Errold F. Moody Jr

FINANCIAL PLANNER

EXPERT WITNESS

INSTRUCTOR

AUTHOR           

Long Term Care

I have written and taught about long term care for many years. In fact, until 2005, I was  one of the few California instructors who taught the mandatory 8 hour Long Term Care course of continuing education for insurance agents. LTC unquestionably will be a major issue for the parents of baby boomers who are now in their 70's and who will certainly face many of the obstacles addressed below. Further, baby boomers will need the info as well since, due to the obvious lack of budgetary controls by politicians, individuals will need to pay most of long term care by themselves. (The very poor will be covered by the government, but the limited care for the middle class will effectively be terminated due to cost.) So, read on. Please note that while the individual areas may not directly impact you, they almost assuredly will impact your children, parents and grandparents.

AOL selected this site as an Editor's Pick for Long Term Care Information

The list below includes all articles and specific links in alphabetical order with accompanying description. The listings in the column to the right are separate sections for articles and links  

1997 NURSING HOME DATA LINK: Basic nursing home data are now available from the Centers for Disease Control. The CDC also has significant material on National Hospital Discharge, Characteristics of Elderly Nursing Home Current Residents and Discharges and much more. 

ACCELERATED DEATH BENEFIT There were 39.9 million individual policies or group certificates that included an accelerated death benefit (ADB) as of December 31, 1997, compared with 18.1 million in 1994.

ADMINISTRATION ON AGING LINK: One of the key sites that offers information on most government programs on aging and eldercare including the Area Agencies on Aging. You MUST go to this site.

ADULT ABUSE PROFESSIONALS AND SURVIVORS LINK:

ADULT DAY CARE LINK: Excellent resource for how to select a quality care center by the Adult Day Care Working Group of Montgomery County, Maryland

AGING: What happens when we get older and why getting older doesn't mean you stop living and thinking.

AGING LINK 1: This site is provided by the American Society on Aging and covers a myriad of issues relating to the elderly and many not addressed elsewhere- elders of color, Gay and Lesbian Aging issues (where one can also subscribe to a newsletter), social security privatization, lon1g term care, mental heath and aging, national conferences, and much, much more. Highly recommended.

AGING LINK 2:  International Longevity Center-Many excellent reports

AGING IN AMERICA 2004 LINK:  Merch Institute of Aging and Health (pdf- 48 pages) “In the United States, 20% of all Americans, or about 70 million people, will have passed their 65th birthday by 2030. The average 75-year-old has three chronic conditions and uses five prescription drugs. This report presents information and recommendations on what policy makers, practicing physicians and patients can and must do to ensure not just longer lives but better lives for Americans.

AGING-RELATED POWERPOINT SLIDES AND TABLES LINK:  Federal Interagency Forum on Aging-Related Statistics for the study entitled Older Americans 2004: Key Indicators of Well-Being.

ALCOHOL AND AGING LINK: Alcoholism is a major problem with the elderly. You need to be aware and know what you might do to help.

ALZHEIMERS: Stages of Alzheimers, tests, caregiver concerns. VERY extensive list of various articles you should find helpful

ALZHEIMERS LINK: An excellent page that provides some extensive and recent articles on Alzheimers and the new treatments.

ALZHEIMERS LINK 2:  Lots of solid info, particularly on medical advances.

ALZHEIMERS LINK 3 from Healthopedia

ALZHEIMERS BEHAVIOR: This "article" by Carly Hellen, ORT/L of the Rush Alzheimer's Disease Control was prepared for staff. But it covers subjects such as Verbal Anxiety, Abusive Language, Stripping, Wandering, Depression, etc. in such a concise fashion that it is must reading for all caregivers that face this horrendous disease. Read this- it can save both you and a loved one a world of grief.

ALZHEIMERS DIAGNOSIS: A descriptive commentary from the National Institute of Neurological Communicative Diseases and Stroke- undated- distributed by the Long Island Alzheimers Foundation.

ALZHEIMERS DISEASE LINK: From the Long Island Alzheimers Foundation. Covers Cost, Diagnosis, Life Expectancy, Local Statistics, Research, Statistics, Symptoms

ALZHEIMER'S DISEASE LINK 2:

ALZHEIMERS INFORMATION LINK: An outstanding site - this page offers helpful advice about choosing a nursing home and how to prepare for the move into a long term care facility.

AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING LINK: They represent non profit organizations providing care for the elderly. Links to State associations, consumer info, etc.

AMERICAN HEALTH CARE ASSOCIATION LINK:   The AHCA is a federation of 50 state health organizations representing nearly 12,000 non-profit and for-profit assisted living, nursing facility, long term care, and subacute care providers that care for more than one million elderly and disabled individuals nationally. The site is an excellent resource for info on state facilities, long term care articles, statistics and much more. Highly Recommended

ASSISTED LIVING: Commentary, charts

ASSISTED LIVING LINK : This site by the Assisted Living Federation of America provides information, articles and an extended checklist for checking out a facility.  About 6.5 million elderly need assistance with activities of daily living- and this number is expected to double by 2020.

ASSISTED LIVING CHECKLIST LINK:  Very good info from Aging Solutions

ASSISTED LIVING 2006 STATE REGULATORY REVIEW LINK:  This report summarizes regulation of assisted living in each state and the District of Columbia. Very extensive. You will need this state info for yourself or a loved one.

2005 State Regulatory Review (PDF: 444 KB)

2004 State Regulatory Review (PDF: 423 KB)

2003 State Regulatory Review (PDF: 343 KB)

2001 State Regulatory Review (PDF: 557 KB)

ASSISTED SUICIDE LINK: (Annals of Internal Medicine) "Assisted suicide requires physician involvement, but physicians' limited competence in performing the full range of tasks, the competencies of other professions, and the possibility that other professions could expand their authority in this area suggest that physician-assisted suicide is a far too narrow construct of the task." An extensive review of this difficult subject. 

BENEFITS CHECK UP LINK: BenefitsCheckUp — a free, easy-to-use service that identifies federal and state assistance programs for older Americans. From the National Council on Aging:You take 10 or 15 minutes to enter information about your financial situation into an online questionnaire. Then, BenefitsCheckUp explains what benefit programs you may be eligible for and how to apply for them.

BIPOLAR LINK: Bipolar disorder is an illness characterized by moments of euphoria and increased irritability. This is usually called manic depression, because there are times of anger and guilt, and then suddenly the person becomes overly excited and has reckless behavior. Lots of information from Caregiver.com

CALIFORNIA NURSING HOME LINK:  provides consumers with comprehensive, consumer-friendly comparative information about the quality of California nursing homes, as well as alternatives to nursing home care, government programs and services, and other helpful resources.

CARE OF THE DYING LINK 1:  Provides info on pain relief and symptom management. Includes Patient Questionnaire, Family Caregiver Questionnaire, Bereaved Family Questionnaire, Professional Questionnaire, Competency Assessment Tool, System Assessment Tool and much much more.

CARE OF THE DYING LINK 2:  Partnership for Caring: America’s Voices for the Dying is a national, nonprofit organization devoted to raising consumer expectations and increasing the demand for excellent care at the end of life. Includes Download Living Wills, Medical Powers of Attorney (Advance Directives)

CAREGIVERS: It's not just the person going in to a home that suffers. Caregivers- mostly women- suffer tremendous financial and emotional burdens. READ THIS- it could save you or a loved one from many problems.

CAREGIVERS LINK 1: In the above pages, I give a good condensed overview of what a caregiver must do and recognize. This link, however, goes to the major web site for caregiving and covers more extensively the areas and problems for a caregiver. Highly recommended.

CAREGIVERS MAGAZINE LINK:   A very extensive monthly commentary on all areas of caregiving. Highly recommended.  

CAREGUIDE LINK: The internet's "most comprehensive Child Care and Elder Care Resource".  Yes, some of the links I provide may be slightly redundant, but you can't afford to miss the information they provide.

CARE LIMITATIONS- A simple chart that describes the percentage of help that nursing home patients need depending upon ADLs .

CHOICES IN DYING LINK:  This organization has fostered the rights of the individual to determine how they might die. A truly controversial issue and this information might help you make up your own mind or accept the decisions of others.

CHOOSING A NURSING HOME LINK Complete guide to choosing a facility, including what to look for, questions to ask, and how to make the transition to living in a facility.

COMMUNICATING WITH PEOPLE WITH DEMENTIA:  This article by Anna Ortegara, RN, MS provides tremendous insight on how to communicate with people who have trouble expressing themselves. Mandatory if you have loved one in any stages of Alzheimers

COMPANY LTC POLICY LINK: A listing of many companies offering long term care policies. You cannot tell if the policies are good or bad per se, but it gives you a place to start.

CONGRESSIONAL PIG BOOK LINK : The 2006 Congressional Pig Book is the latest installment of Citizens Against Government Waste’s (CAGW) 16-year exposé of pork-barrel spending. This year’s list includes: $13,500,000 for the International Fund for Ireland, which helped finance the World Toilet Summit; $6,435,000 for wood utilization research; $1,000,000 for the Waterfree Urinal Conservation Initiative; and $500,000 for the Sparta Teapot Museum in Sparta, N.C.

COST OF CARE MAP LINK: (John Hancock) Go to this page, click interactive map. then click any areas you are interested in and you get invaluable data. Highly recommended.

COSTS OF DYING: What are the costs to Medicare.

COUNSELING: Counseling for the elderly, speech pathologist, more

CREMATION LINK: "The Internet Cremation Society is an organization that screens cremation service providers throughout the U.S. and Canada and selects just one in a geographic area. Each society's prices are among the lowest available in its area and most service the entire state in which they operate." I would still suggest doing an extended search in your own area, but these prices and services should provide a good place to start.

DEATH AND RELATED COMMENTARY: Euthanasia, what are your concerns and how do you feel about it, costs, statistics. Most recent are statistics on how death occurs in various areas of the United States

DEPRESSION: The World Health Organization has identified Clinical Depression as the fourth leading cause of premature death and disability- and moving up. Don't pass this off as just having a bad week. Understand the problem and get treated.

DEPRESSION LINK 1:  The site for the National Depressive and Manic Depressive Association that provides information and resources for the problem of depression. Highly Recommended

DEPRESSION LINK 2: "This site is the Internet's central clearing house for information on all types of depressive disorders and on the most effective treatments for individuals suffering from Major Depression, Manic-Depression (Bipolar Disorder), Cyclothymia, Dysthymia and other mood disorders."

DEPRESSION LINK 3: A most important subject that, if it hasn't impacted you yet, may do so as you get older. Be prepared to help yourself or a loved on.

DEPRESSION LINK 4 Resorces to assist people at risk for depression.

DISABILITY RESOURCE LINK: Huge directory resource  of 2,500 links and 36 convenient categories for one-stop shopping  for the blind, deaf, and others that are impaired who might need glasses, canes, special vans, hoists, wheelchairs, etc. Very extensive.

DISABLED ELDERLY: General statistics. Not as many elderly are as disabled as in the past.

DISEASE/DEATH LINK:  Notifiable Diseases/Deaths in Selected Cities Weekly Information. Astound your friends and families with interesting statistics at cocktail parties, bar mitzvahs, golfing dates and more. Become the person looked up to in your community.

DRUG INTERACTION LINK: This service allow you to take the preventative step of whether the drugs you are taking interact with each other, or interact with a certain food, and cause a bad reaction in the body.

DYING INSTRUCTIONS LINK:  (pdf) By R. Douglas Pauley. Darn good material if you are dying

ELDER LINK: An extensive site covering all areas of elder care along with over 4,000 specific links.

ELDER LINK 2:  Articles, comprehensive checklists, and links to key resources designed to make it easier for family caregivers to quickly find the information they need

ELDER GLOSSARY LINK:  This glossary covers terms related to elder care, retirement and estate planning. It also includes related financial, insurance and legal terms.

ELDERCARE LINK: Search and compare nursing homes, assisted living facilities, home health and hospice agencies. Obtain discounts on eldercare

ELDERCARE GLOSSARY LINK: Extensive listings of words and terms used in healthcare, long-term care and Medicare and Medicaid.

ELDER CARE ONLINE LINK:

ELDER STATISTICS 2003 LINK:   Great stuff

JOURNAL OF ALZHEIMER'S DISEASE LINK:  The Journal of Alzheimer’s Disease is an international multidisciplinary journal with a mission to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment and psychology of Alzheimer’s disease.

ELDERCARE LOCATOR LINK: This is a site that helps the elderly locate support services throughout the U.S. Yes, you can get to this site through other links I have provided, but I provide some redundancy since certain areas are more important.

ELDERLY ABUSE: A lot more common then you expect and it will get worse as there are more and more elderly.

ELDER ABUSE LINK: This is the National Center on Elder Abuse (NCEA) and "is operated jointly with the National Association of State Units on Aging, the National Committee for the Prevention of Elder Abuse, and the University of Delaware to serve the information and knowledge and skills development needs of professionals concerned with elder abuse/neglect." This is a serious issue that affects more elderly than you can imagine. Use this resource.

ELDER ABUSE STUDY LINK: The National Elder Abuse Incidence Study; Final Report September 1998. You have no idea how extensive elder abuse is.

ELDER CARE ONLINE LINK:

ELDER CARE CALCULATOR LINK:  (The MetLife Caregiving Costs Study: Productivity Losses to U.S. Business; National Alliance for Caregiving) the average caregiver costs an employer $2,110 per year. For those caregivers providing the most intense levels of care, the cost per employee is $2,441, totaling $17.1 billion. The total annual cost for all caregivers is $33.6 billion.

ELDERLAW LINK:  The home page for the National Association of Elder Law Attorneys

ELDERLY ASSETS AND INCOME LINK:  Research on what the elderly and near elderly have in assets

END OF LIFE LINK:  Last Acts is a campaign to improve end-of-life care by a coalition of professional and consumer organizations.

END OF LIFE CARE LINK Lots of excellent information and links to other areas

END OF LIFE SEARCH LINK: This is the Growth House's search engine dedicated to end of life issues.  Very extensive.

EUTHANASIA AND ETHICS LINK: Extensive resources including court decisions, legislation, basic documents, statistical information and web sites dedicated to euthanasia issues

EUTHANASIA WORLD DIRECTORY LINK:  Information of all types, list of world organizations, recent court decisions, the Oregon and Australia laws, Kervorkian, and much more. This is a controversial area but something you should at least be aware of. Recognize that while you may find it morally reprehensible, others believe it to be their right and you may need to discuss the issues intelligently. As a personal note- unless I am "assured" of a quick and painless death, I would consider this in a heartbeat.

EVALUATION OF NURSING HOMES: From "Nursing Homes" by Forest. Must reading when reviewing criteria in selecting a home.

EVALUATION OF NURSING HOME LINK: This is part of the page for Careguide and has some articles addressing what to look for in a facility

EXERCISE: Want to live longer, healthier and smarter?

EXTENDED CARE LINK: This site by the Extended Care Information Network is a resource for extended care assistance, news and advice and provides information on over 35,000 providers in the United States provides information on adult day care, assisted living facilities, skilled care, retirement facilities, respite care  and more.

FACILITIES LINK:  This site provides some limited articles on long term care, how to pick a nursing home, etc. but, most specifically, info on Alzheimer's facilities, Assisted Living, Home Health Care, Retirement Homes, Hospices, Nursing and Rehab Facilities, CCRS's in 32 metropolitan areas.

FACTS ON DYING LINK:  Excellent material from an ongoing study by the Brown University Medical School.

FALLING DOWN: The elderly have lots of problems and many of them are due to falling down. (Do you know the major cause?) What you can do to prevent falls.

FALLING DOWN LINK: One in three Americans over the age of 65 will suffer a fall each year. The risk of falls increases with age. The annual incidence of falls increases to 50 percent in older adults over age 80.3 percent of Americans over age 65 will have a severe fall. 1 percent of Americans over age 65 will fall and sustain a hip fracture (200,000). Each year 10,000 deaths in older adults are attributed to falls. Falls play a major role in 40 percent of nursing home admissions.

FAMILY MEDICAL AND LEAVE ACT: James Obrien, Esq, Nixon Peabody LLP, New York

FEDERAL LTC LINK: The Federal plan reimburses the actual cost of care in a nursing home, assisted living facility, or at home -- up to the daily maximum you select. It also pays for ``informal care,'' assistance provided by friends, neighbors and family members, with some restrictions. Other pluses: It includes international coverage, waives your premium once you go on claim and you can take it with you if you leave the group.

FEDERAL LTC GLOSSARY LINK:  Interpretation of issues for the FED policy.

FUNERALS: Extensive commentary on all types of funerals, regulations, costs and organizations

FUNERALS LINK: Excellent source of additional information on all the areas affecting the death of a loved one- grief , living wills, body donations, etc. Highly recommended.

GERIATRICS MEDICAL CARE LINK: Extensive listing of all types of problems for the elderly- Demographics,  History and Physical Examination, Mental Status Examination, Delirium, Behavior Disorders in Dementia, Comprehensive Geriatric Assessment, Prevention of Disease and Disability, and on and on. Mandatory link. If you are old, getting old or know someone who is old, this is excellent material. And if you are a hypochondriac of any type, knock yourself out.

GERONTOLOGICAL SOCIETY OF AMERICA LINK: Its mission is "to promote the scientific study of aging and to foster growth and diffusion of knowledge..." Good information for us all. And here is another GERONTOLOGY LINK that provides a huge number of links to web sites on all areas of gerontology.

GEROPSYCHOLOGY LINK: A resource on the study of neurological, psychological and sociological aspects of the aging process. Very extensive

GLOBAL AGING LINK:  The site provides some insightful articles about aging throughout the world and incorporates issues of elder rights, pension plans, population, health, etc. Also has lots of news regarding the U.S. and helps to put many aging issues into focus on a worldwide basis.

GLOSSARY: One of the more extensive glossaries on Long Term Care. Should be beneficial when trying to decipher the words and phrases in a contract.

GRIEF LINK: If you have lost a loved one and need help, use this site. Whether for you, a loved one or a friend, it is invaluable.

GUIDE TO CHOOSING A NURSING HOME LINK: An solid online guide published by the Health Care Financing Administration that is mandatory reading- along with some of the more extensive material and books I have previously identified- in selecting a proper facility for a loved

HCFA MEDICAID MALE LIFE EXPECTANCY LINK

HCFA MEDICAID FEMALE LIFE EXPECTANCY LINK

HEALTH INSURANCE INFORMATION LINK: "Free, accurate and unbiased consumer help with Medicare, managed care, Medigap insurance, long term care insurance and more for Medicare beneficiaries, their families and others." Very Good information and highly recommended

HOME CARE: Caring for a Relative- what to look for.

HOME CARE LINK:   database of more than 20,000 home care and hospice agencies.

HOME CARE AND HOSPICE STATE ASSOCIATIONS LINK:  Address, phone, web sites and Email for every state and jurisdiction

HOME CARE STATISTICS LINK: An extensive article about all the elements of home care. Required reading.

HOME HEALTH AGENCIES RATING LINK:  Home health report cards on 8,000 Home Health Agencies

HOME HEALTH CARE: Short checklist.

HOME MODIFICATION FOR THE ELDERLY LINK: "Home Modification and Repair includes adaptations to homes that can make it easier and safer to carry out activities such as bathing, cooking, and climbing stairs and alterations to the physical structure of the home to improve its overall safety and condition."

HOSPICE: What to consider, how they help. One person quoted those in hospices as being the finest, most dedicated and caring people you will ever meet. In the book "How We Die", it indicates that only 20% of use will die "nicely" and quickly. The rest of us will put up with pain and mess. A hospice is a dignified way to go.

HOSPICE LINK 1: An extensive site that allows one to find info on hospice, caregiving, pain, bereavement and more 

HOSPICE LINK 2:  This is the site for the Hospice Foundation of America. Hospice is used in the terminal stages of life and allows a transitional period without pain surrounded by caring staff. A place of saints and angels.

HOSPICE LINK 3: Hospice Association of America

HOSPICE LINK Hospice Referral and Care: Practical Guidance for Clinicians CME/CE, Author: Perry Fine, MD. This article is one of the most complete I have seen on the subject. What Is Hospice?, What Should You Expect From a Quality Hospice Program?, Who Pays for Hospice Services?, Recent Developments in Hospice Care, Criteria and Eligibility for Hospice Services, The Prognosis: How Can I Be Sure It's Time to Refer to Hospice Services?, Local Coverage Determinations for Hospice Eligibility (Determination of 6 Month Prognosis), Hospice Screening Tools From the LCD, Clinical Judgment and Nontraditional Patients, Measuring Clinical Decline, Needs of the Patient and Family, What to Say and When to Say It, Barriers to Hospice Access, Family/Caregiver Support, Working With Hospice Clinicians/Organizations, Resources for Clinicians, Resources for Patients, Families, and Caregivers

HOSPITAL REPORT LINK: Ratings on a state by state basis

HOW TO CHOOSE A HOME CARE PROVIDER LINK: This is the site for the National Association for Home Care- non profit home care and hospice care agencies. The information will be invaluable when you need to pick someone to help your aging parents.  

HUMAN MORTALITY DATABASE LINK detailed mortality and population data to researchers, students, journalists, policy analysts, and others interested in the history of human longevity.

IMPAIRMENT: This chart, excerpted from Dr. Kuhn, shows the Levels of Impairments and Symptoms of Dementia

INCOME OF THE AGED CHARTBOOK 2000 LINK, This chartbook focuses on the receipt and shares of income from Social Security, pensions, assets, earnings, and public assistance. That information demonstrates the role that Social Security plays in the income security of the aged, as well as the important role that other income sources play in providing for a secure retirement.

INCONTINENCE: If an elderly person has incontinence and is also demented, the problem needs to be closely scrutinized. This article from the Alzheimers Association should help

INDICATORS ON THE AGING POPULATION LINK:  Massive study on aging by the National l Institute on Aging, Part 1. Includes Indicators of Population, Economics, Health Status, Health Risks and Behaviors and Health Care. Exceptional material.

JCAHO LINK: Joint Commission on Accreditation of Healthcare Organizations is an independent, not-for-profit organization that evaluates and accredits nearly 20,000 health care organizations and programs, including ambulatory care centers, behavioral health care organizations, health plans, home care organizations, hospitals, laboratories, long term care facilities, and long term care pharmacies.

LAST ACTS LINK: This site is for the "Care and Caring at the end of Life". Sure it may be redundant with the hospice link above and others here and under estate planning, but  the U.S. is woefully behind the times in helping/letting people die with dignity. These sites can provide some of the insight necessary when death is near.

LEADING CAUSES OF DEATH LINK (1999)  (pdf)

LIBRARY ON AGING LINK:  The web and gopher servers listed in the GeroWeb Virtual Library on Aging contain information which may be useful to those interested in gerontology, geriatrics, the process of aging, services for the elderly, or the concerns of senior citizens in general.

LIFE, DEATH AND HEALTH STATISTICAL LINK: Huge database of info from the CDC. Great material Once again, the government puts out a great site.

LIFE EXPECTANCY: If you are 45, how long do you have to live? How about age 65 or 75 or even 85. You must know these numbers in order to do estate, insurance or retirement planning.

LIFE EXPECTANCY LINK : The above site requires printing out a form and does not provide an on line answer- though it is very descriptive. This site is not as definitive but allows you to plug in answers and get a result. You should try it.

LIFESPAN: Commentary on life span, figures for other countries and more.

LIVING WILL AND HEALTH CARE DIRECTIVE: No, these are not the forms but certain questions you should ask yourself about the treatment you would like.

LTC CALCULATOR LINK: The two calculators below can show you the costs for different benefit plans under the Federal Program.

NOTE- this is NOT private coverage. This is a special Federal program available for federal employees. But it will help gauge the risk

LTC COST CALCULATOR LINK:  Select the state and city closest to you and it gives the home health care, assisted living and nursing home cost. Highly recommended.

LTC SAMPLE RATE LINK: This is a California insurance department link and the costs may only be applicable to this state.

LONG-DISTANCE CAREGIVING LINK:   MetLife

LONG TERM CARE LINK:  Excellent source of articles by MIB Inc. Highly recommended.

LONG TERM CARE COMMENTARY: Miscellaneous comments on various issues including some aspects of LTC policies, misrepresentation, procedures, etc. At least 80 pages.   

LONG TERM CARE COST LINK:  This site is oriented to long term care info overall, but it does have a simple calculator that lets you put in your age and state and it new calculates the possible cost of long term and nursing home care along with the odds of needing them

LONG TERM COST OF CARE LINK 2:   This is a John Hancock site. Once you get to the front page, look at the Resource Center and 'Cost of Care in Your Area'.

LONG TERM CARE LINK 1: This site is by the Administration on Aging and has numerous articles that you should familiarize with if you are old, expect to get old or simply know somebody that is old. (That should cover all the bases, don't you think? So go to this site and do some homework.) 

LONG TERM CARE LINK 2: An independent site that has some good info and links.

LONG TERM CARE DUE DILIGENCE FOR ADVISERS LINK:  by Stephen A. Moses

LONG TERM CARE HISTORY LINK: by Karen Stevenson Brown. This section of ElderWeb is a comprehensive overview of how our long term care system has evolved by examining the events and decisions that changed the way that we have provided and paid for the care of our elderly over the years.

LONG TERM CARE HOSPITALS LINK:  Long-term care hospitals, in general, are defined in the Medicare law as hospitals that have an average inpatient length of stay greater than 25 days. These hospitals typically provide extended medical and rehabilitative care for patients who are clinically complex and may suffer from multiple acute or chronic conditions. Services may include comprehensive rehabilitation, respiratory therapy, cancer treatment, head trauma treatment and pain management.

LONG TERM CARE INSURANCE INFORMATION LINK: The U. S. Administration on Aging has posted a page of links including info on Consumer Information, Information and Counseling Programs, State Information Sites, Public/Private Partnerships for Long Term Care, Public Policy, Statistics on Nursing Home Costs, Bibliography, Long Term Care Insurance Industry Associations, Independent Brokers of Long Term Care Insurance Carriers, Insurance Companies

LTC INSURANCE RISKS LINK:  AARP

LONG TERM CARE INSURANCE STUDY LINK:  (Fourth Intercompany Study of Long-Term Care Insurance) . Available data was collected on policies issued between January 1, 1984 and December 31, 2001. Claims incurred on policies in force during this time were followed from claim inception through the earlier of claim termination, or June 30, 2002. The data available for this report increased significantly from the previous study. The exposure increased almost 50%, the claims almost doubled and the claim payments tripled.

LONG TERM CARE INSURANCE 2000- 2001 LINK: HIAA

LONG TERM CARE NEW YORK LINK:  A good overview that any potential purchaser should review before purchasing a policy.

LONG TERM CARE QUIZ: Can you answer these questions? You better know the answers BEFORE you buy. Always check your state insurance department for additional info. Also contact your Area Agency on Aging.

LONG TERM CARE STATISTICS: Generally included in full text but primarily includes some new commentary- such as the fact that nursing home occupancy is actually falling

LONG TERM CARE TEXT: A lengthy article (over 50 pages) covering all issues of long term care including extensive statistics, ADL's and benefit eligibility, differences in policies, updates, health care issues, trusts, reverse mortgages, community care and much, much more. Significant input from Mary Kaufmann, Alameda Area Agency on Aging with some of the best analysis on policies anywhere.

LONGEVITY LINK:  International Longevity Center- An affiliate of Mount Sinai School of Medicine. Check the publications section for lengthy articles

LTC CHART BOOK LINK Exceptional information from the Urban Institute in a tabular format. Highly recommended (PDF)

MANAGED CARE AND DISABILITIES LINK:  This site "provides information relevant to researchers, policymakers, consumers, and advocates on a wide range of issues associated with managed care and disabilities." Sponsored by the Office of the Assistant Secretary for Planning and Evaluation within the Department of Health and Human Services. 

MANAGED CARE COMMENTARY: "HMO's are wonderful for people who want to embrace euthanasia. For those who want the option of whether or not to receive costly life prolonging care, HMO's are not the place to go." Here are other pros and cons

MANAGED CARE GLOSSARY LINK: An extensive 26 page glossary of terms you should familiarize yourself with when using a managed care facility. As C Everett Koop says- The Best Prescription is Knowledge.

MANAGED CARE QUESTIONNAIRE: Kate Kincaid is the Editor in Chief for California Broker magazine. Beyond that, and most importantly, is the fact that she is an excellent and knowledgeable writer on complicated issues.  This questionnaire is must reading.

MEDICAID: Various articles including when may be the best time to legally spend down to Medicaid state limits if you are going into a nursing home

MEDICAID ANNUITY LINK:  I do not agree with the use of annuities to get under Medicaid coverage. The site is used for information.

MEDICAID LONG TERM CARE LINK:  This is a most involved area for those that are poor and the site addresses Medicaid payments for nursing home care, home health care services, hospice, more.

MEDICAID AND LONG TERM CARE LINK:  An extensive research paper on the problems with Medicaid covering long term care.

"And nursing homes, which cost Americans $103.2 billion in 2002, were paid approximately half by Medicaid, one-quarter by private pay, one-eighth by Medicare, and one-sixteenth by private health insurance."

MEDICAID SPENDDOWN LINK:  (Stephen J. Kaufmann) I am not condoning it- just for reference

MEDICAID STATE  APPLICATION LINK:

MEDICAID STATE INFORMATION LINK: This site provides contact entities, addresses and telephone numbers of direct assistance.

MEDICAID TRANSFER RULE LINK: Click link titled, "What if I Give It All Away?" A good overview for transfer of assets in order to get on Medicaid (though not a very good idea if you want the best of care)

MEDI-CAL (MEDICAID) LONG TERM CARE LINK: Medi-Cal pays for 64 percent of all nursing home days in California and accounts for 45 percent of total nursing home expenditures. In contrast, the Medicare program, which pays for no more than the first 100 days of a nursing home stay, covers only 9 percent of total nursing home days and 25 percent of total expenditures.

MEDICAL PROBLEMS: If you have had prior medical conditions and want a long term care policy, will the companies cover at all and, if so, what do they review?

MEDICARE INTERACTIVE LINK: your one-stop source for information about health care rights, options and benefits. Brought to you by the Medicare Rights Center, a national not-for-profit, consumer service organization, dedicated to ensuring that older adults and people with disabilities get good affordable health care."

MEDICARE MANAGED CARE LINK:  Mandatory page if you wish to use a managed care HMO plan. Simply include your state of residence- or preferably your zip code- and you can get an analysis of a company's plan for that area- coverage, costs, etc.

MEDICARE HANDBOOK 2003 LINK:  PDF- just about everything you wanted to know. Great info

MEDICARE HEALTH PLAN LINK: Helping you compare health plans in your area.

MEDICARE INTERACTIVE LINK:  Lots of good information

MEDICARE AND MEDICAID LINK: This site is administrated by the Centers for Medicare and Medicaid and lets consumers and professionals retrieve information about literally every aspect of these two explosive issues. Highly recommended.

MEDICARE PERSONAL PLAN FINDER LINK: Medicare's Personal Plan Finder helps you narrow down your Medicare health plan choices and choose the plan that's best for you.

MEDICARE PRESCRIPTION DRUG LINK: Including Medicare-Approved Drug Discount Cards

MEDICARE STATISTICS and COMMENTARY: Who gets help and who pays. Interesting statistics. Great for parties

MEDICARE SUPPLEMENTAL QUOTE LINK: The site allows you to get quotes in any state on any type plan. You still have to do some more homework but it is an excellent place to start.

MEDICATIONS: What am I taking, why, what are the implications to my health, etc. Basic questions that should always be asked.

MEDIGAP PLAN LINK: A very good overview of the 10 "basic" Medicare Supplemental plans by the New York HIICAP

MEDIGAP PLANS: Only 10 (essentially) are allowed to be sold throughout the U.S. This article will help explain some differences and give additional insight to some problems.

MEMORY STUDY LINK: The National Institute on Aging is trying to get the word to people over age 55 that if they're getting abnormally forgetful, they should see a doctor. Scientists have just discovered that a memory problem called ''mild cognitive impairment'' can be an early warning sign of Alzheimer's - and they're beginning three huge studies to see if certain drugs could prevent those patients from ever getting Alzheimer's.

MENTAL HEALTH DICTIONARY LINK: Center for Mental Health Services

MORE CARING: Additional insight for caregivers of the elderly and chronically ill. Must reading.

MORTALITY TABLES LINK

NATIONAL ASSOCIATION OF STATE UNITS ON AGING LINK:  The mission of the Association is to advance social, health, and economic policies responsive to the needs of a diverse aging population and to enhance the capacity of its membership to promote the rights, dignity and independence of, and expand opportunities and resources for, current and future generations of older persons, adults with disabilities and their families. Great info

NATIONAL CENTER FOR HEALTH STATISTICS LINK: This is part of the CDC (Center for Disease Control) but I have separated it out due to the vast amount of numbers that one can use for lifetime expectancies, what people die from and a host of other valuable statistics for retirement, estate planning and more.

NATIONAL COMMITTEE FOR QUALITY ASSURANCE LINK: Direct link to the NCQA- the independent organization responsible for the report cards on many HMO's. Excellent additional information and highly recommended.

NATIONAL INSTITUTE ON AGING LINK 

The NIA’s mission is to improve the health and well-being of older Americans through research, and specifically to:

Support and conduct high quality research on:

-aging processes

-age-related diseases

-special problems and needs of the aged

Train and develop highly skilled research scientists from all population groups

Develop and maintain state-of-the-art resources to accelerate research progress

Disseminate information and communicate with the public and interested groups on health and research advances and on new directions for research.

NURSING LINK:  Everything you wanted to know about the field.

NURSING HOME AND HOME CARE COSTS 2004 LINK pdf) The average daily cost of a private room in a nursing home in the United States is $70,080 per year, or $192 per day, according to the 2004 MetLife Market Survey of Nursing Home and Home Care Costs. The highest rates were reported in the state of Alaska where the cost is $204,765 per year ($561/day on average). The lowest rates were found in Shreveport, Louisiana at $36,135 per year ($99/day). The average length of stay in a nursing home for current residents is 2.4 years, which makes the average cost of a nursing home stay approximately $168,192.

• The average daily rate for a private room in a nursing home is $192 or $70,080 annually.

• The average daily rate for a semiprivate room in a nursing home is $169 or $61,685 annually.

• The average hourly rate for Home Health Aides (HHAs)provided by a home care agency is $18 per hour.

Home Health Care

Over 1.3 million patients received home health care services from 7,200 agencies in 2000,with over half receiving help with at least one activity of daily living.Seven in ten patients were ages 65 and older,and of all patients receiving care,65%were women.

Home Health Caides provide assistance with personal care functions,such as bathing and dressing,and may also offer companion care.

Based on the market survey for 2003,the average daily rate for a private room in a nursing home was $181 ($66,065 annually),and for a semiprivate room $158 ($57,670 annually).

The 2004 daily rate for a private room in a nursing home is $192 ($70,080 annually),and for a semi- private room $169 ($61,685 annually).

The hourly rate in 2003 for a Home Health Aide was $18.The 2004 hourly rate is $18.

NURSING HOME COMPARE LINK This Medicare site provides detailed information about the performance of every Medicare and Medicaid certified nursing home in the country. Extremely valuable.

NURSING HOME COMPARISON LINK: Helps you compare nursing homes in your area by looking at nursing home characteristics, resident characteristics, state inspections results, and nursing staff information.

NURSING HOME EVALUATION: In addition to "Evaluation of a Nursing Home" is this paraphrased commentary from Joanne Meshinsky, author of "How To Find a Nursing Home". Absolutely must reading. Buy her book if you can still find it.

NURSING HOME LINK:  Nursing Home Abuse and Neglect Resource Center at NursingHomeAlert.com is an informational website designed to help the elderly and their families. Total nursing home revenues have topped 55 billion dollars. The 10 largest publicly-traded nursing home chains control 1/4 of this country's nursing home beds.

NURSING HOME LINK 2:  Find and compare nursing homes

NURSING HOME QUALITY MONITOR LINK: From Consumer Reports. Just click on your state

NURSING HOME RATING LINK:  Nursing home report cards on 17,000 Nursing Homes

NURSING HOME RATING LINK 2:   patient care quality ratings for 16,000 nursing homes nationwide

NURSING HOME REVIEW LINK: Information on all 17,000 in the United States.

NURSING HOME STATISTICS, ARTICLES AND COMMENTARY:  Number of facilities nationwide, who pays, number of beds, Medicare and Medicaid, more.

NURSING HOME UK LINK: A directory for the United Kingdom

NURSING HOME SURVEY LINK: 1999 Summary This report from the U. S. National Center for Health Statistics presents estimates of nursing homes and their current residents and discharges in the United States. The data are summarized by characteristics of facilities such as information about Medicare and Medicaid certification, bed size, type of ownership, services provided, and per diem rates. Data are also summarized by characteristics of current residents and discharges such as demographic and resident characteristics, health and functional status, services provided, primary diagnosis, and all-listed diagnoses. Data in this report are based on data collected from the 1999 National Nursing Home Survey.

NURSING HOME WATCH LIST LINK: A state by state review by Consumer Reports from July 1995 to October 1998 that raise questions about the quality of care delivered to residents. Unfortunately the details to the extent of the problem are not provided so you have to do a lot more homework by yourself . But it may give a place to start.

NURSING STAFF RATIO STUDY LINK: Appropriateness of Minimum Nurse Staffing Ratios.

OBESITY LINK: The American Obesity Association. The loss of lives will be greater than that for tobacco.

OCCUPATIONAL THERAPIST: These individuals may help the disabled function better.

OMNIBUS BUDGET RECONCILIATION ACT: General comments about 1987 law.

OUTDOOR TREATMENTS FOR ALZHEIMERS PATIENTS: Short article on how to make the outdoors safer and more appealing for Alzheimers patients.

PALLIATIVE CARE: The issue of reducing pain at the end stages of death

PALLIATIVE CARE ARTICLE LINK: Palliative care is defined as comprehensive, interdisciplinary care of patients and families facing a terminal illness, focusing primarily on comfort and support. Key aspects include meticulous symptom control; psychosocial and spiritual care; a personalized management plan that maximizes patient-determined quality of life; family oriented care that extends through the time of bereavement; and delivery of coordinated services, especially in the home but also in hospital, extended care facilities, day care centers, and specialized units.

PALLIATIVE CARE LINK (Annals of Internal Medicine) Comprehensive palliative care (Pain management), as exemplified by many state-of-the-art hospice programs, is the standard of care for the dying. Although palliative care is very effective, physicians, nurses, patients, families, and loved ones regularly face clinically, ethically, legally, and morally challenging decisions throughout the dying process. This is especially true when terminally ill patients are ready to die in the face of complex, difficult-to-treat suffering and request assistance from their health care providers.

PALLIATIVE CARE LINK: What Is Palliative Care?

PERSONAL CARE ISSUES- Eating: From Anna Ortigara, Rush Alzheimer Disease Center, is this extensive list of factors, causes and strategies for helping someone with dementia. Absolutely invaluable information by one of the most knowledgeable people in the "business" of caring.

PERSONAL CARE ISSUES- Bathing

PERSONAL CARE ISSUES- Dressing

PERSONAL CARE ISSUES- Toileting.

PHYSICIAN ASSISTED SUICIDE LINK:  "Physician-Assisted Suicide: Physician-assisted suicide (PAS) is perhaps the most compelling and clinically relevant mental health issue in palliative care today. The desire for death, the consideration of suicide, the interest in PAS, and the relationship of these issues to depression and other psychosocial issues appear to be of paramount importance. Psychosocial and psychiatric issues are among the most powerful predictors of desire for death and interest in PAS. Evaluation and intervention in these areas, particularly depression, is a critical component of compassionate care."

PHYSICIAN DIRECTED SUICIDE:  Guidelines from the Annals of Internal Medicine

PHYSICIAN RATING LINK:  Education and training, Governmental disciplinary actions, Board certifications, Years since medical school, Locations, Gender, Information on area hospitals

PHYSIOLOGY OF AGING- Internal: An article by Mary Kaufmann of the Alameda Area Agency on Aging

PHYSIOLOGY OF AGING- External: An article by Mary Kaufmann of the Alameda Area Agency on Aging

PREDICTING TIME TO NURSING HOMES AND DEATH WITH ALZHEIMERS LINK

PRELIMINARY CAUSES OF DEATH LINK 2000 (pdf)

RESIDENTIAL CARE FACILITIES LINK: Examines the issue of quality care in licensed facilities for the elderly.

RESPITE CARE CHECKLIST: If someone is coming to relieve you, they need information on the patient in order to give excellent care immediately. Even DNR's can be addressed. This can help reduce questions, improve care and relieve anxiety.

SENIOR HOUSING LINK: This site provides listings to over 60,000 facilities nationwide. You can find them by health status, type (independent, assisted living, or nursing care), check on prices and more. See also Nursing Homes USA above

SPIRITUAL GUIDE: "Issues of the spirit are important when caring for the elderly in long term care environments, as well as preparing residents, families, and staff for the death of a resident." This is an excellent article by members of Ingleside Skilled Nursing and Rehabilitation Center along with a  Spiritual Assessment guide that I think you will find beneficial- and illuminating. The success of this can be implemented anywhere and  will be an inspiration for many.

STATE DEPARTMENTS ON AGING AND LTC OMBUDSMAN A complete list of addresses, telephone numbers, links

STATE DAILY LONG TERM CARE COSTS:  These figures easily show how the various 1999 AVERAGE state costs vary. May also give you an idea where you might wish to retire- particularly if your health history portends long term care. 

STATE FAMILY CAREGIVER SUPPORT LINK: States have a variety of programs in place to support family caregivers of older people. Just click on your individual state 

STATE MEDICAID ELIGIBILITY LINK: (PDF)

STATE MEDICAID DIRECTORS LINK The primary purposes of NASMD are to serve as a focal point of communication between the states and the federal government and to provide an information network among the states on issues pertinent to the Medicaid program.

STATE PROFILES LINK: A compilation of data on many dimensions of long-term care in each state and the District of Columbia. This series was developed to help inform policy discussions among public and private sector leaders in long-term care throughout the United States from AARP.

STEPS FOR THE SERIOUSLY ILL: Dr. Joanne Lynn, Director of the RAND Center to Improve Care for the Dying

SUICIDE/ EUTHANASIA LINK

TAX POSITIONS OF NTQ LTC POLICIES LINK: Includes letters from the IRS

TAX TREATMENT OF TAX QUALIFIED VERSUS NON TAX QUALIFIED POLICIES: Are the differences for TQ and NTQ clear for either coverage or taxation? I think not. And I spoke with the IRS in reference to same.

UK CARE HOMES LINK: guide solely aimed at care homes throughout the UK. 

VALUES: Form for individual information and preferences on long term care and dying. Highly recommended. Paraphrased from "Ethics on Call." Every elderly person should fill one out.

VETERANS DURABLE POWER OF ATTORNEY: A form from the VA that elaborates further on the Durable Power of Attorney for Health Care.

VIATICAL SETTLEMENTS: General comments about an issue of selling your life insurance before death. Very contentious issue.

VIATICAL SETTLEMENT LINK : This site by viatical author Gloria Wolk provides some good insight to the various settlements along with the risks and warnings for people that do not do their homework. This is an involved area during the end of life that requires careful review before utilization.  

WHO WILL PROVIDE CARE: Do you really want to move in with friends or your children? Ask these questions first. See also Elderly abuse. Don't get your self in an emotional quagmire that can cause injury to both parties.

WORLD AGING MAP LINK (AARP) contains aging-related information on specific nations around the world. It includes demographic data, research reports, and other materials about dozens of nations.

WORKBOOK: This is a good tool for prospective purchasers of long term care in reviewing some of the basic issues you need to recognize before purchase. These contracts are difficult to understand and most of the companies are too new in the business to bother with.