LTC Insurance Research Articles

Application of the international classification of functioning, disability, and health to disability assessment for older people in China.

In the previous research, the Disability Assessment Scale based on ICF had been constructed for LTC insurance in China. To apply this scale in further studies, it is essential to establish assessment standards for disability levels. To establish standardized disability classification criteria and identify the disability statuses and levels in older people. This is a cross-sectional study, in which 1,610 older individuals in 15 long-term care institutions in China were assessed by the disability assessment scale based on ICF. Cluster analysis was used for classification of the disability levels. Mean (SD) and median (IQR) were used to describe the scores for each item and each dimension. The total scores of the disability assessment scale were classified into six disability levels. The overall disability level of the 1,610 participants was moderate-to-severe. The disability in the dimension of "self-care ability and activity" was the most obvious and severe. The Disability Assessment Scale is capable of identifying disability statuses and levels of older people, and it can serve as a valuable tool for investigating the disabilities among old people and for conducting cross-national comparisons of disability levels.

Study on the Dilemma of Implementing Rural LTC Insurance and the Implementation Path

Against the backdrop of China's ageing situation and the rising number of disabled persons, the Ministry of Human Resources and Social Security started to promote the construction of long-term care insurance in 2016. Compared to the mature LTC insurance models in developed Western countries, there are still many problems in the process of promoting LTC insurance in China due to the short duration of the pilot. This paper presents a synthesis of the dilemmas observed by different scholars in the process of promoting LTC insurance, and summarises the solutions and concrete implementation paths proposed by other scholars in response to these dilemmas. It can be found through the study that the lack of policies and laws, backward physical conditions and the difficulty in changing attitudes are the main reasons why it is difficult to promote LTC insurance in rural areas. Different scholars have accordingly put forward suggestions such as extending funding channels, strengthening the training of talents and creating a perfect care model.

The Effect of Business Operating Systems on Nursing Home Termination.

Objectives: Nursing home terminations have increased worldwide due to rising costs, staffing shortages, and the coronavirus disease pandemic. However, little is known about the impact that business operating systems have on nursing home termination. Methods: This study used the National Long-term Care database, which comprised 7,842 operating nursing homes in January 2018. Nursing home termination was identified when nursing homes discontinued provision of long-term care services to all residents between January 2018 and December 2020. Business operating systems that were reimbursed by the LTC insurance system were the exposure of interest. The logistic regression model for nursing home termination included a series of organizational, internal, and external factors as covariates. Results: From 2018 to 2020, 83 (1.1%) nursing homes were terminated. The proportion of reimbursed nursing homes varied greatly depending on the type of business operating systems. Implementing physical function training and improving working conditions were significantly associated with a lower risk of nursing home termination. Conclusion: Financial incentives to several business operating systems are an effective way to build a sustainable environment for nursing homes to continue to exist.

Progress and determinants of transition from non-graded older persons to being beneficiaries for long-term care insurance system: A longitudinal study

Purpose: The purpose of this study is to identify the progress of transition from the non-graded to the approved for Long-term Care Insurance (LTCI) and analyze the factors affecting becoming beneficiaries. Methods: This study was designed as a prospective cohort study. Study population was the non-graded for LTCI in 2018. We tracked and observed study population until December 2020 by using big data. Variables in the analysis consisted of the individual (socioeconomic characteristics, health status, medical service usage) and community-related (physical environment, local infrastructure, local older population, local social capacity, health policy) factors. Competing risks regression analysis was used to identify determinants of transition from the non-graded to beneficiaries for LTCI. Results: We analyzed 52,308 non-graded for LTC insurance. The average period of transition from the non-graded to beneficiaries was about 15.61 months, the cumulative transition rate for 6 months was 4.8%, and the cumulative transition rate for 36 months was 49.6%. The individual factors (higher age, female, low income, lower daily living ability, lower cognitive-behavioral score, dementia, low back pain, and lower medical expenses), as well as the community factors (rural areas) were determinants for the transition to beneficiaries. Conclusion: To prevent non-graded from being persons with LTC needs, we suggested that it is necessary to develop a policy that can establish an integrated community-based support system by selecting vulnerable groups such as rural residents and low-income groups. In addition, additional research is needed to evaluate the effect of preventive programs for the non-graded on maintaining and improving their health and functional status.

A review study of the providing elderly care services in different countries.

Background:Population aging leads to change of population structure and increase care needs. Lack of proper planning in this field will lead to occur increasing problems. In this paper, the review of the elderly care plans at various levels in some European and Asian countries, comparing these countries with Iran with the goal of using their experiences to enhance elderly plans have been done.Methods:This research was a review study of library documents and resources and systematic search. Data were collected using the resources, databases, scientific databases and websites of the Ministry of Health and Welfare of the studied countries.Results:Based on this research in the studied countries, the care services of the elderly is based on the important principle of coordination between different organs of the country, followed by the creation of LTC insurance and provision of health and social services for the elderly and mainly the type of home care. In Iran country, providing appropriate services and cares for the elderly with existing plans and policies is not possible and the need to provide appropriate service packages based on the different systems of successful countries and applying the experiences of these countries is essential.Conclusion:Given the current status of the Iranian elderly population in terms of policies and plans and the types and methods of providing services, quality, access and financial resources allocated to this age group, compared to the studied countries, there is a well and integrated plan is essential.

Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data

Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3)higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Long term care insurance with state-dependent preferences.

We study the demand for Long Term Care (LTC hereafter) insurance in a setting where agents have state-dependent preferences over both a daily life consumption good and LTC expenditures. We assume that dependency creates a demand for LTC expenditures while decreasing the marginal utility of daily life consumption, for any given consumption level. Agents optimize over their consumption of both goods as well as over the amount of LTC insurance (LTCI). We first show that some agents optimally choose not to insure themselves, while no agent wishes to buy complete insurance, in accordance with the so-called LTCI puzzle. At equilibrium, the transfer received from the insurer covers only a fraction of the LTC expenditures. The demand for LTCI need not increase with income when preferences are non state-dependent or insurance is actuarially unfair. Also, preferences have to be state-dependent with no insurance bought to rationalize the empirical observation of a higher marginal utility at equilibrium when autonomous. Finally, focusing on iso-elastic preferences, we recover the empirical observation that health/LTC expenditures are not very sensitive to income, and we show that LTCI as a fraction of income should decrease with income and then become nil above a threshold.

Retirement Planning: Reimagined and Revamped for Successful Aging

What grade should current retirement planning programs receive in which thousands of Americans participated in for their third segment of life? If success is measured by basic goal achievements that most desire (i.e. financial security, not be a burden, and avoiding institutional living), then we have failed significantly. Ninety percent of the population want to age in their own home, yet, only 30% get to. Sixty-six percent report that their employers did “nothing” to help with retirement transition; another 16% state “not sure” to what employers actually did. Seventy percent will travel through Long Term Care services in their lifetime, yet only 8% have LTC insurance. Only one-fourth of Baby Boomers are confident that they will have enough money to last through retirement. Retirement contribution starts with the first paycheck followed by 3-4 decades of employment with possible access to retirement preparedness counsel. Why, then, has planning fall short of being adequate? Are individuals too trusting of the programs from their employers or financial advisors that they don’t question completeness? Are professionals practicing in siloed spaces that they fail to realize their services may impact client’s other areas of life, especially, last years of life? Why is there a lack in a multi-disciplinary team approach which can ensure better predictability of outcomes? We propose a multi-pronged, integrated program: LifePlanning Model, which includes a coordinated, multi-disciplinary approach with a pull-it-together focus for the emerging retiree. The wholistic-based framework guides people through issues in the health, housing, financial, legal and family domains.

Gone with the windfall – Germany's Second LTC Strengthening Act and its intergenerational implications

Due to the debate about the generosity of LTC insurance benefits the German government decided to increase benefits and widen the circle of LTC beneficiaries with the Second LTC Strengthening Act. In this paper, we evaluate the long-term implications of this recent reform for the German LTC insurance scheme. Using the framework of generational accounting we show that the reform has led to a widening of the short-term gap between revenues and expenditure and that the LTC insurance is not sustainably financed, neither pre- nor post-reform. By the early 2020s there will be fiscal pressure for further reforms. From an intergenerational perspective, the reform can be seen as a windfall to current beneficiaries increasing the intergenerational redistribution through the pay-as-you-go system.

Aging and Health Care Expenditures: A Non-Parametric Approach

One of the most important controversies in health economics concerns the question whether the imminent aging of the population in most OECD countries will place an additional burden on the tax payers who finance public health care systems. Proponents of the “red-herring hypothesis” argue that this is not the case because most of the correlation of age and health care expenditures (HCE) is due to the fact that the mortality rate rises with age and HCE rise steeply in the last years before death. The evidence regarding this hypothesis is, however, mixed. Our contribution to this debate is mainly methodological: We argue that the relationship of age, time to death (TTD) and HCE should be estimated non-parametrically. Using a large panel data set from the German Statutory Health Insurance, we first show that the parametric approach overestimates the expenditures of the high age classes and thus overstates the increase of future HCE due to aging. Secondly, we show that the non-parametric approach is particularly useful to answer the question whether age still has an impact on HCE once TTD is taken into account and find that it is clearly the case. This relationship is even more pronounced for long-term care expenditures (LTCE). We then show that the age-expenditure relationship is not stable over time: for many age classes, HCE in the last year of life grow considerably faster than HCE of survivors. We explore the impact of these findings on the simulation of future HCE and find that population aging will in fact contribute to rising HCE in the coming decades. We also find that the impact of different population projections provided by the statistical offices has a greater impact on these simulations than previously acknowledged. However, the total impact of demographics on future HCE and LTCE is dwarfed by the exogenous time trend, which is due to medical progress and increasing generosity of public LTC insurance.

A Multi-State Model of Functional Disability and Health Status in the Presence of Systematic Trend and Uncertainty

This paper proposes a multi-state model of both functional disability and health status in the presence of systematic trend and uncertainty. We classify each individual observation along two dimensions: health status (other than disability) and disability and use the multi-state latent factor intensity (MLFI) model to estimate the transitions rates. The model is then used to calculate (healthy) life expectancy and price a variety of insurance products. We illustrate the importance of various factors and quantify the potential losses from model misspecification. Our results suggest that insurers should pay great attention to health status, trend, and systematic uncertainty in disability/mortality modeling and insurance pricing. We also find that integrating LTC insurance with life annuity can help to reduce the systematic uncertainties

Long Term Care Insurance with State-Dependent Preferences

We study the demand for actuarially fair Long Term Care (LTC hereafter) insurance in a setting where autonomous agents only care for daily life consumption while dependent agents also care for LTC expenditures. We assume that dependency decreases the marginal utility of daily life consumption. We first obtain that some agents optimally choose not to insure themselves, while no agent wishes to buy complete insurance. We then show that the comparison of marginal utility of income (as opposed to consumption) across health states depends on (i) whether agents do buy LTC insurance at equilibrium or not, (ii) the comparison of the degree of risk aversion for consumption and for LTC expenditures, and (iii) the income level of agents. Our results then offer testable implications that can explain (i) why few people buy Long Term Care insurance and (ii) the discrepancies between various empirical works when measuring the extent of state-dependent preferences for LTC.

A Canadian Parlor Room-Type Approach to the Long-Term Care Insurance Puzzle

We examine the different hypotheses which have been put forward to explain the low demand for long-term care insurance using the results from a survey of 2000 Canadians that was conducted in the autumn of 2016. Defining the natural market of long-term care insurance buyers as the one catering to individuals aged between 50 and 70, we find that a remarkable proportion of this natural market has never been approached to purchase such protection. We estimate that approximately 60% of this natural market is currently under-served. After eliminating risk perception and demand side explanations for the low market penetration of long-term care insurance, we conclude that supply-side factors and the crowding-out by government programs are the most likely culprits in explaining the low proportion of Canadians that purchase LTC insurance from private providers.

Uncertain altruism and the provision of long term care

When family assistance is uncertain, benefits cannot be conditioned on family aid. We study the role of private and public LTC insurance in this environment and compare the properties and optimality of the topping up versus opting out public insurance schemes. Under topping up, the required LTC is less than full insurance and should be provided publicly unless private insurance market for dependency is fair. With an opting out scheme, there will be three possible equilibria depending on the children's degree of altruism. These imply: full LTC insurance with no aid from children, less than full insurance just enough to induce aid, and full insurance with aid. Fair private insurance can support only the first equilibrium. Opting out policies are self-targeted and dominate topping up schemes when the degree of children's altruism is sufficiently large. However, when the degree of altruism is small the dominance goes in the opposite direction.

Policy Dilemmas in Financing Long‐term Care in Europe

AbstractLong‐term care (LTC) is the largest insurable risk facing the elderly in most high‐income countries. Paradoxically, institutional responses to the need to insure ex ante (i.e. before the contingency occurs) the financial risks of needing LTC, either through social, private, or self insurance, exhibit limited development. In contrast, mechanisms to finance LTC ex post continue to develop, primarily those supported by the public sector (i.e. subsidies or tax deductions) and the family (i.e. intergenerational transfers). Both ex ante and ex post types of financing mechanisms are found to be subject to shortcomings which give rise to dilemmas for public policy. Governments confront these dilemmas in different ways, causing a great deal of heterogeneity in the financing and provision of LTC services across Europe.

The Computer Competency of Nurses in Long-Term Care Facilities and Related Factors

It is important for nurses who work in long-term care facilities (LTCFs) to have an adequate level of computer competency due to the multidisciplinary and comprehensive nature of long-term care services. Thus, it is important to understand the current computer competency of nursing staff in LTCFs and the factors that relate to this competency. To explore the computer competency of LTCF nurses and to identify the demographic and computer-usage characteristics that relate significantly to computer competency in the LTCF environment. A cross-sectional research design and a self-report questionnaire were used to collect data from 185 nurses working at LTCFs in Taipei. The results found that the variables of the frequency of computer use (β = .33), age (β = -.30), type(s) of the software used at work (β = .28), hours of on-the-job training (β = -.14), prior work experience at other LTCFs (β = -.14), and Internet use at home (β = .12) explain 58.0% of the variance in the computer competency of participants. The results of the present study suggest that the following measures may help increase the computer competency of LTCF nurses. (1) Nurses should be encouraged to use electronic nursing records rather than handwritten records. (2) On-the-job training programs should emphasize participant competency in the Excel software package in order to maintain efficient and good-quality of LTC services after implementing of the LTC insurance policy.

The Impact of Systematic Trend and Uncertainty on Mortality and Disability in a Multi-State Latent Factor Model for Transition Rates

Multiple state functional disability models do not generally include systematic trend and uncertainty. We develop and estimate a multi-state latent factor intensity model with transition and recovery rates depending on a stochastic frailty factor to capture trend and uncertainty. We estimate the model parameters using U.S. Health and Retirement Study (HRS) data between 1998 and 2012 with Monte Carlo maximum likelihood estimation method. The model shows significant reductions in disability and mortality rates during this period and allows us to quantify uncertainty in transition rates arising from the stochastic frailty factor. Recovery rates are very sensitive to the stochastic frailty. There is an increase in expected future lifetimes as well as an increase in future healthy life expectancy. The proportion of lifetime spent in disability on average remains stable with no strong support in the data for either morbidity compression or expansion. The model has widespread application in costing of government funded aged care and pricing and risk management of LTC insurance products.

Managing Retirement Risks with Reverse Mortgage Loans and Long-Term Care Insurance

Health status and health costs a major longevity risk in retirement. Health state important in retirement planning (Ameriks et al., 2011; Yogo, 2009). Large component of wealth in illiquid home equity (Home-ownership rate: 80% for 65 ). Housing and LTC are complementary ways of financing or insuring health costs (Davido, 2010). LTC costs are increasing and the increase is projected to continue (Congressional Budget Office, 2004; Shi and Zhang, 2013). Australia: government requires co payment for LTC costs, potential use of home equity to fund costs. U.S.: Medicaid and Medicare private insurance personal payment. The private LTC insurance market is an important supplement (Glendinning et al., 2004; Colombo et al., 2011).

LTC Community Wants Inclusion in Reform

LTC Community Wants Inclusion in Reform

A Study on the Screening System of the National LTC Insurance in Korea : Focusing on the Relationship between the Nursing Service Time and the Functional Statuses of Elders:

A Study on the Screening System of the National LTC Insurance in Korea : Focusing on the Relationship between the Nursing Service Time and the Functional Statuses of Elders: