Published Articles/Studies:
· Life Settlements vs. STOLI: Let’s Get the Debate Straight
(published December, 2008 - ProducersWEB)
· Understanding the Differences between Stranger Owned Life Insurance (STOLI)and Life Settlements
(published December, 2008 - On the Risk)
· Life Settlements vs. STOLI
(published December, 2008 - Insurance News Net Magazine)
· Underwriting the “Silver Tsunami”
(published November, 2008 - ProducersWEB)
· Alternative Pay Plan
(published October, 2008 - Assisted Living Executive (magazine of ALFA)
· Economic Storms and Quality of Life in the Wake of the “Silver Tsunami”
(published September, 2008 - ProducersWEB, and ISIS)
· The Silver Tsunami (magazine cover story) and WHITE PAPER
(published August, 2008 - Insurance News Net Magazine )
· WHITE PAPER- Life Settlements: Looking for a Calm Financial Harbor in a “Perfect Storm”
(published July, 2008)
· Underwriting in the 21st Century: Informals—Turning a Pain into Profits
(published June, 2008 - On the Risk, and InsuranceNewsNet, June, 2008, ProducersWEB,
July, 2008)
· Life Settlements: Protecting the Golden Goose
(published April, 2008 - Insurance News Net Magazine)
· Underwriting in the 21st Century: Exploring the Direct-to-Consumer Channel
(published September, 2007 - On the Risk, and InsuranceNewsNet, September, 2007, ProducersWEB,
November, 2007, posted on SmartBrief)
· Aging and Long-Term Care Insurance: A National Policy Perspective
(published August, 2007 - Society of Actuaries: Long Term Care Section Newsletter, and
InsuranceNewsNet, September, 2007, ProducersWEB, September, 2007, posted on SmartBrief)
· Underwriting in the 21st Century: Remote Underwriting Study 2007 (Underwriting in your Underpants)
(published June, 2007 - On the Risk)
· Underwriting in the 21st Century: Understanding the Risks of Private Aviation
(published March, 2007 - On the Risk and InsuranceNewsNet, July, 2007 World News Network, July, 2007, ProducersWEB, October, 2007)
· INDUSTRY STUDY- Underwriting in your Underpants: Remote Underwriting Study 2006-2007
(Released at 37th Annual MUD Meeting as reported by National Underwriter, January, 2007, and featured by Insurance News Net, January, 2007, InsureIntell, February, 2007, Hot Notes by Hank George, 2007, posted on SmartBrief)
· Bringing Together the Pieces of the Insurance Puzzle by Understanding the Lifecycle of a Policy
(published February, 2007 - InsuranceNewsNet and HealthDecisions, InsureIntell, April, 2007, ProducersWEB, August, 2007)
· Breaking Down Barriers Between Underwriting and Distribution
(published January, 2007 – InsuranceNewsNet and InsureIntell, February, 2007; ProducersWEB, July, 2007)
· Overcoming the Underwriting Crunch through Outsourcing
(published January, 2007 – InsuranceNewsNet and InsureIntell, February, 2007)
· Underwriting in the 21st Century: Life Outside the Home Office
(published December, 2006 - On the Risk and InsuranceNewsNet, March, 2007, ProducersWEB, August, 2007)
· Underwriting in the 21st Century: Mastering the APS Paradox
(published September, 2006 - On the Risk and InsuranceNewsNet, February, 2007, InsureIntell, February, 2007, ProducersWEB, September, 2007)
· Underwriting As A Profit Center: Bringing Together the Pieces of the Puzzle
(published June, 2006 - On the Risk)
· How Insurance Companies Benefit from Professionally Summarized (APS) Attending Physician Statements
(published June, 2006 – InsuranceNewsNet and HealthDecisions)
· Underwriting As A Profit Center or How I Survived The 21st Century
(published December, 2005 - On the Risk)
Thursday, August 7, 2008
WHITE PAPER- Life Settlements: Looking for a Calm Financial Harbor in a Perfect Storm
Life Settlements: Looking for a Calm Financial Harbor in a “Perfect Storm”
Executive Summary
The U.S. is facing a three front crisis that poses long lasting implications for the providers of senior housing and senior care:
The economy is currently in its worst slump since the great depression, and we may never see home values or commodity prices (fuel, groceries, etc.) return to where they were just a year ago.
The 65+ population is about to explode with the aging of the Baby Boomers, and as they age we will see life expectancies continue to increase.
Governmental budgets will be pushed more and more to the breaking point trying to fund the care of the exploding senior population through Social Security, Medicare, and in particular, Medicaid.
The senior housing and senior care industry is only beginning to come to grips with this “perfect storm” of demographic and economic factors-- and how it will impact the financing of their services. Adaptation and creativity will be necessary to stay ahead of the evolving U.S. socio-economic landscape.
In this paper we explore how a market innovation that emerged over the last decade called a “Life Settlement”, is now being used as an alternative funding mechanism for the entire continuum of senior housing and care.
Introduction: Stormy Seas Ahead
We see the headlines everyday.
Study Finds Increases in Nursing Home, Assisted Living Costs
Genworth study tracks fifth straight year of cost increases, trend to continue with Baby Boomers
-- AP Newswire April 29, 2008
Americans Delay Retirement as Housing, Stocks Swoon
Nest Eggs Shrink; Deferring Dreams
--
getCSS("3088867")
Wall Street Journal April 1, 2008
Bleak Retirements for 150 Million?
Majority of Americans aren’t saving nearly enough; expenses they’ll face are sobering
--
getCSS("3088867")
MSN Money.com MarketWatch March 28, 2008
Housing prices to free fall in 2008 - Merrill
According to a Merrill Lynch report, home prices will drop 15 percent this year, and declines will continue in 2009 (and 2010).
-- CNNMoney.com staff writer January 23, 2008
Only 1 in 4 U.S. Adults Think They Can Pay for Long-Term Care
74% Confident they do not have enough money, 33% Unsure
-- SeniorJournal.com February 1, 2006
The economy is besieged by slumping home sales and foreclosures, erratic stock prices, imploding sub-prime mortgage portfolios, and people’s incomes are being eaten up at an alarming rate by the increasing cost of goods and fuel. But for the most vulnerable of our population, seniors facing health and long term care challenges, the added pressures of this down economy have created a “perfect storm”.
The combined impact of these negative economic conditions, and the pressure on public programs to meet the increasing demand to fund senior care, is creating a surging tide for seniors that threaten to put many underwater. The undeniable goal of government is for individuals to cover senior housing and long term care expenses with more and more private funds. But very few have managed to accumulate enough savings to independently sustain years of quality lifestyle and care. Now, compounding this problem is the fact that traditional sources of funds are drying up as the housing and stock markets swoon.
According to a MSN Money.com Market Watch report (March 28, 2008) “a sixty five year old couple retiring now would need more than $300,000 set aside just to pay for health care costs over twenty years and would need $550,000 if they were to live into their early nineties.” Particularly alarming, according to the report, is the fact that these numbers, “haven’t factored in the costs of nursing homes, assisted living facilities or home health aides—and those costs are staggering!” The reality is that very few people will have half a million dollars to cover health care costs-- without even accounting for the costs associated with long term care and retirement living. Most people will depend on public funds to take care of them, but as the Baby Boom generation swells the number of seniors age 65 and over, those public funds will become harder and harder to access. Many others that are relying on equity built up in their homes or stocks are finding out now just how risky that proposition can be.
Fortunately, a financial tool has emerged that can provide a readily available source of funds for seniors that own a life insurance policy. It is called a Life Settlement, and very quickly it is becoming a financial tool for retirement living and skilled nursing facilities. In the face of falling home and stock values, rising inflation, and depleted savings; generating cash through a Life Settlement is rapidly becoming a welcome and much needed financial alternative to these strained resources.
A New Financial Option Emerges
The definition of a Life Settlement is simply this: It’s the sale of a life insurance policy by the policy holder while still alive to an institutional investor that will pay a lot more for the policy than the cash “surrender” value. The institutional investor will then carry the policy as an investment for the remaining life span of the policy owner. The Life Settlement secondary market emerged about ten years ago as financial institutions began competing to buy and hold people’s life insurance policies as investments. Life insurance values are guaranteed and disconnected from the economy so there is no fluctuation, as is the case with real estate and stocks. Understanding the significance of owning a life insurance contract with guaranteed value, all of the major players on Wall Street (Morgan, Chase, Goldman, UBS, Deutsch Bank, AIG, etc.), as well as major hedge funds and global financial institutions are now buying people’s policies on a mass scale.
A Life Settlement can be thought of similarly to a Reverse Mortgage. It is an alternative way for seniors to tap into an existing asset to generate liquidity to cover immediate needs —but there are also important differences:
- A Reverse Mortgage is a loan that must be paid back, with interest and fees, once the secured property is no longer the primary residence (a prohibitive requirement for someone seeking to move into a senior housing or care facility).
- A Life Settlement is the sale of a life insurance policy to a third party while the policy owner is still alive for a lump sum payment-- and since it is not a loan, the funds are unrestricted and require no repayment.
The Long Term Care Crisis Grows
People seldom plan for a crisis and instead are forced to react to it when it is upon them. A recent study on how choices are made about senior housing and senior care showed three all too familiar patterns:
13% actively plan for retirement and how they will live as they grow older and frailer
40% actively plan following a “near catastrophic” health event such as total joint replacement or extended illness
46+% never plan and must make decisions about site of care in a very short period of time, usually while still in the hospital
The problem is that the combined impact of our nation’s economic strains and people’s tendency to not plan and save threatens to sink the vast majority of people’s chances for quality “golden years”. Compounding the stress on the system is the fact that by 2020, the population of 65+ will increase 48% and the population of 85+ will increase 43%. The growth of the 65+ population will be attributable mostly to the aging of the Baby Boomers, but the growth of the 85+ population is primarily a factor of increasing life expectancy.
Currently in the U.S. there are over 1.5 million people living in nursing homes. Of that population, 72% are female and the 85+ population is growing the fastest with a 20% increase. The oldest old are living longer and they are costing more than ever to support with private or public funds. This is important to consider when planning for the future because as of today, 56% of residents will live in a nursing home anywhere from one to five years or more (with a national average of 30 months).
For the population of 900,000 people currently living in assisted living facilities, the vast majority of financing is private pay. In addition to the monthly cost for a room, apartment or cottage; residents may also face one-time entrance fees ranging from $60,000-$350,000 for higher end “resort style” properties. Additional monthly fees ranging from $348-$522 are often times charged for transportation, dementia care, meal delivery to residence, and other extras that would add to quality of life.
As of 2000, the most recent year for data, there were 1,355,290 people receiving some form of extended home-based healthcare. Of that population, 70% were 65+ and 65% were female. The average time span of care was for 312 days, and over 93% of the care was being delivered by Medicare/Medicaid certified agencies.
Fast Fact
Current national average costs across the three categories of long term care for 2008
Home/Community-
Non-Medicare Certified, Licensed “Companion” Care - $18/hr (4% over 2007)
Non-Medicare Certified, Licensed “Home Health Aide” - $19/hr (3% over 2007)
Medicare Certified “Home Health Aide” - $38/hr (18% over 2007)
Adult Day Health Care Center - $61 per day
Assisted Living Facility-
Private One Bedroom - $3,008 per month (11% over 2007)
Nursing Home-
Semi-Private Room - $187 per day (4% over 2007)
Private Room - $209 per day (2% over 2007)
With the reality of these kinds of costs and the growing senior population; we will see increasing pressure on publicly funded programs such as Medicare and Medicaid (which combined pays for roughly 80% all long term care related expenses in the U.S.) and moves to make it more difficult to qualify. The long term care industry and the government at all levels are in agreement. More emphasis must be placed on the individual to pay for as much care and housing as possible with private funds before any public funds are made available. But what are some private funding options that people should be considering?
An obvious source of funds to cover these expenses would be from long term care insurance. The only problem is that tax deductions have never been established that would incentivize growth in the market, and it has been stalled for over a decade. As of today, long term care insurance accounts for an anemic single digit percentage of all funding for senior housing and care. That leaves private pay to pick up close to 20% of the approximate total of $200 billion spent on all long term care service last year. But where do those funds come from if you have not saved literally hundreds of thousands in cash?
A primary option that people have often looked to is cashing in their home through a sale to raise the funds to sustain themselves (or to meet spend down requirements). But, the current real estate market has taught us, as is the case with the stock market, that it is always vulnerable to a correction. Another means to extract equity from a home could be through a reverse mortgage, and it might be a good option for a home healthcare arrangement, but what happens if health conditions deteriorate rapidly and the person must move into a facility on short notice? The home owner is then faced with the dilemma of funds that can’t be used for a setting outside of the home, and a loan that must be paid back immediately.
If a person has built up cash value in a life insurance policy, they could consider taking a loan against the policy or surrendering it for the cash value. Also, if someone attempts to qualify for Medicaid, a life insurance policy would be an “unprotected” asset subject to the 60 month look back period, and it would need to be liquidated and spent down on care before eligibility could begin. According to a Federal Government Accounting Office (GAO) report released to the U.S. Congress in March, 2007: when examining a sample population of over 500 Medicaid applicants entering long term care facilities, 38% owned a life insurance policy that needed to be liquidated because it exceeded minimum state mandated asset levels. Statistical data gathered on policies “settled” in 2007 continues to verify that the difference between the amounts of money that can be realized through a Life Settlement is significantly greater than through cash “surrender” value.
When cashing out a life insurance policy, either by choice or because of an eligibility mandate, the superior option is a Life Settlement. This process will ensure that the highest possible value is obtained for the policy through bidding from multiple institutional sources in the secondary market. Also, any tax implications for capital gains realized from a Life Settlement would be offset by deductions based on spending the money for “the entire cost of maintenance in a nursing home or home for the aged” (sec. 1016 U.S. Master Tax Code 2008). When the time comes to look at funding vehicles to pay for long term care related expenses, cashing in a life insurance policy through a Life Settlement could be an excellent financial move.
Storm Clouds Begin to Clear
For seniors faced with the uncertain prospect of selling their home, securities or savings in such a down economy, Life Settlements are not only a chance to consider accessing an asset that will not fluctuate in value, but it is also an opportunity to liquidate a less dearly held asset. People obviously have a sentimental attachment to their home, stocks and other personal assets. This can cause delays in moving forward—but people have no sentimental attachment to an insurance policy and are more willing to liquidate it as a first option. If you can eliminate the reluctance seniors have about tapping into their most dearly held assets, and in the process eliminate the worry seniors have about outliving their money, then you can eliminate the delays in making a commitment to a course of action.
This is not just a financial tool-- it is also a great marketing and relationship building opportunity by providing another option for prospective and current residents to find money to pay for residency and services. Properties are able to remove reasons for delay, and can provide peace of mind for seniors about prematurely running out of money. It is also another opportunity to reach out to residents and prospects and show them that you are actively looking to work with them because you care about their well being.
How Life Settlements are Being Used to Pay for Senior Housing and Care
The majority of people who can be helped by a Life Settlement are first encountered during the admissions/registration process. People who are living independently and have recently encountered a pressing need to understand their options about the best retirement or long term living scenario, and how to pay for it, will be those most likely to possess some measure of financial means and own a life insurance policy. Typically social workers, the marketing department or the administrative/admissions office will be in a position to offer this as an option when people are considering their finances. There may also be some current residents that still own policies and need help raising money (and they would most certainly be eligible), but primarily it will be those living independently who have not yet altered their finances that will be most readily helped.
The process of a Life Settlement is straightforward and takes between 30-60 days-- obviously much quicker than relying on the sale of a home. Remember, this is not a loan, not a government program and not long term care insurance—it is the sale of an asset through a competitive bidding process that will provide the policy owner with a lump sum payment for a far greater amount than the cash surrender value. Once a policy owner sells their policy, they are no longer responsible for the premiums and they are free to use the money anyway they want. Also important to note is that there are absolutely no costs involved for the facility, and no up front fees or out of pocket expenses involved for the policy owner.
In the case of people entering a private pay arrangement directly or after a Medicare funded “short term” stay is over, how to raise enough money to last indefinitely could be one of the biggest emotional and financial challenges of their life. For those intimidated by the thought of selling their home or liquidating other assets to secure the funds they will need, a Life Settlement is a welcome alternative source of funds to access.
Anyone that owns life insurance and will rely on Medicaid to cover expenses associated with their care will be required to cash in the policy if its face value exceeds state mandated asset levels. The proceeds must then be spent down to cover the cost of care before Medicaid coverage can begin. If they decide to hold onto a policy, the beneficiaries could be subject to asset recovery efforts once the policy owner is deceased. The owner of a life insurance policy in this situation would be well served to explore the benefits of a Life Settlement. They could receive significantly more money than the cash “surrender” value that would be given to them by an insurance company-- and in turn sustain a private pay arrangement for a much longer period of time.
Conclusion: A Win – Win Scenario
According to the Society of Actuaries’ 2007 Retirement Survey: 60% of retirees worry about three things--
The cost of health care
The effect of inflation on their nest eggs
Not being able to maintain a reasonable standard of living for the rest of their lives
With today’s economy those concerns are well founded. There is billions of dollars worth of life insurance owned by people over the age of 65 today-- tapping into Life Settlements as an alternative funding option for senior housing and care makes a lot of sense. Any chance to overcome financial hurdles preventing seniors from securing the best possible arrangement is in the best interest of the individual and their family, the facility and the government. Life Settlements are an easy to understand and straightforward financial tool to accomplish the goal of welcoming a resident who is able to afford living without fear of running out of money.
Sources
AARP Public Policy Institute, Across the States Profiles of Long Term Care and Independent Living, Seventh Edition 2006
Genworth Financial, 2008 Costs of Care Survey, April 2008
Government Accounting Office (GAO), Report to Congressional Requesters on Medicaid Long Term Care Impact of Deficit Reduction Act, March 2007
Health Care Financing Review, Winter 2002 Study
Life Policy Dynamics, 2007 Summary: U.S. Life Settlement Market Analysis, March 2008
MetLife Mature Market Institute, Demographic Profile Americans 65+, 2008
MetLife Mature Market Institute, Demographic Profile American Baby Boomers, 2008
MetLife Mature Market Institute, Market Survey of Adult Day Services & Home Care Costs, September 2007
MetLife Mature Market Institute, Market Survey of Nursing Home & Assisted Living Costs, October 2007
MSN Money.com Market Watch, Bleak Retirements for 150 Million?, March 2008
Society of Actuaries, Life Settlements 101: Introduction to the Secondary Market in Life Insurance, October 2007
United States Census Bureau
Executive Summary
The U.S. is facing a three front crisis that poses long lasting implications for the providers of senior housing and senior care:
The economy is currently in its worst slump since the great depression, and we may never see home values or commodity prices (fuel, groceries, etc.) return to where they were just a year ago.
The 65+ population is about to explode with the aging of the Baby Boomers, and as they age we will see life expectancies continue to increase.
Governmental budgets will be pushed more and more to the breaking point trying to fund the care of the exploding senior population through Social Security, Medicare, and in particular, Medicaid.
The senior housing and senior care industry is only beginning to come to grips with this “perfect storm” of demographic and economic factors-- and how it will impact the financing of their services. Adaptation and creativity will be necessary to stay ahead of the evolving U.S. socio-economic landscape.
In this paper we explore how a market innovation that emerged over the last decade called a “Life Settlement”, is now being used as an alternative funding mechanism for the entire continuum of senior housing and care.
Introduction: Stormy Seas Ahead
We see the headlines everyday.
Study Finds Increases in Nursing Home, Assisted Living Costs
Genworth study tracks fifth straight year of cost increases, trend to continue with Baby Boomers
-- AP Newswire April 29, 2008
Americans Delay Retirement as Housing, Stocks Swoon
Nest Eggs Shrink; Deferring Dreams
--
getCSS("3088867")
Wall Street Journal April 1, 2008
Bleak Retirements for 150 Million?
Majority of Americans aren’t saving nearly enough; expenses they’ll face are sobering
--
getCSS("3088867")
MSN Money.com MarketWatch March 28, 2008
Housing prices to free fall in 2008 - Merrill
According to a Merrill Lynch report, home prices will drop 15 percent this year, and declines will continue in 2009 (and 2010).
-- CNNMoney.com staff writer January 23, 2008
Only 1 in 4 U.S. Adults Think They Can Pay for Long-Term Care
74% Confident they do not have enough money, 33% Unsure
-- SeniorJournal.com February 1, 2006
The economy is besieged by slumping home sales and foreclosures, erratic stock prices, imploding sub-prime mortgage portfolios, and people’s incomes are being eaten up at an alarming rate by the increasing cost of goods and fuel. But for the most vulnerable of our population, seniors facing health and long term care challenges, the added pressures of this down economy have created a “perfect storm”.
The combined impact of these negative economic conditions, and the pressure on public programs to meet the increasing demand to fund senior care, is creating a surging tide for seniors that threaten to put many underwater. The undeniable goal of government is for individuals to cover senior housing and long term care expenses with more and more private funds. But very few have managed to accumulate enough savings to independently sustain years of quality lifestyle and care. Now, compounding this problem is the fact that traditional sources of funds are drying up as the housing and stock markets swoon.
According to a MSN Money.com Market Watch report (March 28, 2008) “a sixty five year old couple retiring now would need more than $300,000 set aside just to pay for health care costs over twenty years and would need $550,000 if they were to live into their early nineties.” Particularly alarming, according to the report, is the fact that these numbers, “haven’t factored in the costs of nursing homes, assisted living facilities or home health aides—and those costs are staggering!” The reality is that very few people will have half a million dollars to cover health care costs-- without even accounting for the costs associated with long term care and retirement living. Most people will depend on public funds to take care of them, but as the Baby Boom generation swells the number of seniors age 65 and over, those public funds will become harder and harder to access. Many others that are relying on equity built up in their homes or stocks are finding out now just how risky that proposition can be.
Fortunately, a financial tool has emerged that can provide a readily available source of funds for seniors that own a life insurance policy. It is called a Life Settlement, and very quickly it is becoming a financial tool for retirement living and skilled nursing facilities. In the face of falling home and stock values, rising inflation, and depleted savings; generating cash through a Life Settlement is rapidly becoming a welcome and much needed financial alternative to these strained resources.
A New Financial Option Emerges
The definition of a Life Settlement is simply this: It’s the sale of a life insurance policy by the policy holder while still alive to an institutional investor that will pay a lot more for the policy than the cash “surrender” value. The institutional investor will then carry the policy as an investment for the remaining life span of the policy owner. The Life Settlement secondary market emerged about ten years ago as financial institutions began competing to buy and hold people’s life insurance policies as investments. Life insurance values are guaranteed and disconnected from the economy so there is no fluctuation, as is the case with real estate and stocks. Understanding the significance of owning a life insurance contract with guaranteed value, all of the major players on Wall Street (Morgan, Chase, Goldman, UBS, Deutsch Bank, AIG, etc.), as well as major hedge funds and global financial institutions are now buying people’s policies on a mass scale.
A Life Settlement can be thought of similarly to a Reverse Mortgage. It is an alternative way for seniors to tap into an existing asset to generate liquidity to cover immediate needs —but there are also important differences:
- A Reverse Mortgage is a loan that must be paid back, with interest and fees, once the secured property is no longer the primary residence (a prohibitive requirement for someone seeking to move into a senior housing or care facility).
- A Life Settlement is the sale of a life insurance policy to a third party while the policy owner is still alive for a lump sum payment-- and since it is not a loan, the funds are unrestricted and require no repayment.
The Long Term Care Crisis Grows
People seldom plan for a crisis and instead are forced to react to it when it is upon them. A recent study on how choices are made about senior housing and senior care showed three all too familiar patterns:
13% actively plan for retirement and how they will live as they grow older and frailer
40% actively plan following a “near catastrophic” health event such as total joint replacement or extended illness
46+% never plan and must make decisions about site of care in a very short period of time, usually while still in the hospital
The problem is that the combined impact of our nation’s economic strains and people’s tendency to not plan and save threatens to sink the vast majority of people’s chances for quality “golden years”. Compounding the stress on the system is the fact that by 2020, the population of 65+ will increase 48% and the population of 85+ will increase 43%. The growth of the 65+ population will be attributable mostly to the aging of the Baby Boomers, but the growth of the 85+ population is primarily a factor of increasing life expectancy.
Currently in the U.S. there are over 1.5 million people living in nursing homes. Of that population, 72% are female and the 85+ population is growing the fastest with a 20% increase. The oldest old are living longer and they are costing more than ever to support with private or public funds. This is important to consider when planning for the future because as of today, 56% of residents will live in a nursing home anywhere from one to five years or more (with a national average of 30 months).
For the population of 900,000 people currently living in assisted living facilities, the vast majority of financing is private pay. In addition to the monthly cost for a room, apartment or cottage; residents may also face one-time entrance fees ranging from $60,000-$350,000 for higher end “resort style” properties. Additional monthly fees ranging from $348-$522 are often times charged for transportation, dementia care, meal delivery to residence, and other extras that would add to quality of life.
As of 2000, the most recent year for data, there were 1,355,290 people receiving some form of extended home-based healthcare. Of that population, 70% were 65+ and 65% were female. The average time span of care was for 312 days, and over 93% of the care was being delivered by Medicare/Medicaid certified agencies.
Fast Fact
Current national average costs across the three categories of long term care for 2008
Home/Community-
Non-Medicare Certified, Licensed “Companion” Care - $18/hr (4% over 2007)
Non-Medicare Certified, Licensed “Home Health Aide” - $19/hr (3% over 2007)
Medicare Certified “Home Health Aide” - $38/hr (18% over 2007)
Adult Day Health Care Center - $61 per day
Assisted Living Facility-
Private One Bedroom - $3,008 per month (11% over 2007)
Nursing Home-
Semi-Private Room - $187 per day (4% over 2007)
Private Room - $209 per day (2% over 2007)
With the reality of these kinds of costs and the growing senior population; we will see increasing pressure on publicly funded programs such as Medicare and Medicaid (which combined pays for roughly 80% all long term care related expenses in the U.S.) and moves to make it more difficult to qualify. The long term care industry and the government at all levels are in agreement. More emphasis must be placed on the individual to pay for as much care and housing as possible with private funds before any public funds are made available. But what are some private funding options that people should be considering?
An obvious source of funds to cover these expenses would be from long term care insurance. The only problem is that tax deductions have never been established that would incentivize growth in the market, and it has been stalled for over a decade. As of today, long term care insurance accounts for an anemic single digit percentage of all funding for senior housing and care. That leaves private pay to pick up close to 20% of the approximate total of $200 billion spent on all long term care service last year. But where do those funds come from if you have not saved literally hundreds of thousands in cash?
A primary option that people have often looked to is cashing in their home through a sale to raise the funds to sustain themselves (or to meet spend down requirements). But, the current real estate market has taught us, as is the case with the stock market, that it is always vulnerable to a correction. Another means to extract equity from a home could be through a reverse mortgage, and it might be a good option for a home healthcare arrangement, but what happens if health conditions deteriorate rapidly and the person must move into a facility on short notice? The home owner is then faced with the dilemma of funds that can’t be used for a setting outside of the home, and a loan that must be paid back immediately.
If a person has built up cash value in a life insurance policy, they could consider taking a loan against the policy or surrendering it for the cash value. Also, if someone attempts to qualify for Medicaid, a life insurance policy would be an “unprotected” asset subject to the 60 month look back period, and it would need to be liquidated and spent down on care before eligibility could begin. According to a Federal Government Accounting Office (GAO) report released to the U.S. Congress in March, 2007: when examining a sample population of over 500 Medicaid applicants entering long term care facilities, 38% owned a life insurance policy that needed to be liquidated because it exceeded minimum state mandated asset levels. Statistical data gathered on policies “settled” in 2007 continues to verify that the difference between the amounts of money that can be realized through a Life Settlement is significantly greater than through cash “surrender” value.
When cashing out a life insurance policy, either by choice or because of an eligibility mandate, the superior option is a Life Settlement. This process will ensure that the highest possible value is obtained for the policy through bidding from multiple institutional sources in the secondary market. Also, any tax implications for capital gains realized from a Life Settlement would be offset by deductions based on spending the money for “the entire cost of maintenance in a nursing home or home for the aged” (sec. 1016 U.S. Master Tax Code 2008). When the time comes to look at funding vehicles to pay for long term care related expenses, cashing in a life insurance policy through a Life Settlement could be an excellent financial move.
Storm Clouds Begin to Clear
For seniors faced with the uncertain prospect of selling their home, securities or savings in such a down economy, Life Settlements are not only a chance to consider accessing an asset that will not fluctuate in value, but it is also an opportunity to liquidate a less dearly held asset. People obviously have a sentimental attachment to their home, stocks and other personal assets. This can cause delays in moving forward—but people have no sentimental attachment to an insurance policy and are more willing to liquidate it as a first option. If you can eliminate the reluctance seniors have about tapping into their most dearly held assets, and in the process eliminate the worry seniors have about outliving their money, then you can eliminate the delays in making a commitment to a course of action.
This is not just a financial tool-- it is also a great marketing and relationship building opportunity by providing another option for prospective and current residents to find money to pay for residency and services. Properties are able to remove reasons for delay, and can provide peace of mind for seniors about prematurely running out of money. It is also another opportunity to reach out to residents and prospects and show them that you are actively looking to work with them because you care about their well being.
How Life Settlements are Being Used to Pay for Senior Housing and Care
The majority of people who can be helped by a Life Settlement are first encountered during the admissions/registration process. People who are living independently and have recently encountered a pressing need to understand their options about the best retirement or long term living scenario, and how to pay for it, will be those most likely to possess some measure of financial means and own a life insurance policy. Typically social workers, the marketing department or the administrative/admissions office will be in a position to offer this as an option when people are considering their finances. There may also be some current residents that still own policies and need help raising money (and they would most certainly be eligible), but primarily it will be those living independently who have not yet altered their finances that will be most readily helped.
The process of a Life Settlement is straightforward and takes between 30-60 days-- obviously much quicker than relying on the sale of a home. Remember, this is not a loan, not a government program and not long term care insurance—it is the sale of an asset through a competitive bidding process that will provide the policy owner with a lump sum payment for a far greater amount than the cash surrender value. Once a policy owner sells their policy, they are no longer responsible for the premiums and they are free to use the money anyway they want. Also important to note is that there are absolutely no costs involved for the facility, and no up front fees or out of pocket expenses involved for the policy owner.
In the case of people entering a private pay arrangement directly or after a Medicare funded “short term” stay is over, how to raise enough money to last indefinitely could be one of the biggest emotional and financial challenges of their life. For those intimidated by the thought of selling their home or liquidating other assets to secure the funds they will need, a Life Settlement is a welcome alternative source of funds to access.
Anyone that owns life insurance and will rely on Medicaid to cover expenses associated with their care will be required to cash in the policy if its face value exceeds state mandated asset levels. The proceeds must then be spent down to cover the cost of care before Medicaid coverage can begin. If they decide to hold onto a policy, the beneficiaries could be subject to asset recovery efforts once the policy owner is deceased. The owner of a life insurance policy in this situation would be well served to explore the benefits of a Life Settlement. They could receive significantly more money than the cash “surrender” value that would be given to them by an insurance company-- and in turn sustain a private pay arrangement for a much longer period of time.
Conclusion: A Win – Win Scenario
According to the Society of Actuaries’ 2007 Retirement Survey: 60% of retirees worry about three things--
The cost of health care
The effect of inflation on their nest eggs
Not being able to maintain a reasonable standard of living for the rest of their lives
With today’s economy those concerns are well founded. There is billions of dollars worth of life insurance owned by people over the age of 65 today-- tapping into Life Settlements as an alternative funding option for senior housing and care makes a lot of sense. Any chance to overcome financial hurdles preventing seniors from securing the best possible arrangement is in the best interest of the individual and their family, the facility and the government. Life Settlements are an easy to understand and straightforward financial tool to accomplish the goal of welcoming a resident who is able to afford living without fear of running out of money.
Sources
AARP Public Policy Institute, Across the States Profiles of Long Term Care and Independent Living, Seventh Edition 2006
Genworth Financial, 2008 Costs of Care Survey, April 2008
Government Accounting Office (GAO), Report to Congressional Requesters on Medicaid Long Term Care Impact of Deficit Reduction Act, March 2007
Health Care Financing Review, Winter 2002 Study
Life Policy Dynamics, 2007 Summary: U.S. Life Settlement Market Analysis, March 2008
MetLife Mature Market Institute, Demographic Profile Americans 65+, 2008
MetLife Mature Market Institute, Demographic Profile American Baby Boomers, 2008
MetLife Mature Market Institute, Market Survey of Adult Day Services & Home Care Costs, September 2007
MetLife Mature Market Institute, Market Survey of Nursing Home & Assisted Living Costs, October 2007
MSN Money.com Market Watch, Bleak Retirements for 150 Million?, March 2008
Society of Actuaries, Life Settlements 101: Introduction to the Secondary Market in Life Insurance, October 2007
United States Census Bureau
Wednesday, August 6, 2008
The Silver Tsunami
The Silver Tsunami- Original Verison
(edited version published August, 2008 Insurance News Net Magazine)
Executive Summary
The approaching surge of Baby Boomers and the ever expanding ranks of the 65+ generation have been on our radar screen for years. But today, it is no longer a concept far off on in the future. The reality is that the conversion of Baby Boomers turning into bona-fide seniors is actually now upon us. The oldest Baby Boomers began qualifying to take government benefits last year, and according to the U.S. Census Bureau, in less than three years 8,000 Americans will start to become Medicare eligible every single day. This generation, from the youngest Baby Boomer to those now in their eighties, will require innovative solutions from life insurance, annuities, health and disability coverage, and long term care to address their financial needs.
But how well do we really know these people? What are their plans for the future and are they financially prepared? What are the realities that will confront them as they move across the age continuum of Baby Boomer to 65-- and then continue aging for many years to come?
In this paper we will look at statistical data from a wide range of sources to create a picture of the Baby Boomers and the 65+ seniors ahead of them. Together they are a “Silver Tsunami” that will hit the U.S. economic and social fabric with a force unprecedented in any nation’s history. We will examine the opportunities and challenges associated with this group. We will also consider the impact of economic conditions and the eventual realities that will confront them, and us all, as aging and the necessity of long term care goes from a distant concept to a frighteningly expensive reality.
Demographic Profiles
The first step in harnessing the opportunities and mastering the challenges that will come in the wake of the “Silver Tsunami” is analyzing and understanding this population that is so different from any other in U.S. history.
The “Silver Tsunami” population can be broken into two distinct cohorts:
Cohort 1- Seniors born 1939 or before that account for 35,986,082, or 12.6% of the U. S. population. The gender split is 42% male and 58% female.
Cohort 2- Baby Boomers born 1946-1964 that account for 76,402,903, or 26% of the U. S. population. The gender split is 49% male and 51% female.
These two age based groups posses unique demographic characteristics that are important to understand if one is to measure, and then fully realize the opportunities of providing financial and healthcare services to meet their needs.
Average life expectancy from age 65 increased from 77.7 to 84 years for males and 79.7 to 87 years for females in the 60 year period from 1940-2000. Life expectancy going forward into 2040 should add another 3 years on average for both males and females. The age group of 85+ is the fastest growing segment, and they are experiencing the highest gains in life expectancy on a percentage basis. Further, the population of Centenarians (age 100+) more than doubled from 37,306 in 1990 to 88,289 in 2004. Important to note with all of the life expectancy gains is that the population of 65+ living in a nursing home accounts for 1,557,800 or 4.5% of the total cohort population. Most people that move into an assisted living or nursing home are a surviving spouse, and to that end, the number of seniors surviving a deceased spouse triples when moving from the age segment 65-74 to 85+.
Fast Fact
Top 5 states of residence for the 65+ cohort as a percentage of population
- Florida (17.6%)
- West Virginia (15.6%)
- Pennsylvania (15.3%)
- Iowa (14.9%)
- North Dakota (14.7%)
- Rhode Island (14.5%)
Average household income for age 65-74 is $35,118, and then drops to $23,890 for age 75+. The 70-74 segment has the highest net worth at $120,000, but once seniors reach age 75+ their average net worth drops to $100,000. For the entire cohort of 65+, home ownership is 80% with almost 75% living unencumbered by a mortgage, but when you remove home equity from the equation, average net worth drops significantly from a high of $31,400 to a low of $19,025.
Fats Fact
Three largest expense areas for the 65+ cohort
housing and food
transportation
healthcare
Baby Boomers account for 48% of U.S. families with 45 million households, and spending power of over $2 Trillion. The younger Boomers born between 1956 and 1964 have an average household population of 3.3 people (with 1 or more children), and an average annual income of $56,500 of which they spend $45,149. The older Boomers born between 1946 and 1955 have an average household population of 2.7 people (with 1 or no children), and an average annual income of $58,889 of which they spend $46,160. 69% of younger Boomers own their homes and devote a larger share of their monthly budgets to mortgage payments. This group also spends about 10% less than the average on life and other forms of personal insurance, while the older Boomers spend 20% more than the average.
Fast Fact
Over 50% of the Baby Boomers live in nine states
California, Texas, New York, Florida, Pennsylvania, Illinois, Ohio, Michigan, and New Jersey.
The population of 65+ will increase 48% and the population of 85+ will increase 43% by 2020. The growth of the 65+ population will be attributable mostly to the aging of the Baby Boomers, but the growth of the 85+ population is primarily a factor of increasing life expectancy. Currently, there are three states where the 65+ population exceeds 15% of the states total: Florida, Pennsylvania, and West Virginia. That number will grow to 42 states by 2020.
When it comes to tracking and categorizing the financial habits of the growing populations of Baby Boomers and Seniors, Claritas developed an effective demographic segmentation system called P$ychleNE (for more information visit www.claritas.com) which is particularly insightful for producers of annuity and life insurance products. Their system breaks down U.S. households by financial behavior across 58 segments within 13 life stage groups going back to 1987. For our two cohorts, the 65+ seniors of cohort 1 and the Baby Boomers of cohort 2, P$ychleNE segments them into two unique groups, and then two more that they share with similar characteristics regardless of age classification. Based on their financial behavior, the segments break out across the following primary classifications and related sub-sets that describe key aspects of their life style and spending habits:
Cohort 1
- Wealthy Seniors (Five sub-sets of 65+ retired and living in comfortable suburban homes with substantial nest eggs)
o Globetrotters
o Golden Agers
o Civic Spirits
o Savvy Savers
o Annuity-Ville
- Mid-scale Matures (Four sub-sets of 65+ with working class wages and modest income producing assets)
o Early-Bird Specials
o Conservative Couples
o Senior Solitaire
o Old Homesteaders
Cohort 2
- Boomer Comfort (Five sub-sets of educated, well-off, tech savvy professionals with six figure incomes, strong performing assets and receptivity to insurance products)
o Power Couples
o Big Spenders
o Jumbo Mortgagees
o Bargain Lovers
o Suburban Scramble
- Financial Elite (Two sub-sets of the most affluent segment in the U.S. with the highest income producing assets, highest incomes, and large sums of money to manage across stocks, real estate, insurance, and annuities)
o Wealth Market
o Business Class
Cohort 1 and 2 Blend
- Upscale Empty Nesters (Four sub-sets of well-off 55+ with sizable income producing assets and retirement accounts with large portfolios of securities and real estate as well as accumulators of insurance and annuities typically with the assistance of financial planners and insurance agents)
o Retiree Chic
o Leisure Land
o Travel & Antiques
o Comfortably Retired
- Retirement Blues (Five sub-sets of 55+ with low levels of income and assets and very modest life styles)
o Retirement Ready
o Hunters & Collectors
o Urbanistas
o Senior City Blues
Impaired Risk
Underwriting impaired risk tends to be more prevalent with our two cohorts, particularly with the 65+ group. This is one of the faster growing segments for the insurance industry with life, annuity and long term care products. This is also becoming an important area for group and work site benefits such as health, disability and disease specific insurance. According to the U.S. Department of Labor, the number of employed people still working between the ages of 65 and 90 has increased from 4.7%, or 600,000 people a decade ago, to 6.4%, or now over 1 million people. This means that the numbers of workers age 65 and over accessing benefits through employers will continue to grow with these evolving economic and life expectancy trends.
Over the last decade, advancements in underwriting and actuarial models, as well as medical science, have made it possible to price all insurance products at competitive rates in ways that once was unavailable to this age group. Underwriting seniors is a different process than underwriting “unimpaired” or relatively young and healthy applicants.
Fast Fact
Top health conditions that become causes of death for those 65+
- Vascular
- Cancer
- Stroke
- Dementia
- Influenza
Once people reach age 65: 80% of seniors report having at least one chronic condition, 50% report at least two, and 30% report having three or more chronic conditions. Additionally, 30% of people 65-70 have reported vascular issues and that number jumps to 70% once you get past the age of 70!
Beyond the obvious underwriting screens that are typically looked for; factors such as recent cessation of smoking, sudden weight loss, frailty and use of assistive devices, ADL impairments, MVR history and work/volunteering/travel schedules are scrutinized more closely with the 65+ group. Underwriting tools that can be used to measure impaired risk include Pulmonary Function Exams to measure decline of lung function, eGFR to measure kidney filtration, Serum Albumin levels as an indicator of “all-cause” mortality risk factors, and MMSE Cognitive Assessments to measure deterioration of visual, verbal, concentration, and orientation levels.
Another important health screen for this cohort is any recent history of falls and broken bones. There is at least a 30% chance that a person will need to move into a nursing home after a fall, and only 33% regain their pre-fall physical condition. Also, there is as high as a 35% chance of death within the first year of a fall.
As the individual ages, certain health conditions shift from being of concern to the norm. For example, seniors will typically experience a slowing of reflexes and loss of muscle mass. Renal and liver functions, as well as pulmonary and vascular capacity can all be expected to decrease. Cognitive abilities will begin to slow, and a certain level of “memory challenge” (not to be confused with Alzheimer’s Disease) will creep into the picture. Also, conditions such as cancer or heart disease that are long in remission, under control and/or being managed by medication become less of a factor in determining overall mortality and morbidity.
Level of education has a direct correlation to income, which in turn has also been proven to have a direct impact to overall health. Baby Boomers are the most educated generation in U.S. history with almost 90% completing high school and then 28.5% going on to earn at least a masters degree. The bottom line is that the better educated someone is, then the higher their income will be and in turn they can expect to be in better health and live longer.
Lastly, an important life expectancy concept to understand is “Morbidity Compression”. Current life expectancy trends indicate that more people than ever are living at a relatively healthy state up to average target ages based on their demographics. But if a person experiences any significant health impairment, then their remaining life expectancy usually becomes compressed. For example, a healthy individual in the 75-80 age range that lives at home, is able to care for and transport themselves, and pursues leisure vocations and social interaction could have a life expectancy of ten or twenty years. But if that individual experiences a TIA/stoke or breaks a hip, and then must either access home care or move into an assisted living or skilled nursing facility, it is more likely that the life expectancy range would compress to less than five years.
The Wild Card: Economic Challenges
There are two inextricably linked fundamentals that determine the quality of life for Baby Boomers and seniors: health and finances. As they age and life expectancies compress, there is less time and vitality available to recover from injury and illness. The same is true of financial “vitality”. People in their thirties and forties have time to recover from set backs in the stock market, housing values, or business and investment fluctuations. Once people reach their sixties, it is too late to start a meaningful savings program (as the benefits of compound interest have long since abated) and if investments and/or property are underperforming there may be little time available to wait for recovery.
Retirements funded by a corporate pension after a life time of service are almost extinct in this country. Beyond Social Security and Medicare, the vast majority of Americans today rely on equity in their homes to be a major component of their retirement. For seniors facing major costs such as health care and long term care, the current state of the economy could not be worse. The impact of the sub-prime mortgage implosion on credit and equities markets has resulted in a huge hit on many American’s net worth via erosion in home equity. In fact the National Association of Home Builders released a report in June of 2008 citing that, $426 billion of equity in the U.S. has vanished. That is almost half a TRILLION dollars taken away from Americans in less than two years!
During an interview with former Federal Reserve Chairman Alan Greenspan in July, 2008 he was quoted as saying that the U.S. housing market is nowhere near the bottom and that our economy is teetering on the brink of recession. He described the confluence of economic factors currently battering the U.S. a once in a century “phenomenon”. Validating his concerns is the most recent reports released on foreclosures showing a 55% increase from July of 2007 to July of 2008. That translates into 1 in every 464 households in this country foreclosed in July, 2008. Maybe even more alarming is the 184% increase in bank repossessions during the same time period. The top states in the country for foreclosures is Nevada, California, Florida, Ohio, Georgia, Michigan, Colorado, Utah, Virginia, Texas, Illinois, and New York.
When Greenspan talks about this “phenomenon” he is talking about the combination of the real estate woes and the alarming pace of inflation in core areas such as food and fuel costs. The impact of these two areas has been causing huge swings on an almost daily basis in the stock market furthering adding to people’s concerns. Energy prices are up almost 30% for the year and food prices have increased 6%. Even with recent declines in oil prices and a drop at the fuel pump, oil prices are still double what they were in the summer of 2007 and grain prices are double what they were in the summer of 2006.
The impact that this is having on seniors is very serious. Home equity is in reverse and savings and equities are being chewed up by inflation and stock market losses. Social programs such as Social Security are not doing much better with the smallest benefit increase in the last four years at 2.3% for 2008. According to the AARP, the number of seniors filing for bankruptcy over the age of 55 in the last year was about 250,000. At this pace, the recent study by Ernst & Young LLP showing that three out of every five new middle class retirees will outlive their financial assets if they do not downwardly adjust their standard of living (expenses) by 24%-37% looks to be optimistic.
During good times, equity in homes and the growth of the stock market can propel a high standard of living in retirement and also help to fund the expenses associated with health care and long term care. But during hard times, when these critical economic engines are not cooperating the outlook can change drastically.
Long Term Care Crisis
The double-edged sword of the senior market is the long term care crisis. Everyone will eventually need to secure some form of long term care and/or assisted living, but no one likes to think about it today and making plans for the future is easily put off until later. In fact, the long term care crisis in the United States is a lot like global warming. There is no denying it is happening and that you are going to be impacted—but it seems like it is far enough away into an uncertain future that today’s needs and priorities take precedence. As is usually the case with the human condition, we seldom plan for a crisis and instead are forced to react to it when it is upon us. One study on how seniors make choices about senior residential and long term care options showed three distinct and familiar patterns:
13% actively plan for retirement and how they will live as they grow older and frailer
40% actively plan following a “near catastrophic” health event such as total joint replacement or extended illness
46+% never plan and must make decisions about site of care in a very short period of time, usually while still in the hospital
On the one hand, the exploding senior population and their inevitable need to finance senior residential and long term care options should be a tremendous opportunity for the financial planning and insurance agency world. The problem is that the combined impact of our nation’s economic strains and people’s tendency to not plan and save, is brewing a perfect storm that threatens to sink the vast majority of people’s chances for quality “golden years”. The costs of healthcare and long term care alone are staggering. According to a MSN Money.com Market Watch report (March 28, 2008) “a sixty five year old couple retiring now would need more than $300,000 set aside just to pay for health care costs over twenty years and would need $550,000 if they were to live into their early nineties.” Particularly alarming, according to the report, is the fact that these numbers, “haven’t factored in the costs of nursing homes, assisted living facilities or home health aides—and those costs are staggering!”
Currently in the U.S. there are over 1.5 million people living in nursing homes. Of that population, 72% are female and the 85+ population is growing the fastest with a 20% increase. The oldest old are living longer and they are costing more than ever to support with private or public funds. This is important to consider when planning for the future because as of today, 56% of residents will live in a nursing home anywhere from one to five years or more (with a national average of 30 months).
For the population of 900,000 people currently living in assisted living facilities, the vast majority of financing is private pay. In addition to the monthly cost for a room, apartment or cottage; residents may also face one-time entrance fees ranging from $60,000-$350,000 for higher end “resort style” or “cottage” properties. Additional monthly fees ranging from $348-$522 are often times charged for transportation, dementia care, meal delivery to residence, and other extras that would add to quality of life.
As of 2000, the most recent year for data, there were 1,355,290 people receiving some form of extended home-based healthcare. Of that population, 70% were from our 65+ cohort and 65% were female. The average time span of care was for 312 days, and over 93% of the care was being delivered by Medicare/Medicaid certified agencies.
Fast Fact
Current national average costs across the three categories of long term care for 2008
Home/Community-
Non-Medicare Certified, Licensed “Companion” Care - $18/hr (4% over 2007)
Non-Medicare Certified, Licensed “Home Health Aide” - $19/hr (3% over 2007)
Medicare Certified “Home Health Aide” - $38/hr (18% over 2007)
Adult Day Health Care Center - $61 per day
Assisted Living Facility-
Private One Bedroom - $3,008 per month (11% over 2007)
Nursing Home-
Semi-Private Room - $187 per day (4% over 2007)
Private Room - $209 per day (2% over 2007)
With the reality of these kinds of costs and the growing senior population; we will see increasing pressure on publicly funded programs such as Medicare and Medicaid (which combined pays for roughly 80% all long term care related expenses in the U.S.), and moves to make it more difficult to qualify. The economic squeeze of inflation, the real estate crisis and stock market performance are all contributing to declines in tax revenues for the states. When taxes shrink one of the most vulnerable areas is also one of the most expensive for state budgets: Medicaid and other social support programs. The long term care industry and the government at all levels are in agreement on how to compensate. More emphasis must be placed on the individual to pay for as much care and housing as possible with private funds before any public funds are made available. But what are some private funding options that people should be considering?
An obvious source of funds to cover these expenses would be from long term care insurance. The only problem is that attractive tax deductions have never been established to incentivize growth in the market, and it has been stalled for over a decade. As of today, long term care insurance accounts for an anemic single digit percentage of all funding for senior housing and care. That leaves private pay to pick up close to 20% of the approximate total of $200 Billion spent on all long term care service last year. But where do those funds come from if you have not saved literally hundreds of thousands in cash?
A primary option that people have often looked to is cashing in their home through a sale to raise the funds to sustain themselves (or to meet spend down requirements). But, the current real estate market has taught us, as is the case with the stock market, that it is always vulnerable to a correction. Another means to extract equity from a home could be through a reverse mortgage, and it might be a good option for a home healthcare arrangement, but what happens if health conditions deteriorate rapidly and the person must move into a facility on short notice? The home owner is then faced with the dilemma of funds that can’t be used for a setting outside of the home, and a loan that must be paid back immediately.
If a person has built up cash value in a life insurance policy, they could consider taking a loan against the policy or surrendering it for the cash value. Also, if someone attempts to qualify for Medicaid, a life insurance policy would be an “unprotected” asset subject to the 60 month look back period. It would need to be liquidated and spent down on care before eligibility could begin. According to a Federal Government Accounting Office (GAO) report released to the U.S. Congress in March, 2007: when examining a sample population of over 500 Medicaid applicants entering long term care facilities, 38% owned a life insurance policy that needed to be liquidated because it exceeded minimum state mandated asset levels.
When cashing out a life insurance policy, either by choice or because of an eligibility mandate, the superior option is a Life Settlement. This process will ensure that the highest possible value is obtained for the policy through bidding from multiple institutional sources in the secondary market. Also, any tax implications for capital gains realized from a Life Settlement would be offset by deductions based on spending the money for “the entire cost of maintenance in a nursing home or home for the aged” (sec. 1016 U.S. Master Tax Code 2008). The Conning & Co. Research study "Life Settlements: Additional Pressure on Life Profits” found that senior citizens owned approximately $500 billion worth of life insurance in 2003, of which $100 billion was owned by seniors eligible for life settlements. Statistical data gathered on policies “settled” in 2007 continues to verify that the difference between the amounts of money that can be realized through a Life Settlement is significantly greater than through cash “surrender” value. When the time comes to look at funding vehicles to pay for long term care related expenses, cashing in a life insurance policy through a Life Settlement could be an excellent financial move.
Conclusion
Previous generations retired on schedule and then lived the rest of their lives on pensions and government benefits. For the most part, they ceased becoming viable consumers of insurance and financial services. The Silver Tsunami generation will live, work, and stay active much longer than any generation in history. This will prolong their need and ability to continue being acquirers of health and financial security products. And with their expectations for quality lifestyles until the very end—they are going to need every possible financial tool to make it happen.
Sources
AARP Public Policy Institute, Across the States Profiles of Long Term Care and Independent Living, Seventh Edition 2006
Claritas P$ycleNE, Actionable Segmentation Solution
Genworth Financial, 2008 Costs of Care Survey, April 2008
Government Accounting Office (GAO), Report to Congressional Requesters on Medicaid Long Term Care Impact of Deficit Reduction Act, March 2007
Health Care Financing Review, Winter 2002 Study
John Hancock Life Insurance, More Tools for Underwriting the Elderly?, October 2007
Life Policy Dynamics, 2007 Summary: U.S. Life Settlement Market Analysis, March 2008
MetLife Mature Market Institute, Demographic Profile Americans 65+, 2008
MetLife Mature Market Institute, Demographic Profile American Baby Boomers, 2008
MetLife Mature Market Institute, Market Survey of Adult Day Services & Home Care Costs, September 2007
MetLife Mature Market Institute, Market Survey of Nursing Home & Assisted Living Costs, October 2007
MSN Money.com Market Watch, Bleak Retirements for 150 Million?, March 2008
Society of Actuaries, Life Settlements 101: Introduction to the Secondary Market in Life Insurance, October 2007
Swiss RE, Underwriting the Elderly presentation at NEHOUA 24th Annual Seminar, October 2007
Americans for Secure Retirement/Ernst & Young LLP, Retirement vulnerability of new retirees: The likelihood of outliving their asset, July, 2008
The New York Times, Budget Pain Hits States, With Relief Not in Sight, July, 2008
MSNBC.com, Higher inflation brings lower standard of living, August, 2008
MSNBC.com, Economy hitting elderly especially hard, July, 2008
MSNBC.com, Greenspan: Economy ‘on the brink’ of recession, July, 2008
MSNBC.com, Foreclosure filings up 55 percent in July, August, 2008
United States Census Bureau
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