Episode Transcript
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Speaker 1 (00:10):
The other day.
Speaker 2 (00:11):
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 sunshine this afternoons. So a
sun sighting for this afternoon. Get ready for that, and
this morning, get ready for a show that's going to
take you deep into the New York State legislature, into
the long term care world, into long term care insurance.
Speaker 1 (00:33):
What's happening.
Speaker 2 (00:34):
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 going
to talk about what's going on around the country in Washington.
This is a long term care show. You need to
(00:55):
know this, folks, because it will affect you. But it
doesn't today. 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 heard about what those costs look like.
(01:18):
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.
Speaker 1 (01:36):
A lot of people think.
Speaker 2 (01:37):
That and they put their head in the sand and say,
I'm not gonna worry about it because that's not gonna
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 sixty five. I here at
(02:00):
two hundred and fifty thousand dollars a year. So what's
going on around the country and the state to help
defray this? And I'm going to introduce some guests right
now we have with us for today this morning. To
start out, Senator Shelley Mayer.
Speaker 1 (02:15):
Good morning, Senator, Good morning, lou how are you.
Speaker 2 (02:18):
I am doing well. I'm going to introduce mister Bob
Vandy for our listeners.
Speaker 1 (02:22):
You may know Bob.
Speaker 2 (02:23):
He has been a frequent guest and past host of
Life Happens Radio. Good morning Bob, heylu good to be
with him, 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 Bar Elderlaw Section,
the Florida Bar Elderlaw Section, and one of the most
(02:43):
knowledgeable people on elder law and long term care.
Speaker 1 (02:46):
Good morning, Howie.
Speaker 3 (02:48):
Good morning lou So.
Speaker 2 (02:50):
Senator Mayor, Let's start off with you, because the budget
has just been actively negotiated and I think it's pretty well.
Speaker 1 (02:58):
Put to bed. But where does it stand today.
Speaker 4 (03:02):
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.
Speaker 3 (03:17):
Some good things and some that of good things.
Speaker 4 (03:19):
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 (03:28):
So from your perspective, what are some of the highlights
and maybe a low light.
Speaker 4 (03:33):
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,
(03:57):
a formula by which schools get paid. 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 there
(04:19):
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 this budget to meet.
Speaker 3 (04:40):
That's very unfortunate, okay.
Speaker 2 (04:42):
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
(05:02):
a panel talking about another topic CDPAP related, which is
long term care financing. Medicaid is the program, as most
of you know, let's listen to this show that finance
is a good portion of long term care. About seventy
five percent of nursing home beds are paid for by Medicaid,
and there is a growing number of people that want
to take advantage of the Medicaid home care program. And
(05:25):
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 4 (05:45):
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 truly
a crisis.
Speaker 2 (06:04):
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
(06:24):
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 guest today on Life Happens, and a whole host
of other people dissecting this issue and these issues and
looking at solutions and Cenator Mayor, let's get right to it.
You have proposed some legislation to take a burden off
(06:48):
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 4 (07:00):
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,
(07:21):
allowing somebody to get a long 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
(07:41):
would be paid for up to a certain number of hours,
and it would avoid it allowed 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's it is
really not a perfect but a good solution to a
problem that you've identified there.
Speaker 2 (08:03):
And it's a payroll deduction right similar to Medicare deduction.
Off of your payroll.
Speaker 4 (08:10):
And yes, it is a modest payroll deduction for employees,
no burden to employers.
Speaker 1 (08:17):
And that's voluntary or is that mandatory.
Speaker 4 (08:20):
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
(08:42):
people need. And it's only a modest percentage of the
population has that long term care insurance.
Speaker 2 (08:49):
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 to at the federal level part
of the Affordable Care Act, which was called the Class Act, which.
Speaker 1 (09:04):
Was a similar type of program.
Speaker 2 (09:05):
Every program has its own unique details and payroll deduction
and praying it 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 4 (09:25):
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
(09:49):
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 incur 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 2 (10:07):
And what would be the benefit that would be derived
if you do participate in There'd.
Speaker 4 (10:12):
Be a lifetime be 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
(10:35):
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 2 (10:46):
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 Directed 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 program
(11:07):
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 4 (11:20):
Thank you so much. I'm looking forward to it as well.
Speaker 3 (11:23):
Thank you for having.
Speaker 2 (11:23):
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.
Speaker 1 (11:40):
An appropriate intro song back into this topic today, Willia
still need me? Will you you still feed me? When
I'm what?
Speaker 3 (11:48):
Bob?
Speaker 1 (11:48):
Sixty four? Sixty four, Holy Toledo.
Speaker 2 (11:51):
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.
Speaker 1 (12:01):
Now we're dating ourselves nineteen. Yeah, that's a long story.
Speaker 2 (12:05):
But in nineteen sixty five Linda 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
(12:27):
now it's maybe eighty four, 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 3 (12:42):
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
(13:02):
that are offered in Florida are not quite the same
as the services they're used to and become accustomed to
in New York. Yeah, and one example of that.
Speaker 2 (13:11):
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 Florida till eighty five, ninety and
then coming back.
Speaker 3 (13:30):
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 has 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
(13:52):
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 weight list
that can run anywhere from several weeks if you're lucky,
several months more likely, and in some cases upwards of
(14:13):
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 weight 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
(14:34):
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 (14:41):
And that's not going to.
Speaker 2 (14:42):
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?
Speaker 1 (15:02):
And how are you going to pay for them? And
that's that's the crux of the issue.
Speaker 3 (15:06):
And it's a real hardship blue on the 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 2 (15:23):
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,
(15:43):
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 US
subsidy on the back end. Which would be a Medicaid
(16:03):
type subsidy 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
(16:24):
any other solution. So it died in committee in the Assembly.
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 3 (16:40):
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
(17:02):
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 solid 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
(17:24):
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
(17:47):
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
(18:10):
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 (18:28):
I couldn't agree more.
Speaker 2 (18:29):
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 concept into what
(18:51):
we call the defined contribution plan. You put a certain
amount of money at risk, and then you could ensure
that risk, so you could by private insurance to cover
the amount that you put at risk that you have
to private pay. But it involved how is something that
is critical and we talk about this in our law practices,
and you're actually bringing your practice cosin ocandra and national
(19:13):
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 3 (19:32):
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,
(19:55):
you need somebody to help plan that care, and an
assessment is the starting point for that. And there are
things called eldercare 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 this service.
(20:16):
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 stop shop where
(20:37):
they can also get the eldercare coordination component. And I
know you're doing that as well, and you're a practice.
Speaker 2 (20:42):
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 exist exactly what you're saying. They
went out to the hospital, to the nursing home, to
the home, did a comprehensive assessment, interviewed the family, look
(21:05):
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
Home Care Advisors does this care coordination and they do
it at every stage. We just did a seminar called
Your Home or the Nursing Home where we had Diane Mikkel,
(21:27):
Gottabiowski and I talk about how to prepare yourself legally,
financially and from a healthcare perspective.
Speaker 1 (21:32):
What do you need to think about and.
Speaker 2 (21:34):
Howie you're taking this to a different level with a
national law firm, which is kind of unique.
Speaker 3 (21:41):
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
(22:01):
is there a need with the platform that a national
law firm provides for this, my hope would be that
others will add this component to their practices and offer
a service that is so sorely needed by anyone that
is going through the long term care system.
Speaker 2 (22:21):
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 are going to tackle all
this and tear it all part. 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
(22:43):
insurance company will actually pay for that assessment and pay
for a care plan through a care coordination benefit. And Bob,
we'll 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 left for several.
Speaker 3 (23:00):
Years, so I will I will say, Lou, 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 is actually a similar bill called the
WISH Act, which stands for Well Being Insurance for Seniors
(23:23):
to Be at Home APPT 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
Slosey out of New York. It was also another who.
Speaker 2 (23:37):
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 3 (23:44):
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
to talk about this in a meaningful way nationally, uh,
if the WISH Act were to be adopted, then it
(24:06):
would similarly require a mandatory payroll attack that would be
shared between employers and employees.
Speaker 2 (24:15):
With news Thursday, tune in to the Elder Law Forum.
We'll be back right after this short break.
Speaker 3 (24:29):
Oh yeah, tell you something. I think your long dust time.
Speaker 1 (24:39):
Say that something I wanna hold? How are you still
with us?
Speaker 3 (24:50):
I am all right.
Speaker 2 (24:52):
So this is Lupiro, your host, Bob Vandy and studio
Howie Crooks down in Florida, and I just want to
close it out, and we're going to roll over to
long term care because I know you have an appointment
how On Thursday, we have a panel called Smart Strategies
to Ensure Long Term Care. We just heard from Senator
Shelley Mayer on a new innovative insurance program proposed for
(25:12):
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. This is the thirtieth annual Elder Law Forum,
and this was one of the topics. Gail Holabenka was
(25:34):
one of my initial guests that we talked about.
Speaker 1 (25:37):
Thirty years ago.
Speaker 2 (25:37):
So Howie, 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 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 3 (25:58):
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
(26:18):
and realized, wow, people, if 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 people to start
taking money quicker out of those accounts of the government
(26:40):
could get its tax dollars. All the government needs to
do is recognize the problem and the tsunami that were
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
seem or results.
Speaker 1 (27:01):
I don't disagree with that.
Speaker 2 (27:02):
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, will 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 care insurance for many years.
Speaker 1 (27:24):
Yeah, no question, Lewin.
Speaker 5 (27:25):
In fact, New York State is probably the most attractive
tax incentive from a premium payment standpoint of any state
in the country. There there still is a twenty percent
tax credit, which is a dollar for dollar reduction on
tax du and twenty 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
(27:46):
credit 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 (27:55):
A roth Ira limitation which or can't contribute to a rock.
Speaker 5 (27:58):
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.
Speaker 1 (28:08):
But you have to be over two percent of your
adjusted gross income. Yeah.
Speaker 5 (28:11):
And the thing is 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. 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.
(28:32):
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 2 (28:41):
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
we look at when we sit down with clients and
(29:01):
they're in that crisis situation I need to pay the
nursing home or I need to pay for home healthcare,
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
(29:22):
with your clients.
Speaker 1 (29:23):
AWI.
Speaker 3 (29:25):
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 into 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 family can
(29:47):
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 damn breaks loose, and this
is so overwhelming for families that if there was a way,
(30:08):
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, for my
(30:28):
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 2 (30:45):
Well, we share that belief, Ali, 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.
Speaker 1 (31:03):
You were one of the three. I was one of
the three.
Speaker 2 (31:04):
Brian Johnson was the third to bring this together, not
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.
Speaker 1 (31:23):
Policy, big beautiful policy go ahead. That was a good impression.
I like that, Yeah, absolutely, Lou.
Speaker 5 (31:30):
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 going
(31:50):
to you know, in terms of an insurance product, Am
I going to pay out a pocket? Am I going
to 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
(32:12):
applaud Senator Mayer's efforts 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 and kind of
(32:33):
piggyback on. 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
(32:56):
so we've got that, if you will, perfect partnership between
the prime in public sector to do that. Things have evolved, obviously,
as I mentioned, premiums have gone up on long term
care insurance. Without question, 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
(33:17):
goes beyond euro 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 at New York. They still offer
partnership products in most other states. It's a dollar for dollar,
(33:37):
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 and 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 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,
(33:59):
but then we have to do that special thing for
New York. No thanks, we're out.
Speaker 1 (34:02):
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 5 (34:10):
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
(34:31):
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 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 gonna have to see what the numbers
(34:52):
are for payroll deductions.
Speaker 2 (34:53):
Oh and we're we're kind of in the weeds now,
I know, in insurance, and that's okay. And on Thursday
we have a full day and if you'd 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 it virtually, the sessions
(35:15):
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 O 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 up for
virtual if you want to come join us at the Desmond.
(35:37):
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 Insurance is
(35:58):
on a long term care panel.
Speaker 5 (36:00):
I can't tell you how pleased I am to have
Shawn back with us. Shawn 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 care services and supports via a life insurance product
(36:23):
that has a long term care rider.
Speaker 1 (36:25):
And this is where the market is. Yep.
Speaker 2 (36:27):
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.
Speaker 1 (36:38):
Long term care.
Speaker 2 (36:39):
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 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
(37:00):
New York State?
Speaker 5 (37:01):
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
(37:23):
New York. That's it on the traditional side. Now, 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 happened. 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 it's still
(37:44):
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 is yes,
(38:07):
you can guarantee those premiums as well as to have
a tremendous amount of flexibility.
Speaker 1 (38:11):
At claim time.
Speaker 2 (38:12):
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. Jallhallabinka,
who designed product and had a policy called Simplicity with
Meta America, one of the long term care companies that
(38:33):
no longer exists or 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 coals. 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 1 (38:55):
Sure indemnity solves that.
Speaker 5 (38:56):
Yeah, Indemnity solves that they're basically the qualify cation 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 enough
(39:17):
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 of times,
(39:39):
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 (39:50):
I will interject that I'm a lawyer. My confession.
Speaker 2 (39:55):
Really, I'm a lawyer and I read contracts in long
term care, and SURE policies are contracts. Life insurance has
a pretty easy trigger. Yeah, 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 until they apply for care. But those
(40:15):
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.
Speaker 1 (40:27):
Yeah, there's no question. You're right.
Speaker 5 (40:29):
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 the various states require. So I get it.
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.
(40:49):
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.
Speaker 1 (40:58):
Boom, Bill York.
Speaker 2 (41:00):
Yeah, the 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
(41:22):
they could never utilize the insurance that would have led
them to Medicaid.
Speaker 1 (41:26):
So you got a double loss.
Speaker 2 (41:27):
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 Mayer
who had to go and she had another event, and
Howard Crooks who's going to come up from Florida. They
will all be at the Desmond on Thursday, along with
(41:49):
Sean Britt from Nationwide Insurance. This panel smart Strategies to
ensure long term care.
Speaker 1 (41:55):
Don't miss it because this is your future.
Speaker 2 (41:59):
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 5 (42:06):
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.
Speaker 2 (42:24):
That's half of the number 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.
Speaker 1 (42:38):
Okay, gatherin here. They are big. We have to listen.
Speaker 2 (42:50):
Welcome back to the last segment of Life Captains who
we've been with us with The whole show started off
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 three other legislators who
are going to talk about state and federal budgets. We
(43:11):
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 ensure care, and this
panel that we're talking about today, and we've had three
(43:31):
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 the details in
a contract which most people have never read. I mean
(43:53):
a life insurance contract. If you have investment components, it's
a little more complicated. But a term insurance policy is
a term sure policy. That's pretty simple. It it is.
Speaker 5 (44:02):
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 (44:17):
Yep.
Speaker 5 (44:18):
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 (44:27):
Why is that a better deal? So to speak.
Speaker 5 (44:30):
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,
(44:52):
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,
(45:13):
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.
Speaker 1 (45:22):
It gives me the flexibility to do that.
Speaker 2 (45:24):
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.
Speaker 1 (45:38):
None. No, that's not what this is.
Speaker 2 (45:40):
This is a benefit that you get the five hundred
thousand dollars death benefit made available to you prior to
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 benefit up to a certain
dollar level. So a lot of contract that i've seen
here two percent. They're different contract, different provisions. But if
(46:05):
you get two percent of the death benefit on a
monthly basis to pay for long term care and it
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.
(46:25):
I had it sitting on my desk for about a year.
I didn't buy it and the policy went away. One
of the big regrets, but the mailbox with the flag up,
here's your check.
Speaker 1 (46:36):
Yeah you got ten grand.
Speaker 2 (46:38):
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 5 (46:53):
Well, I think the reason historically has been cost because
when you're an actually pricing this stuff, you know those
guys that sitting 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 good
(47:14):
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 simple, 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
(47:36):
more about nationwide particular offense and in the industry.
Speaker 2 (47:39):
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 signing up right now at pyrolaw dot com.
Speaker 1 (47:54):
Go to the events tab and you can sign up.
Push that button.
Speaker 2 (47:57):
This Monday at twelve noon, my partners Aaron Connor, Frank Heming,
and myself we'll 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,
(48:17):
which is a regular feature of Pure O'Connor and Strauss
join us for Medicaid 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
(48:38):
rationalize the payment for long term care? Just give your
two cents from the insurance side, and I'll give it
from the legal side if we have time.
Speaker 5 (48:45):
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
(49:06):
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
(49:26):
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
(49:47):
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 2 (49:53):
Yeah, and interestingly, the Compact for Long Term Care was
a product of the New York State Bar Elderlaw Section.
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,
(50:15):
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,
(50:35):
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
(50:58):
we'll be back.
Speaker 1 (50:59):
Stay well, stay dry, See you next week
The other day.
Speaker 2 (00:11):
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 sunshine this afternoons. So a
sun sighting for this afternoon. Get ready for that, and
this morning, get ready for a show that's going to
take you deep into the New York State legislature, into
the long term care world, into long term care insurance.
Speaker 1 (00:33):
What's happening.
Speaker 2 (00:34):
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 going
to talk about what's going on around the country in Washington.
This is a long term care show. You need to
(00:55):
know this, folks, because it will affect you. But it
doesn't today. 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 heard about what those costs look like.
(01:18):
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.
Speaker 1 (01:36):
A lot of people think.
Speaker 2 (01:37):
That and they put their head in the sand and say,
I'm not gonna worry about it because that's not gonna
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 sixty five. I here at
(02:00):
two hundred and fifty thousand dollars a year. So what's
going on around the country and the state to help
defray this? And I'm going to introduce some guests right
now we have with us for today this morning. To
start out, Senator Shelley Mayer.
Speaker 1 (02:15):
Good morning, Senator, Good morning, lou how are you.
Speaker 2 (02:18):
I am doing well. I'm going to introduce mister Bob
Vandy for our listeners.
Speaker 1 (02:22):
You may know Bob.
Speaker 2 (02:23):
He has been a frequent guest and past host of
Life Happens Radio. Good morning Bob, heylu good to be
with him, 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 Bar Elderlaw Section,
the Florida Bar Elderlaw Section, and one of the most
(02:43):
knowledgeable people on elder law and long term care.
Speaker 1 (02:46):
Good morning, Howie.
Speaker 3 (02:48):
Good morning lou So.
Speaker 2 (02:50):
Senator Mayor, Let's start off with you, because the budget
has just been actively negotiated and I think it's pretty well.
Speaker 1 (02:58):
Put to bed. But where does it stand today.
Speaker 4 (03:02):
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.
Speaker 3 (03:17):
Some good things and some that of good things.
Speaker 4 (03:19):
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 (03:28):
So from your perspective, what are some of the highlights
and maybe a low light.
Speaker 4 (03:33):
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,
(03:57):
a formula by which schools get paid. 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 there
(04:19):
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 this budget to meet.
Speaker 3 (04:40):
That's very unfortunate, okay.
Speaker 2 (04:42):
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
(05:02):
a panel talking about another topic CDPAP related, which is
long term care financing. Medicaid is the program, as most
of you know, let's listen to this show that finance
is a good portion of long term care. About seventy
five percent of nursing home beds are paid for by Medicaid,
and there is a growing number of people that want
to take advantage of the Medicaid home care program. And
(05:25):
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 4 (05:45):
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 truly
a crisis.
Speaker 2 (06:04):
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
(06:24):
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 guest today on Life Happens, and a whole host
of other people dissecting this issue and these issues and
looking at solutions and Cenator Mayor, let's get right to it.
You have proposed some legislation to take a burden off
(06:48):
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 4 (07:00):
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,
(07:21):
allowing somebody to get a long 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
(07:41):
would be paid for up to a certain number of hours,
and it would avoid it allowed 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's it is
really not a perfect but a good solution to a
problem that you've identified there.
Speaker 2 (08:03):
And it's a payroll deduction right similar to Medicare deduction.
Off of your payroll.
Speaker 4 (08:10):
And yes, it is a modest payroll deduction for employees,
no burden to employers.
Speaker 1 (08:17):
And that's voluntary or is that mandatory.
Speaker 4 (08:20):
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
(08:42):
people need. And it's only a modest percentage of the
population has that long term care insurance.
Speaker 2 (08:49):
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 to at the federal level part
of the Affordable Care Act, which was called the Class Act, which.
Speaker 1 (09:04):
Was a similar type of program.
Speaker 2 (09:05):
Every program has its own unique details and payroll deduction
and praying it 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 4 (09:25):
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
(09:49):
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 incur 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 2 (10:07):
And what would be the benefit that would be derived
if you do participate in There'd.
Speaker 4 (10:12):
Be a lifetime be 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
(10:35):
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 2 (10:46):
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 Directed 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 program
(11:07):
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 4 (11:20):
Thank you so much. I'm looking forward to it as well.
Speaker 3 (11:23):
Thank you for having.
Speaker 2 (11:23):
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.
Speaker 1 (11:40):
An appropriate intro song back into this topic today, Willia
still need me? Will you you still feed me? When
I'm what?
Speaker 3 (11:48):
Bob?
Speaker 1 (11:48):
Sixty four? Sixty four, Holy Toledo.
Speaker 2 (11:51):
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.
Speaker 1 (12:01):
Now we're dating ourselves nineteen. Yeah, that's a long story.
Speaker 2 (12:05):
But in nineteen sixty five Linda 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
(12:27):
now it's maybe eighty four, 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 3 (12:42):
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
(13:02):
that are offered in Florida are not quite the same
as the services they're used to and become accustomed to
in New York. Yeah, and one example of that.
Speaker 2 (13:11):
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 Florida till eighty five, ninety and
then coming back.
Speaker 3 (13:30):
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 has 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
(13:52):
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 weight list
that can run anywhere from several weeks if you're lucky,
several months more likely, and in some cases upwards of
(14:13):
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 weight 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
(14:34):
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 (14:41):
And that's not going to.
Speaker 2 (14:42):
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?
Speaker 1 (15:02):
And how are you going to pay for them? And
that's that's the crux of the issue.
Speaker 3 (15:06):
And it's a real hardship blue on the 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 2 (15:23):
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,
(15:43):
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 US
subsidy on the back end. Which would be a Medicaid
(16:03):
type subsidy 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
(16:24):
any other solution. So it died in committee in the Assembly.
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 3 (16:40):
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
(17:02):
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 solid 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
(17:24):
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
(17:47):
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
(18:10):
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 (18:28):
I couldn't agree more.
Speaker 2 (18:29):
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 concept into what
(18:51):
we call the defined contribution plan. You put a certain
amount of money at risk, and then you could ensure
that risk, so you could by private insurance to cover
the amount that you put at risk that you have
to private pay. But it involved how is something that
is critical and we talk about this in our law practices,
and you're actually bringing your practice cosin ocandra and national
(19:13):
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 3 (19:32):
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,
(19:55):
you need somebody to help plan that care, and an
assessment is the starting point for that. And there are
things called eldercare 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 this service.
(20:16):
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 stop shop where
(20:37):
they can also get the eldercare coordination component. And I
know you're doing that as well, and you're a practice.
Speaker 2 (20:42):
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 exist exactly what you're saying. They
went out to the hospital, to the nursing home, to
the home, did a comprehensive assessment, interviewed the family, look
(21:05):
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
Home Care Advisors does this care coordination and they do
it at every stage. We just did a seminar called
Your Home or the Nursing Home where we had Diane Mikkel,
(21:27):
Gottabiowski and I talk about how to prepare yourself legally,
financially and from a healthcare perspective.
Speaker 1 (21:32):
What do you need to think about and.
Speaker 2 (21:34):
Howie you're taking this to a different level with a
national law firm, which is kind of unique.
Speaker 3 (21:41):
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
(22:01):
is there a need with the platform that a national
law firm provides for this, my hope would be that
others will add this component to their practices and offer
a service that is so sorely needed by anyone that
is going through the long term care system.
Speaker 2 (22:21):
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 are going to tackle all
this and tear it all part. 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
(22:43):
insurance company will actually pay for that assessment and pay
for a care plan through a care coordination benefit. And Bob,
we'll 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 left for several.
Speaker 3 (23:00):
Years, so I will I will say, Lou, 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 is actually a similar bill called the
WISH Act, which stands for Well Being Insurance for Seniors
(23:23):
to Be at Home APPT 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
Slosey out of New York. It was also another who.
Speaker 2 (23:37):
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 3 (23:44):
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
to talk about this in a meaningful way nationally, uh,
if the WISH Act were to be adopted, then it
(24:06):
would similarly require a mandatory payroll attack that would be
shared between employers and employees.
Speaker 2 (24:15):
With news Thursday, tune in to the Elder Law Forum.
We'll be back right after this short break.
Speaker 3 (24:29):
Oh yeah, tell you something. I think your long dust time.
Speaker 1 (24:39):
Say that something I wanna hold? How are you still
with us?
Speaker 3 (24:50):
I am all right.
Speaker 2 (24:52):
So this is Lupiro, your host, Bob Vandy and studio
Howie Crooks down in Florida, and I just want to
close it out, and we're going to roll over to
long term care because I know you have an appointment
how On Thursday, we have a panel called Smart Strategies
to Ensure Long Term Care. We just heard from Senator
Shelley Mayer on a new innovative insurance program proposed for
(25:12):
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. This is the thirtieth annual Elder Law Forum,
and this was one of the topics. Gail Holabenka was
(25:34):
one of my initial guests that we talked about.
Speaker 1 (25:37):
Thirty years ago.
Speaker 2 (25:37):
So Howie, 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 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 3 (25:58):
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
(26:18):
and realized, wow, people, if 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 people to start
taking money quicker out of those accounts of the government
(26:40):
could get its tax dollars. All the government needs to
do is recognize the problem and the tsunami that were
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
seem or results.
Speaker 1 (27:01):
I don't disagree with that.
Speaker 2 (27:02):
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, will 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 care insurance for many years.
Speaker 1 (27:24):
Yeah, no question, Lewin.
Speaker 5 (27:25):
In fact, New York State is probably the most attractive
tax incentive from a premium payment standpoint of any state
in the country. There there still is a twenty percent
tax credit, which is a dollar for dollar reduction on
tax du and twenty 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
(27:46):
credit 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 (27:55):
A roth Ira limitation which or can't contribute to a rock.
Speaker 5 (27:58):
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.
Speaker 1 (28:08):
But you have to be over two percent of your
adjusted gross income. Yeah.
Speaker 5 (28:11):
And the thing is 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. 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.
(28:32):
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 2 (28:41):
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
we look at when we sit down with clients and
(29:01):
they're in that crisis situation I need to pay the
nursing home or I need to pay for home healthcare,
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
(29:22):
with your clients.
Speaker 1 (29:23):
AWI.
Speaker 3 (29:25):
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 into 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 family can
(29:47):
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 damn breaks loose, and this
is so overwhelming for families that if there was a way,
(30:08):
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, for my
(30:28):
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 2 (30:45):
Well, we share that belief, Ali, 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.
Speaker 1 (31:03):
You were one of the three. I was one of
the three.
Speaker 2 (31:04):
Brian Johnson was the third to bring this together, not
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.
Speaker 1 (31:23):
Policy, big beautiful policy go ahead. That was a good impression.
I like that, Yeah, absolutely, Lou.
Speaker 5 (31:30):
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 going
(31:50):
to you know, in terms of an insurance product, Am
I going to pay out a pocket? Am I going
to 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
(32:12):
applaud Senator Mayer's efforts 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 and kind of
(32:33):
piggyback on. 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
(32:56):
so we've got that, if you will, perfect partnership between
the prime in public sector to do that. Things have evolved, obviously,
as I mentioned, premiums have gone up on long term
care insurance. Without question, 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
(33:17):
goes beyond euro 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 at New York. They still offer
partnership products in most other states. It's a dollar for dollar,
(33:37):
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 and 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 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,
(33:59):
but then we have to do that special thing for
New York. No thanks, we're out.
Speaker 1 (34:02):
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 5 (34:10):
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
(34:31):
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 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 gonna have to see what the numbers
(34:52):
are for payroll deductions.
Speaker 2 (34:53):
Oh and we're we're kind of in the weeds now,
I know, in insurance, and that's okay. And on Thursday
we have a full day and if you'd 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 it virtually, the sessions
(35:15):
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 O 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 up for
virtual if you want to come join us at the Desmond.
(35:37):
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 Insurance is
(35:58):
on a long term care panel.
Speaker 5 (36:00):
I can't tell you how pleased I am to have
Shawn back with us. Shawn 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 care services and supports via a life insurance product
(36:23):
that has a long term care rider.
Speaker 1 (36:25):
And this is where the market is. Yep.
Speaker 2 (36:27):
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.
Speaker 1 (36:38):
Long term care.
Speaker 2 (36:39):
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 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
(37:00):
New York State?
Speaker 5 (37:01):
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
(37:23):
New York. That's it on the traditional side. Now, 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 happened. 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 it's still
(37:44):
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 is yes,
(38:07):
you can guarantee those premiums as well as to have
a tremendous amount of flexibility.
Speaker 1 (38:11):
At claim time.
Speaker 2 (38:12):
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. Jallhallabinka,
who designed product and had a policy called Simplicity with
Meta America, one of the long term care companies that
(38:33):
no longer exists or 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 coals. 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 1 (38:55):
Sure indemnity solves that.
Speaker 5 (38:56):
Yeah, Indemnity solves that they're basically the qualify cation 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 enough
(39:17):
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 of times,
(39:39):
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 (39:50):
I will interject that I'm a lawyer. My confession.
Speaker 2 (39:55):
Really, I'm a lawyer and I read contracts in long
term care, and SURE policies are contracts. Life insurance has
a pretty easy trigger. Yeah, 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 until they apply for care. But those
(40:15):
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.
Speaker 1 (40:27):
Yeah, there's no question. You're right.
Speaker 5 (40:29):
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 the various states require. So I get it.
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.
(40:49):
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.
Speaker 1 (40:58):
Boom, Bill York.
Speaker 2 (41:00):
Yeah, the 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
(41:22):
they could never utilize the insurance that would have led
them to Medicaid.
Speaker 1 (41:26):
So you got a double loss.
Speaker 2 (41:27):
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 Mayer
who had to go and she had another event, and
Howard Crooks who's going to come up from Florida. They
will all be at the Desmond on Thursday, along with
(41:49):
Sean Britt from Nationwide Insurance. This panel smart Strategies to
ensure long term care.
Speaker 1 (41:55):
Don't miss it because this is your future.
Speaker 2 (41:59):
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 5 (42:06):
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.
Speaker 2 (42:24):
That's half of the number 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.
Speaker 1 (42:38):
Okay, gatherin here. They are big. We have to listen.
Speaker 2 (42:50):
Welcome back to the last segment of Life Captains who
we've been with us with The whole show started off
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 three other legislators who
are going to talk about state and federal budgets. We
(43:11):
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 ensure care, and this
panel that we're talking about today, and we've had three
(43:31):
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 the details in
a contract which most people have never read. I mean
(43:53):
a life insurance contract. If you have investment components, it's
a little more complicated. But a term insurance policy is
a term sure policy. That's pretty simple. It it is.
Speaker 5 (44:02):
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 (44:17):
Yep.
Speaker 5 (44:18):
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 (44:27):
Why is that a better deal? So to speak.
Speaker 5 (44:30):
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,
(44:52):
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,
(45:13):
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.
Speaker 1 (45:22):
It gives me the flexibility to do that.
Speaker 2 (45:24):
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.
Speaker 1 (45:38):
None. No, that's not what this is.
Speaker 2 (45:40):
This is a benefit that you get the five hundred
thousand dollars death benefit made available to you prior to
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 benefit up to a certain
dollar level. So a lot of contract that i've seen
here two percent. They're different contract, different provisions. But if
(46:05):
you get two percent of the death benefit on a
monthly basis to pay for long term care and it
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.
(46:25):
I had it sitting on my desk for about a year.
I didn't buy it and the policy went away. One
of the big regrets, but the mailbox with the flag up,
here's your check.
Speaker 1 (46:36):
Yeah you got ten grand.
Speaker 2 (46:38):
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 5 (46:53):
Well, I think the reason historically has been cost because
when you're an actually pricing this stuff, you know those
guys that sitting 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 good
(47:14):
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 simple, 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
(47:36):
more about nationwide particular offense and in the industry.
Speaker 2 (47:39):
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 signing up right now at pyrolaw dot com.
Speaker 1 (47:54):
Go to the events tab and you can sign up.
Push that button.
Speaker 2 (47:57):
This Monday at twelve noon, my partners Aaron Connor, Frank Heming,
and myself we'll 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,
(48:17):
which is a regular feature of Pure O'Connor and Strauss
join us for Medicaid 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
(48:38):
rationalize the payment for long term care? Just give your
two cents from the insurance side, and I'll give it
from the legal side if we have time.
Speaker 5 (48:45):
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
(49:06):
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
(49:26):
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
(49:47):
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 2 (49:53):
Yeah, and interestingly, the Compact for Long Term Care was
a product of the New York State Bar Elderlaw Section.
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,
(50:15):
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,
(50:35):
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
(50:58):
we'll be back.
Speaker 1 (50:59):
Stay well, stay dry, See you next week
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