of home care defined as sort of
assistance in the elements of daily living.
Speaker 1 (10:38):
And this, Folks, is a topic that we can't do
in fifteen minutes. That Senator Mayor has a hard stop.
She has another event that she has to go to.
But we will look at this issue the New York
State legislation, the Consumer Directored to Personal Assistance program because
when children have to take care of parents, that's one
way that they can actually get paid and take care
of the aging parent. And that's part of the CDPAP
(10:59):
program and all of the other options at the Elder
Law Forum this Thursday, and you can register for that
at purolaw dot com. Senator Mayor, thank you so much
for your time this morning. We are really looking forward
to your panel on Thursday.
Speaker 3 (11:12):
Thank you so much. I'm looking forward to it as well.
Thank you for having.
Speaker 1 (11:15):
Me, Senator Shelley Mayer bringing some innovation to New York
State and a piece of legislation. We have to take
a short break and Howie Crooks is going to be
back with us along with Bob Vandy right after this
an appropriate intro song back into this topic today, Will
(11:37):
you still need me? Will you still feed me? When
I'm what? Bob? Sixty four sixty four, Holy Toledo. And
that tells you, folks, what the ages were when people
started thinking about this when that song was written, which
was right around the time Medicare and Medicaid passed back
in the early sixties. Now we're dating ourselves nineteen. Yeah,
that's a long story. But in nineteen sixty five, Linda
(11:59):
Johnson passed Medicare Medicaid, a federal and state program for medicaid,
federal program for medicare, and this long term care topic
dropped to the bottom here over the last fifty five
sixty years because of the aging population, the cost. And
we don't at sixty four, we're working. I'm sixty six,
I'm working my tailoff, and now it's maybe eighty four,
(12:21):
maybe ninety four, maybe one hundred and four, and we're
going in that direction. So, Howie, you're in Florida. You've
got a lot of these folks aging out in Florida.
What's going on down there?
Speaker 2 (12:34):
So lou in Florida, which, as everyone is aware, it's
a huge retirement state. People love the weather down here,
and we have many New Yorkers who come down here, Lou.
But I have to say that people are disappointed when
they come to Florida when they realize that the services
(12:54):
that are offered in Florida are not quite the same
as the services they're used to and I'm accustomed to
in New York. Yeah, And one example of that.
Speaker 1 (13:03):
It's a great point, Howie, and I'm glad you raised it,
because you live it, your license, you practice in both states.
And we've talked about this. New York Times ran the
series of articles about fifteen years ago called the Boomerang Effect,
people going to Florida at sixty five, retiring with all
their money, living in floridau till eighty five ninety and
then coming back.
Speaker 2 (13:22):
Correct. And just one example of that, Lou, is that
people who are interested in accessing the Medicaid home care
program in New York, which is historically been one of
the remote most robust home care programs in the entire
United States. Although it's it's got some kinks in the
armor over the last five or so years, it's still
(13:44):
one of the best and one of the most comprehensive
in scope of coverage. You can apply for home care
services in New York and you can get services almost immediately,
whereas in Florida they put you on a wait list
that can run anywhere from several weeks if you're lucky,
several months more likely, and in some cases upwards of
(14:05):
six nine months, even upwards of a year, depending upon
how you're rated for the services. So, as you and
I both know, and as I'm sure many of your
listeners are aware, when you need the services, going on
a wait list is not going to help you all
that much, because you need the services now, and you know,
finding out six months or nine months later that you
(14:27):
may or may not be called up off the weight
list to get the services that you needed six or
nine months ago is not a very helpful benefit.
Speaker 1 (14:34):
And that's not going to help how you when you're
at that discharge planner's office and they're saying, okay, you
have to leave the hospital, now, where are you going
to go? And they're going to give you a list
of nursing homes. Go shop for a nursing home, pick
five and we'll place you in one. Or you're going
to go to rehab bed or can you go home?
And that's the question, can you go home? And if
you go home, what services are available and how are
(14:54):
you going to pay for them? And that's the crux
of the issue.
Speaker 2 (14:58):
And it's a real hardship blue on families, Oh yeah,
because they're navigating this for the first time and they
don't know where to look, where to turn, and they
don't know what resources that they can access, and they
really need help and how are you?
Speaker 1 (15:15):
You and I have worked together with the New York
State Bar Association. Bob Vandy has been part of this
whole thought process. This goes back to the early two thousands,
so we're going back beyond twenty years ago. Twenty two
to twenty three years ago. I was the chair of
the Elder Lost Section of the New York State Bar
Association and you were the chair, I believe right after me,
(15:35):
right And so we work together on a program called
the Compact for Long Term Care, which we thought was
the most innovative financing solution for long term care, allowing
people to use their own dollars upfront to pay for
care and then having an ability to get a subsidy
on the back end, which would be a Medicaid type subsidy,
(15:56):
but having personal responsibility upfront. And that went through the
New York State Senate like hot knife through butter. We
passed unanimously two years in a row. We got to
the Assembly and they didn't like it so much because
they thought single payer, that Medicaid was going to pay
for everything for everybody in that we didn't need any
other solution. So it died in committee in the Assembly.
(16:19):
But later on it got put into the Governor's Budget
bill by Governor Patterson, and it's on the books today.
So that compact would have been right at the heart
of this issue.
Speaker 2 (16:32):
Well, yeah, and what's so nice about the compact program,
which is about as unique and innovative a program I've
ever seen When we're talking about the topic of long
term care and medicaid. The personal responsibility component that you
refer to allows people to take ownership of the need
to plan for their long term care, which is something
(16:54):
that the senator was speaking about. You know, people don't
typically think about long term care planning when they're in
their twenties or thirties, but if you did, similar to
the way you contribute to social security, then when you retire,
there's at least a fund that pays you in your
retirement years. Right, So the analogy would be we need
to have people taking more personal responsibility. But what I
(17:16):
really love about the Compact program is the personal responsibility
component number one, but number two. It allows you to
commit to a sum certain towards the cost of your
long term care with the confidence and knowledge that once
you've satisfied your pledge amount, the government will take over
after that. And that gives peace of mind because it
(17:40):
means you're not looking at the daunting prospect with a
long term care need that you're going to have to
go through all of your assets. If all your assets
are going to be exhausted, well that's devastating to anyone
and anyone's family. But this gives people the dignity of
knowing that they contributed towards their own needs, but not
to the full exhaustion of their assets, so they can
(18:02):
still live a decent life and then have the government
come in after a certain period of time. So I
think this program is still amazing to this day, and
as you said, it's on the books. If we can
ever get it funded, I think it would be transformational
in the long term care world.
Speaker 1 (18:20):
I couldn't agree more. And I see in an empty
chair here the spirit of Gail Holabinka sitting nodding her head.
Gail unfortunately passed over the last year. And Gail was
one of the architects of the best insurance program I
think that has come out for long term care called
the Partnership, and Bob Vandy's going to talk about that
in the second half a little bit, The Partnership for
long term Care, and this was the evolution of Gail's
(18:42):
concept into what we called the defined contribution plan. You
put a certain amount of money at risk, and then
you could ensure that risk, so you could buy private
insurance to cover the amount that you put at risk
that you have to private pay. But it involved howis
something that is critical. We talk about this in our
law practices, and you're actually bringing your practice Cosin O'Connor
(19:05):
and national practice into this world. And that is when
you have that need for services, the first thing you
need is a comprehensive, well structured assessment and a plan.
And the compact built that plan into the system. How
important is that to your clients?
Speaker 2 (19:24):
Extremely? It's what I was saying earlier, when you're hit
with a discharge scenario and you have not thought through
long term care planning, long term care financing options, what
resources do I need? Where do I find those resources
who are the best of the best With any resource category,
(19:47):
you need somebody to help plan that care, and an
assessment is the starting point for that. And there are
things called elder care coordinators, people who are out there
who can help you connect all the dots within the
long term care planning spectrum. And people so sorely need
(20:07):
this service. Many don't even know that it's available until
the need arises. And we're about to embark on a program,
as you well know, lou at Cos and O'Connor, where
we're going to have eldercare coordinators on our staff because
the clients who come to see us for the legal
and financial planning, they also want to have a one
(20:28):
stop shop where they can also get the eldercare coordination component.
And I know you're doing that as well, and you're
a practice.
Speaker 1 (20:34):
Yeah, I have evolved from that, and you and I
have had this conversation. We've actually spoken to bar associations
about this, how to integrate it into your practice. And
there are different models, and we had the employee model.
I had two social workers on staff at Pierre O'Connor
and Strauss right here in Latham, New York, and those
two social workers did exactly what you're saying. They went
out to the hospital, to the nursing home, to the home,
(20:55):
did a comprehensive assessment, interview the family, look at medical records,
talk to doctors, and put a whole care plan together.
We spun that out into ever Home Care Advisors and
we've had them on this show multiple times. They're still
very active here in the community. And ever Homecare Advisors
does this care coordination and they do it at every stage.
We just did a seminar called Your Home or the
(21:17):
Nursing Home where we had Diane, Mikel Gottabiowski and I
talk about how to prepare yourself legally, financially and from
a healthcare perspective. What do you need to think about
and Howie you're taking this to a different level with
a national law firm, which is kind of unique.
Speaker 2 (21:33):
It really is. There are certainly any number of law
firms nationally that do this, but none with the scale
that a national law firm like Coson O'Connor brings and
I'm very excited about this project Glue because not only
(21:53):
is there a need with the platform that a national
law firm provides for this, I hope would be that
others will add this component to their practices and offer
our service that is so sorely needed by anyone that
is going through the long term care system.
Speaker 1 (22:13):
And Howe, we got a little over a minute left,
and I know you have to go to an appointment
as well, and Bob and I are going to tackle
all this and tear it all apart. But even in
long term care insurance policies, many of them, there is
a care coordination benefit where people don't know that this exists,
and you don't have to go through something called an
elimination period. You don't have to wait the thirty or
ninety or one hundred days to start collecting money. The
(22:35):
insurance company will actually pay for that assessment and pay
for a care plan through a care coordination benefit. And
Bob will tackle that in a bit. But Howie, this
is so important and you're doing it now on a
national level. What else is going on at the National
Academy of Elder Law Attorneys, a group that you led
for several.
Speaker 2 (22:53):
Years, so I will I will say Lue that you
had Senator Mayor talking about a New York piece of
legislation that would provide for long term care planning through
payroll deductions. There's actually a similar bill called the WISH Act,
which stands for Well Being Insurance for Seniors to Be
(23:15):
at Home Act, that was introduced recently in the US Congress.
It's actually been reintroduced because it was introduced a few
years ago as well. It's by Representative Swosey out of
New York. It was also another Tom.
Speaker 1 (23:29):
Is a great story because he was a county executive,
so he dealt with these issues as a county executive
in the budget in his budget.
Speaker 2 (23:37):
Correct. Yes, and I think another representative from Michigan whose
name escapes me. But in any event, the reason why
this is so important, I think you mentioned the Class Act.
Now you mentioned the new piece of legislation proposed in
New York. But at the federal level, if we're really
going to talk about this in a meaningful way nationally,
if the WISH Act were to be adopted, then it
(23:58):
would similarly require a mandatory payroll attack that would be
shared between employers and employees.
Speaker 1 (24:06):
And now we have a heart stop with the news Thursday.
Tune in to the Elder Law Forum. We'll be back
right after this short break. So this is Lupiro, your host,
Bob Vandy, and studio Howie Crooks down in Florida, and
I just want to close it out, and then we're
going to roll over to long term care insurance because
I know you have an appointment, how he on Thursday,
we have a panel called Smart Strategies to Ensure long
(24:30):
Term Care. We just heard from Senator Shelley Mayer on
a new innovative insurance program proposed for New York State.
We're talking about a program introduced by Congressman Tom Swazi
called the Wish Act, and we're going to talk a
little bit more about that in the second half, which
is a federal program to tackle this. These issues are
not new. We've been talking about them for thirty years.
(24:51):
This is the thirtieth annual Elderlaw Forum and this was
one of the topics. Gail Holabinka was one of my
initial guests that we talked about thirty years ago. So Howie,
this this topic has not evolved and government is probably
not the best place to try to solve this problem
because you're subject to political cycles and budgets, but it
(25:12):
needs to have some innovation, and this is the Wish
Act is part of that, and that would bring something
to the table that hasn't been there before.
Speaker 2 (25:21):
Well, I agree, Lou, but let me say this. You know,
years ago, the government decided that Americans weren't saving enough,
so they created this thing called individual retirement accounts and
many other byproducts ensued from there to encourage Americans to save.
And then the government woke up a few years ago
(25:41):
and realized, wow, people of this has been so successful.
We've got billions of dollars that are tied up in
these individual retirement accounts and other retirement planning vehicles, and
they're not being taxed. So they adopted the Secure Act
and Secure two point zero to force peop well to
start taking money quicker out of those accounts of the
(26:03):
government to get its tax dollars. All the government needs
to do is recognize the problem and the tsunami that
we're about to confront in long term care and do
something similar to promote Americans from a tax incentivized way
to plan for their long term care. And I suspect
you'll see similar results.
Speaker 1 (26:24):
I don't disagree with that. And it reminds me of
another Beatles song, The Taxman, and one of the lines
is if you want to talk, if you want to walk,
we'll tax your feet. So government's going to find your
money somehow, some way, and they're going to try to
tax it. And Bob, you've been part of this from
the insurance side, and tax benefits have been built into
long term care insurance and incentives to buy long term
(26:45):
care insurance for many years. Yeah, no question, Lewin.
Speaker 4 (26:48):
In fact, New York State is probably the most attractive
tax and centive from a premium payment standpoint of any
state in the country. There still is a twenty percent
tax credit, which is a dollar for dollar reduction on
tax do and discount off your premium for sure. Now
they did when COVID came around in the middle of
the night. This change came about with that tax credit
(27:10):
that put a cap on, an income cap on it,
so if you're above a certain income level, there's only
a certain amount of that credit you can take advantage of,
similar to.
Speaker 1 (27:18):
A rough IRA limitation which can't contribute to a rock.
Speaker 4 (27:21):
Yeah, but it's still the most attractive in the country.
At the federal level, there's a deduction potentially available that's
tied to the medical expense deduction if you're itemizing your taxes,
but you have to be over two percent of your
adjusted gross income. Yeah, and the thing is you the
the other challenges. You got to be itemizing your deductions,
which with everything going on with salt and everything else,
it becomes more complicated. Far fewer of people are actually itemizing.
(27:44):
Almost everyone is using standard Yeah, so that becomes a
little problematic. But the good news is, certainly from a
private insurance standpoint, the benefits that are received from almost
every policy or income tax free as well. So you're
potentially getting a tax credit or deduction on the front
end while you're not necessarily having to pay for the
benefits on the back end. So from a tax leverage standpoint,
it's a pretty good deal.
Speaker 1 (28:04):
And how you bring up an excellent point because the
government got tired of waiting for its money. Clever lawyers
like us got clever and stretched those iras and left
them to two year olds with an eighty year life expectancy.
So there's no money coming out in the early years
of just accumulating tax deferred The roth to me is
one of the greatest gifts. But as an attorney, how
what we look at when we sit down with clients
(28:24):
and they're in that crisis situation I need to pay
the nursing home or I need to pay for home
health care, is medical expense deductions. And what we try
to do is pair up those iras or tax hostile
assets tax deferred assets and bring them into the game
at the appropriate time and use a deduction to offset
that income. And I know you do a lot of
similar planning with your clients.
Speaker 2 (28:46):
HOWI yeah, absolutely. I think it's one of the things
that people don't realize that when you're entering into a
need for long term care, just think about all the
moving parts that go in to trying to figure out
what level of care a person needs, where they're going
to receive that care, what kind of resources that the
(29:08):
family can access to support them through a very difficult
time in their lives, and the legal and financial planning
issues that come up. It really is all thrust upon
a family all at once, so the dam breaks loose,
and this is so overwhelming for families that if there
(29:30):
was a way Lou and I haven't figured it out
yet that we can get people to start thinking about
these things before the crisis hits, then there are things
that they can do to plan well in advance for
these kinds of issues and become much more educated about them.
And that would be if I had a wish Lou
(29:51):
for my entire career, it would be to be able
to do exactly what you're doing with your radio show.
Getting the information out, such critical information that people need
is so very very important. If we can get people
to do that before the crisis hits, then it would
it would go a long way to solving some of
these problems.
Speaker 1 (30:08):
Well, we share that belief, HOWI and for fourteen years
life happens? Are You Prepared? Has been brought to the
people here in the Capitol region and as national online
You can listen to WGY dot com if you're so inclined.
But education is a key. And Bob, at the beginning
fourteen years ago, we had the three amigos, you were
one of the three. I was one of the three.
Brian Johnson was the third to bring this together, not
(30:31):
just talking about law, but bringing the long term care
insurance discussion together with it, and I have always felt
that this was peanut butter and jelly. You need the
legal side, you need the financial side, and in the beginning,
the Partnership for Long Term Care did this in a
beautiful policy, big beautiful policy go ahead. That was a
good impression. I like that, Yeah, absolutely, Lou.
Speaker 4 (30:53):
I can't count the number of times we've had similar
conversation on this and how he brings up so many
vital points, not the least of which is we're hurting
cats here. I mean, there's so much going on in
terms of not only the legal planning you need to do,
but you know, at the end of the day, you
got to pay for it. How are we going to
pay for it? Am I going to access the Medicaid system?
Am I going to use private financing? Am I gonna
(31:13):
you know, in terms of an insurance product? Am I
going to pay out a pocket? Am I gonna count
on the New York Long Term Care Trust Act or
the Wish Act or the Class Act or whatever it
might be. And the answer could very well be, in
a sense, all of the above. The partnership was a
step in the right direction, for sure, but it was
a little bit restrictive in the sense that as things evolved,
long term care insurance got more expensive. I applaud Senator
(31:36):
Mayer's efforts. She is as she's talked candidly about reacting
to phone calls that she's gotten from constituents that have
expressed concern over the fact that, hey, my premiums are
going up on my long term care insurance? What do
I do now? And she's hearing that and responding to that,
and she's got the State of Washington kind of piggyback on.
(31:56):
The partnership was a different animal in the sense that
it allowed the front end for the individual to do
what how he was describing, which is, Okay, I'm going
to take care of the front end. I'm going to
fulfill my personal responsibility or dare I say pledge, And
then on the back end, I'm going to be able
to access that Medicaid system and have potentially all of
my assets disregarded through the Medicaid extended coverage. And so
(32:19):
we've got that, if you will, perfect partnership between the
private and public sector to do that. Things have evolved, obviously,
as I mentioned, premiums have gone up on long term
care insurance.
Speaker 1 (32:30):
Without question.
Speaker 4 (32:31):
It's a longer discussion than today. But more concerning than
that is the fact that there's no carriers currently offering
coverage within that partnership program. It goes beyond here, and
it's too bad because it is such a wonderful program,
but for a number of reasons that go beyond the
scope of our discussion today. Hopefully we can get to
them a little more on Thursday. Insurance carriers have looked
(32:53):
at New York. They still offer partnership products. In most
other states. It's a dollar for but the carriers can
put a product out there that meets all the other
state requirements. But then you have unique states like New York,
in Indiana and California. Connecticut is a little easier where
they've said, well, we love what you're doing with the
partnerships in the other state, but this is what we
(33:14):
want in New York. And so unfortunately, increasing the carriers
have said, it doesn't make sense for us to do
this for all other states, but then we have to
do this special thing for New York.
Speaker 1 (33:24):
No thanks for out. Well, when you have one hundred
percent attrition of the insurance companies that have offered that
product should tell you something. But the state hasn't really
kept pace with this.
Speaker 4 (33:33):
It's the other part of it, lou Is in that
regard apologies for the interruption, is the other cat herding
that we have to recognize here, and it's important, i
think for Senator Mayor as well, is the product that
she has put out there, with the modifications that have
been made, the two hundred dollars a day for two years,
that can potentially qualify as a long term care insurance
(33:54):
product in the state of New York. The former version
of that was more closely aligned with the state of Washington,
which was one hundred dollars a day for three hundred
and sixty five days, so that thirty six than five
hundred versus the seventy three thousand that would not even
have qualified as a long term care insurance product in
New York. So I'm glad to see they've made that modification.
The jury style. We're going to have to see what
(34:15):
the numbers are for payroll deductions, and we're we're kind
of in the weeds now in insurance, and that's okay.
And on Thursday we have a full day and if
you would like to join us, you can do it
virtually from the comfort of your own home, and you
can sign up for the Elder Law Forum. It's eight
thirty to four and it's a full day of discussion
topics and you can pick and choose if you're doing
(34:36):
it virtually, the sessions that you want to sit in on,
and you can sign up right now on the pyro
Law that's p I E R R Law dot com website.
Check out the agenda. It's an amazing array of speakers
on all facets of healthcare long term care in New
York State. And go to the events tab and sign
(34:56):
up for virtual if you want to come join us
at the Desmond. I think there are still a few seats,
although we're approaching our max capacity at the Desmond for
Thursday for live in person, but you can still register
at pyrolaw dot com. And we're gonna take this panel,
Bob and you me. We also have an expert coming
from Nationwide Life Insurance and tell our listeners why Life
(35:20):
Insurance is on a long term care panel. Well, I
can't tell you how pleased I am to have Shawn
back with us. Seawan britt Is. She's the director, one
of the directors of the Advanced Planning Area at Nationwide
Financial out in Columbus, Ohio, and she's back with us
for a repeat visit this year, and I'm so happy
that she is. Nationwide has taken the tack that they
want to develop a product that pays for long term
(35:42):
care services and supports via a life insurance product that
has a long term care rider.
Speaker 1 (35:48):
And this is where the market is. Yep. And we
talk about this all the time because when I did
this thirty years ago, folks, I was being told long insurance,
long term care insurance is the answer by Senator Hannan
and a bunch of other people in New York State legislature.
Long term care insurance is the answer. I said, Okay,
you know, but you have to have a backup. You
have to have a coordination of what Medicaid is doing
(36:09):
with long term care insurance. And that was the partnership
which just disintegrated because of a lot of restrictions that
you're talking about. And for thirty years, long term care
insurance has devolved. And now how many carriers do we
have available in New York State?
Speaker 4 (36:24):
Well, in our space, in the brokerage space, there's one.
It's Mutual of Omaha, which is a wonderful carrier. They're
a mutual company owned by their policyholders. They're very good
to work with from a brokerage standpoint, they're very consumer friendly.
But it's one carrier. There are a couple of other
companies on what we call the career agency sides, Northwestern Mutual,
New York Life both have product in the state of
(36:46):
New York. That's it on the traditional side. Now there's
still I think it's worth making the point traditional long
term care insurance is still a wonderful product. And despite
the rate increases that have happened, and there are valid
reasons that we don't have time for today, why that's happen.
It's never easy to have that conversation. I don't like
paying the increased premium that Karen and I have had
to pay, but there are valid reasons for it, and
(37:07):
it's still a value, and there's a difference between cost
and value that gets lost sometimes. So I encourage people
to look at the potential value of that long term
care insurance product versus purely the cost. Where SEAN and
Nationwide come in is they've handled one of those potential
concerns that people have, which is, are my premiums guaranteed
with the products that Nationwide and others provide. The answer
(37:29):
is yes, you can guarantee those premiums as well as
to have a tremendous amount of flexibility at claim time.
Speaker 1 (37:35):
Yeah, and Nationwide products I like. I'm a fan me
too of Nationwide because they have several features that are
really solid. One of them is their benefits are indemnity
benefits and that pob to me, has been the holy
grail from day one, and Gale felt the same way. Jallallabinka,
who designed product and had a policy called Simplicity with
met America, one of the long term care companies that
(37:56):
no longer exist their sales product, but having indemnity benefits
just explain to our listeners the difference. And I'm seeing
this every day in my practice. And I know you're
saying you're not, but I am the back end of
these policies. I'm getting clients raked over the cols. We
need more medical evidence, we need more of this, We
need more of that. When they start to file claims
and they have to get reimbursed, it's been difficult.
Speaker 4 (38:18):
Sure, indemnity solves it. Yeah, indemnity solves that. Basically the
qualification trigger, if you will, is very similar between those products.
I either have to be unable to perform two out
of six of those things we call ADLs or activities
of daily living bathing, eating, dressing, toileting, transferring, or continents.
Or I have to have a cognitive impairment that's significant
(38:39):
enough that I need help. And so if one of
two of one of those two triggers is met, then
I presumably am eligible for a benefit under the policy.
Where it gets murkier is with a reimbursement policy. The
theory there is that I'm paying for a service and
I'm getting reimbursed from my policy. Within the policy, there's
language that dictates what that service is, and a lot
(39:02):
of times, especially with older policies, I have to be
receiving care from, for example, a certified home health care
agency as opposed to my next door neighbor or a
sibling or whatever.
Speaker 1 (39:13):
I will interject that I'm a lawyer. My confession. Really,
I'm a lawyer and I read contracts, and long term
care insurance policies are contracts. Life insurance has a pretty
easy trigger, you're dead or you're not. Long term care
insurance does not. It has a very complex set of
provisions in every contract that no one has ever read
(39:36):
until they apply for care. But those are the important
provisions that define how you get your benefits and when
you can get your benefits, and those are forgive me.
Those are never sold as part of the sale for
a long term care product. Yeah, there's no question. You're right.
Speaker 4 (39:52):
It's a contract. In order for the carriers to be
able to price it and submit it for filings in
all the states, they have to have a contract that
meets whatever requirements of the various states require.
Speaker 1 (40:03):
So I get it.
Speaker 4 (40:04):
And that can become problematic, especially as we talk about
fairly regularly, and I know that we're going to talk
about on Thursday as part of the Elder Law Forum.
Is especially as you get outside of a more urban
or suburban area, you get out in the rural areas.
What if I don't have a certified home health care
agency to come out and take care of Boville, New York.
Speaker 1 (40:23):
Yeah, a client this is a few years ago, had
a partnership policy. And with the partnership you use long
term care insurance. You get three They had three years
of nursing home care or six years of home health
care and you have to use your insurance benefit to
trigger the Medicaid benefit. They couldn't find a provider under
their contract that could staff a home care case, so
(40:45):
they could never utilize the insurance that would have led
them to Medicaid. So you got a double loss. There.
Can't use your insurance and you can't get Medicaid under
the partnership. So we're going to come back after a
short break and delve a little more deeply into this
and we'll give you a little more information on the
Elder Law Forum. I want to thank Senator Mayor who
had to go and she had another event, and Howard
(41:07):
Crooks who's going to come up from Florida. They will
all be at the Desmond on Thursday, along with Sean
Britt from Nationwide Insurance. This panel smart Strategies to ensure
long term care. Don't miss it because this is your future.
If you live long enough, the odds are and we'll
give the statistic out if you live to be sixty five,
what's the chance that someday you'll need long term care?
Speaker 4 (41:29):
Well, like, statistics are funny things, lou right, I mean
the prevailing statistic that we've loved for the last thirty
years is seventy percent. There's a seventy percent chance that
I'm going to need some level of long term care
services after I turn age sixty five. The more realistic
number as time has evolved is probably fifty percent. That's
hall of the outum.
Speaker 1 (41:48):
There are going to need this conversation, and the trick
is we don't know which half. We'll be back after
a short break. You're listening to Life Happens Radio on
Talker Radio WGY with Senator Shelley Mayer. Yes, we have
a budget, folks, it's been signed, it's in the can.
We're going to talk about it in depth on Thursday.
We have state legislators, including our own John McDonald and
(42:11):
three other legislators who are going to talk about state
and federal budgets. We have directors of the State Office
for Aging, the Office for People with Developmental Disabilities, leaders
of healthcare groups, the Eddie, Saint Peter's, and others here
up in the North Country Hudson Headwaters talking about how
to provide care, how to pay for care, how to
(42:31):
ensure care. And this panel that we're talking about today,
and we've had three of the panelists on with us
on life happens here. I'm sitting now with mister Robert Vandy,
the president of Advisors Insurance Brokers, one of the leading
experts on long term care insurance, and Bob. We were
talking about the evolution of the market, the move toward
life insurance, the products that are available out there, and
(42:53):
the details in a contract which most people have never read.
I mean a life insurance contract. If you have investment components,
it's a little more complicated. But a term insurance policy
is a term insurance policy. That's pretty simple, isn't it.
Speaker 4 (43:05):
It is, And the raw reality is, no matter what
kind of insurance is, whether it's car insurance or home insurance,
or life insurance or long term care insurance, a vast
majority of people, they get that policy delivered to them
when they purchase it. And that policy goes into the
drawer and draws dust for the next twenty or thirty
or forty years or more.
Speaker 1 (43:21):
Yep.
Speaker 4 (43:21):
And it's just the raw reality of it. Not the
best way to go about your planning, but it is
the way it is, and I get that. I want
to make sure I put a fine point on a
question you asked before the break, which is, hey, how
about this indemnity thing.
Speaker 1 (43:31):
Why is that a better deal? So to speak.
Speaker 4 (43:34):
I understand the implications and some of the challenges with reimbursement.
It does what it's intended to do most of the time.
You've highlighted what occasionally does come up. It sounds like
you're experiencing more than what we might be seeing. I
see that anecdotally, but it sounds like you may be
experiencing that a little more. Indemnity potentially solves the issue
you've described, Lou in a very important way, and that is,
(43:56):
once I've hit those triggers that two of six activities
I can't perform with that cognitive impairment, it gives me
cash I can then use. Yeah, I can then use
that cash for whatever I want. So if I have
that issue of not being able to find a home
healthcare agency near me in Boonville or otherwise, I can
use that cash and I can do whatever I want
with it. So if I do have that family member,
(44:17):
if I do have that sibling or child or neighbor
that I would like to pay to help take care
of me at home because I can't find an agency,
it gives me the flexibility to do that.
Speaker 1 (44:27):
And just to give an example which I use with
my clients all the time. Okay, you buy a five
hundred thousand dollars life insurance policy and you don't have
to have a big cash accumulation inside the contract. So
typically won't a lot of people think, oh, I buy
whole life and I have to invest and I can
then borrow against it. None. No, that's not what this is.
This is a benefit that you get the five hundred
thousand dollars death benefit made available to you prior to
(44:51):
death when you need long term care. Those same triggers
that you mentioned to qualify you to collect a benefit,
and that's a tax free bene up to a certain
dollar level. So a lot of contracts that I've seen
are two percent. They're different contract different provisions. But if
you get two percent of the death benefit on a
monthly basis to pay for long term care and it
(45:14):
comes out as cash tax free every month, you're getting
a ten thousand dollars check in your mailbox. What could
you do on a monthly basis with ten thousand dollars?
A lot? A lot and Gail's marketing for her Simplicity product,
I had it sitting on my desk for about a year.
I didn't buy it and the policy went away. One
(45:35):
of the big regrets, but the mailbox with the flag up,
here's your check. Yeah you got ten grand. What a
difference that is then paying that ten grand and then
itemizing every hour, every minute of care that's been provided
to you and submitting that claim on a monthly basis.
To me, this is like, holy cow, why would I
ever do that as opposed to getting a check?
Speaker 4 (45:57):
Well, I think the reason historically has been called because
when you're an actually pricing this stuff, you know those
guys that sit in the padded cells that the home
office is pricing this stuff, it's it's less expensive to
price reimbursement than it is cash. Without getting into detail,
the thing I love and you had the hat maybe
you still do cash is king. And then also our
(46:18):
good buddy Phil Gallant, who we both know well. Phil
had a saying that sticks to me with this day,
which is, so let me make sure I understand this.
If I get sick, I get a check. So get sick,
get check is the way that he used to describe it,
which was brilliant, because yeah, so we love those products.
That doesn't mean I don't like reimbursement products and we
differ a little bit on that, but each has its
own place. Sean's going to share with us a lot
(46:40):
more about nationwide particular offense and in the industry.
Speaker 1 (46:43):
That's their philosophy. Yeah, for sure to provide that indemnity benefit.
But we have about three minutes left. I do want
to kind of bring us back. If you want to
join us for the Elder Law Forum, you can do
that by by signing up right now at pyrolaw dot com.
Go to the events tab and you can sign up
push that button. This Monday at twelve noon. My partners
(47:04):
Aaron Connor, Frank Hemming and myself will all be part
of the forum on Thursday. Are going to highlight the
different segments and sections of the Elder Law Forum and
give a little precursor to what the day is going
to be like. So if you want to get the
thirty minute version of the Elder Law Forum, join us
Monday for the webinarm Medicaid Mondays, which is a regular
feature of pere O'Connor and Strauss. Join us for Medicaid
(47:25):
Monday this coming Monday, and again go to purolaw dot
com or you can call our office anytime at five
pine eight four five nine twenty one hundred and bob
public financing, private financing, making sense of this? And I've
always said that, why don't we rationalize the payment for
long term care? Just give your two cents from the
(47:47):
insurance side, and I'll give it from the legal side
if we have time.
Speaker 4 (47:49):
Well, I I am idealistic a little bit, I think,
I confess, Lou. We've talked about a lot today without
getting into tremendous detail in any particular spot. Personally, I'm
a fan of the model, for example, that Congressman Swazi
has put out there with the Wish Act. It's simpler
not only for US residents to be able to either
(48:09):
carve out enough of their assets or income or buy
an insurance policy that covers that front end that they
would be required to contribute for, then the Wish Act
to step in on the back end. That's a different
model than what Senator Mayor has put out there, which is, hey,
we'll handle the front end the first seventy three thousand
dollars as it looks like it stands now, but then
(48:30):
you're on the hook for anything above and beyond that.
So selfishly. From an insurance standpoint, it's easier for actuaries
to price for the front end than it is the
back end. So that would be my preference from a
public financing standpoint, to then fold in the private financing
at the end of the day. A million times we've
talked about this. There is no one perfect solution. We
(48:51):
need to find a way where we can put the
private and public sectors together to figure out a way
around the financing part.
Speaker 1 (48:57):
Yeah, And interestingly, the Compact for Long Term Care was
a product of the New York State Bar Elderlaw Section,
which Howard Crooks and I were at the time chairs
of in successive years, and we brought in two legislative aids,
Bob Hers and Greg Olsen. We invited them to our
annual meeting. We did a full study on long term care,
and that's a published study that the Bar Association did,
(49:19):
and we went back to our offices, thought nothing of it,
and within two months we had a piece of legislation
that Bob Hurs wrote called the Compact for Long Term Care,
and there it started. And so we'd worked for two
years on that legislation with phone calls every two weeks,
our two hour phone calls and what Bob said to us,
find every way that anyone could possibly game the system,
(49:39):
and we took out everything that could be done, and
we thought we had a really good bill. It's still
on the books. We're going to talk about it this Thursday.
Bob Vandy, thank you for joining me here. Thanks in
the studio every Saturday morning, we're here on Life Happens Radio.
We hope this is information that's useful to you. We
hope you can join us on Thursday. If not, join
us Monday at noon for the Medicaid Monday episode and
(50:02):
we'll be back. Stay well, stay dry, See you next
week