Welcome to our article on "Long Term Care Essentials: Clinical Assessment." In this informative piece, we will explore the crucial role of clinical assessment in long-term care, providing you with valuable insights and guidance.

Understanding Long Term Care

Long-term care refers to the range of services and support provided to individuals who have chronic illnesses, disabilities, or other conditions that limit their ability to perform daily activities independently. It encompasses a variety of settings, including nursing homes, assisted living facilities, and home care. The goal of long-term care is to ensure individuals receive the necessary assistance and support to maintain their quality of life.

The Importance of Clinical Assessments in Long Term Care

When it comes to long-term care, a comprehensive clinical assessment is essential. It involves a thorough evaluation of an individual's physical, mental, and social needs, enabling healthcare professionals to develop personalized care plans that promote the highest level of well-being and quality of life.

A clinical assessment serves as the foundation for understanding an individual's unique care requirements. It provides valuable information that helps healthcare professionals identify potential risks, strengths, and areas of improvement. By conducting a clinical assessment, caregivers can tailor their approach and interventions to meet the specific needs of each individual, ultimately enhancing their overall care experience.

What is a Clinical Assessment?

A clinical assessment is a systematic evaluation of an individual's health status, functional abilities, and overall well-being. It involves gathering information through various methods, such as interviews, observations, and medical tests. The assessment aims to gather a comprehensive understanding of the individual's physical, emotional, and social aspects to develop an accurate care plan.

Healthcare professionals, including nurses, physicians, and therapists, play a vital role in conducting clinical assessments. They utilize their expertise and knowledge to gather relevant data, interpret the results, and make informed decisions about the individual's care. A collaborative approach involving the individual, their family, and the healthcare team is crucial for a comprehensive and accurate assessment.

The Role of Healthcare Professionals in Conducting Clinical Assessments

Healthcare professionals are at the forefront of conducting clinical assessments in long-term care settings. Their expertise and experience allow them to assess an individual's health status, identify potential risks, and develop appropriate care plans. These professionals collaborate with the individual, their family, and other members of the healthcare team to gather relevant information and ensure a holistic approach to care.

Nurses play a vital role in clinical assessments, as they often have direct and frequent contact with individuals in long-term care settings. They conduct initial assessments, monitor changes in health status, and coordinate care plans. Physicians provide medical expertise, diagnose conditions, and prescribe appropriate treatments. Therapists assess and address specific functional and rehabilitative needs.

Key Components of a Clinical Assessment

A comprehensive clinical assessment involves evaluating various aspects of an individual's health and well-being. The key components typically include:

• Medical History: Gathering information about past and current medical conditions, surgeries, medications, allergies, and immunizations.
• Physical Examination: Conducting a thorough assessment of the individual's vital signs, body systems, mobility, and sensory functions.
• Mental Health Evaluation: Assessing cognitive functions, emotional well-being, and mental health conditions.
• Functional Assessment: Evaluating the individual's ability to perform activities of daily living, such as bathing, dressing, eating, and mobility.
• Social Assessment: Considering the individual's social support system, living arrangements, and community engagement.
• Nutritional Assessment: Assessing dietary habits, nutritional status, and any specific dietary needs or restrictions.
• Environmental Assessment: Evaluating the individual's living environment for safety, accessibility, and potential hazards.

Each component provides valuable information that contributes to a holistic understanding of the individual's care needs.

The Benefits of Comprehensive Clinical Assessments

Comprehensive clinical assessments offer numerous benefits for both individuals in long-term care and their caregivers. Some of the key benefits include:

• Accurate Care Planning: Clinical assessments provide a detailed understanding of an individual's needs, enabling healthcare professionals to develop personalized care plans tailored to their specific requirements.
• Early Intervention: Identifying potential risks and areas of improvement allows for early intervention, preventing complications and promoting better health outcomes.
• Enhanced Communication: Clinical assessments serve as a platform for effective communication among healthcare professionals, individuals, and their families, ensuring everyone is on the same page regarding care goals and interventions.
• Continuity of Care: Clinical assessments facilitate seamless transitions between different care settings by providing a comprehensive overview of the individual's health status and care requirements.
• Quality Improvement: Clinical assessments contribute to ongoing quality improvement efforts in long-term care settings by identifying areas for improvement and evaluating the effectiveness of interventions.

By conducting comprehensive clinical assessments, healthcare professionals can optimize the care experience for individuals in long-term care settings.

How Clinical Assessments Contribute to Personalized Care Plans

Personalized senior care plans are at the core of effective long-term care. They ensure that individuals receive the specific support and interventions they need to maintain their well-being. Clinical assessments play a crucial role in developing personalized care plans by providing healthcare professionals with the necessary information to tailor their approach.

Based on the findings of a clinical assessment, healthcare professionals can identify the individual's strengths, weaknesses, and preferences. They can then develop care plans that address the individual's unique needs, goals, and aspirations. This person-centered approach promotes individual autonomy, enhances the care experience, and improves overall quality of life for individuals in long-term care.

Tools and Techniques Used in Clinical Assessments

Healthcare professionals employ various tools and techniques to conduct clinical assessments effectively. These may include:

• Questionnaires and Surveys: Standardized questionnaires and surveys help gather specific information about an individual's health status, functional abilities, and quality of life.
• Observation and Interview: Direct observation and interviews with the individual, their family, and caregivers provide valuable insights into their daily routines, abilities, and challenges.
• Medical Tests and Assessments: Diagnostic tests, such as blood tests, imaging studies, and cognitive assessments, help identify and evaluate specific health conditions and functional abilities.
• Assistive Technology: Technology-based tools, such as electronic health records, wearable devices, and remote monitoring systems, can aid in collecting and analyzing data for clinical assessments.

By utilizing these tools and techniques, healthcare professionals can gather accurate and comprehensive information to inform their care decisions.

Common Challenges in Conducting Clinical Assessments

While clinical assessments are essential, they can present certain challenges for healthcare professionals. Some common challenges include:

• Limited Time: Healthcare professionals often have limited time to conduct thorough assessments due to heavy workloads and time constraints.
• Subjectivity: Clinical assessments may involve subjective judgments, relying on the interpretation of healthcare professionals, which can introduce bias.
• Complexity: Assessing an individual's health status and well-being requires considering multiple factors and potential interactions, making the assessment process complex.
• Lack of Standardization: There may be variations in assessment practices and tools across different healthcare settings, leading to inconsistencies in care planning.

Despite these challenges, healthcare professionals strive to overcome them and conduct effective clinical assessments to ensure the best possible care for individuals in long-term care.

Best Practices for Conducting Effective Clinical Assessments

To enhance the effectiveness of clinical assessments, healthcare professionals can follow these best practices:

• Establish Rapport: Building trust and rapport with the individual and their family is crucial in obtaining accurate and honest information.
• Allow Sufficient Time: Allocating adequate time for assessments ensures thorough evaluations and reduces the risk of overlooking important details.
• Collaborate with the Individual: Involving the individual in the assessment process empowers them and helps validate their experience, preferences, and goals.
• Utilize Interdisciplinary Approaches: Collaboration among healthcare professionals from different disciplines promotes a holistic understanding of the individual's care needs.
• Continual Evaluation and Update: Regularly reviewing and updating clinical assessments ensures that care plans remain relevant and effective as the individual's needs evolve.

By adhering to these best practices, healthcare professionals can optimize the clinical assessment process and improve the overall care experience.

The Role of Technology in Enhancing Clinical Assessments

According to experts in elder care, technology plays an increasingly significant role in enhancing clinical assessments in long-term care. Electronic health records (EHRs) allow for centralized and accessible documentation of assessment findings, facilitating communication and collaboration among healthcare professionals. Wearable devices and remote monitoring systems provide real-time data that can inform clinical assessments and enable proactive interventions. Artificial intelligence (AI) and machine learning algorithms can help analyze large datasets, identify patterns, and predict health outcomes.

As technology continues to advance, it holds immense potential for revolutionizing the clinical assessment process, improving accuracy, efficiency, and outcomes for individuals in long-term care.

The Future of Clinical Assessments in Long Term Care

Looking ahead, the future of clinical assessments in long-term care is promising. Advancements in technology, increased awareness of person-centered care, and a growing emphasis on interdisciplinary collaboration are shaping the future of clinical assessments.

Innovations such as telehealth, virtual reality, and remote monitoring systems are likely to become more prevalent, enabling healthcare professionals to conduct assessments remotely, monitor individuals' health in real-time, and provide interventions promptly. Standardization of assessment tools and practices across healthcare settings will enhance consistency and improve care coordination.

Moreover, a shift towards more person-centered and holistic care approaches will further emphasize the importance of comprehensive clinical assessments to tailor care plans to individuals' unique needs and preferences.

Conclusion

Comprehensive clinical assessments play a critical role in long-term care, ensuring individuals receive the personalized support and interventions they need to maintain their well-being. By conducting thorough assessments, healthcare professionals can gather valuable information, develop tailored care plans, and enhance the overall care experience for individuals in long-term care settings.

As we continue to evolve in our understanding of long-term care, it is essential to prioritize the importance of clinical assessments and strive for continuous improvement in assessment practices. By embracing technology, interdisciplinary collaboration, and person-centered approaches, we can optimize the clinical assessment process and ultimately provide the best possible care for our loved ones in long-term care settings.

If the chosen option is to have hired professionals look after them, these hired professionals can visit them at their homes, or they can be taken care of at long term care facilities such as nursing homes. If hired professionals are going to be providing the care, regardless of the location, it’s going to cost money. This is where long term care insurance comes into the picture.

Many people choose not to purchase long term care insurance frankly because it’s not an insurance everyone needs. The odds of eventually using car insurance, homeowner’s insurance, health insurance, and even life insurance are greater than eventually using long term care insurance. Therefore, many people opt not to add another bill to their lists of household finances; however, in the event that you do need long term care, how are you going to pay for your household finances and the cost of long term care? Having long term care insurance will take care of paying for your long term care.

Before you head to your local insurance agent, research your family history. Have there been any family members who have ended up needing long term care? For what reason, and for how long, did they need the long term care? How did they pay for the long term care? Use these answers to help determine whether or not long term care insurance is right for you.

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Types:

There are various long-term care policies catering to the physical ailments that afflict old age. Often, severe medical conditions require specially trained nurses and doctors twenty-four hours a day. Long-term care envelopes regular care required by a person ailing with an acute illness or disability. The degree of care generally includes bathing, dressing and many other specific services.

Main Concern:

The main concern of most families is to provide their aging parents with the best available long-term care, without resulting in a major monetary burden for the rest of the family. Usually, most families wonder when to time the long-term care for their aged relatives; whether it is required at all, or would the care given by family members themselves be enough.

Major Disagreement:

One of the greatest arguments against buying a long-term care policy is that people feel that the money paid as premium would be wasted if there were no need for the benefit. It is akin to people hesitating about getting their car insured, for there is no guarantee of the car being damaged in an accident. Of course, it boils down to priorities; just as one insures a car to take care of unforeseen circumstances, long-term care insurance provides future security by taking care of an aging loved one.

Reasons:

Though it is not possible to predict if there would ever be a need for hospitals, home-care services, or assistance in living, still, you could opt for a long-term care insurance policy for reasons such as:

- Restoration of personal freedom - Easing the burden on care-takers - To save assets for the rest of the family - To access the virtual helping hand at a time of acute crisis.

Eligibility:

A senior citizen would be eligible for funds provided they meet the following criteria:

- If he or she is unable to perform at least two to three, out of five or six, regular activities that are necessary for daily life, which includes bathing, dressing, toiletry, moving about, feeding oneself, and the like.

- All tax-qualified policies state that a qualified doctor must declare the applicant severely ill.

- The illness should have signs of lasting for at least for ninety days.

Though long-term insurance policies are an expensive buy, yet their significance is important for senior citizens. As one ages, there is a growing fear of being hindered by illness and disability, the costs involved, and being a burden on one’s family. A long-term care insurance policy goes a long way in easing these fears, helping senior citizens face their silver years confidently.

The point is that the average American does not truly understand either the risks or complexity of long term care issues, and that is a shame because it will affect us all in one or another in the next few years.

So what is long term care anyway? Basically it is custodial care that is provided for someone when they need assistance with activities of daily living such as eating, bathing, dressing, transferring, toileting and continence. This could be as a result of illness, an unexpected accident, a cognitive disorder such as Alzheimers, or just plain aging.

So what pays for long term care? Well, if the custodial care is not being provided in conjunction with skilled care performed by medical personnel, there are only a few options for paying for services rendered. They are (1) your own savings, (2) Medicare, (3) Medicaid, (4) long term care insurance. Interestingly, neither health insurance nor Medicare is designed to cover costs for long term care services over an extended period, and Medicaid will only pay for services after you have exhausted your own funds and are impoverished.

Who usually receives long term care? The bulk of services are received by seniors over 65 and the chances of needing this kind of care increases dramatically as a person reaches their seventies and eighties. However, an important point that is often overlooked is that 40% of long term care is received by folks under 65 each year. This is because of accidents, illnesses such as Parkinsons, strokes, and so forth that affect younger people as well as seniors.

How expensive is long term care? That all depends on where it is received. If received in a nursing home, it can cost $70,000 a year and more in many places. The vast majority of care though is provided in the home by informal caregivers made up of friends and family. This can be less expensive financially, but the emotional and physical toll of such care being provided by folks who are just doing the best that they can under very difficult circumstances while still trying to carry on their own lives is often devastating. The facts are that home and community-based care along with nursing home care represent the largest out-of-pocket expenses facing seniors today.

Why is this an issue that Americans need to learn more about? The need for long term care is already placing a heavy strain on the country's financial resources today, but in a few years the "baby boomer" generation will be retiring and will become the "senior boomer" generation instead. This will overwhelm the current system beyond any capacity to cope. The huge number of seniors being cared for by a much smaller number of their children, coupled with the fact that few seniors today are preparing for their own care creates a recipe for serious trouble. Any help provided by government sources will be either produced by much higher taxes on the working class or by cutting back the benefits for care received, which will only create even more stress and strain for informal caregivers.

I invite you to learn all that you can about this vital issue and do your part to take steps to avoid the long term care crisis that is currently looming in America's future.

Understanding the wording of a policy and correctly comparing policies from various companies can be daunting for most folks and exhausting. You must develop a grasp of insurance lingo, and it wouldn't hurt to know how specific points in each contract have been interpreted by courts of law, either.

In case you weren't aware, the LTCi sales brochures are not contacts. Sales brochures are created to briefly explain a product and to entice you to buy it. What is printed in a brochure does not represent the intricacies of contract law, yet the brochure MUST, by law, be congruent with the related, legal contract.

Even worse, no insurance company's promotional literature can be trusted to thoroughly detail the terms of the target policy/contract. Sales is sales, and truth is truth. (Although, in most states, it is against the law to knowingly produce long term care insurance marketing materials that mislead the public.) I don't believe the Madison Avenue style brochures and commercials which I see created to push pharmaceutical drugs. Instead, I go online and research the contra-indications, side-effects, suitability of the drug for a particular aliment, as well as law-suits against the company manufacturing it. That's called "due diligence" and we owe it to ourselves to do our due diligence when it comes to matters that will affect our loved ones and ourselves.

Research pertaining to your decision about long term care insurance is no less important than what you put in your body. So, you must read your policy contract thoroughly. If you have any doubts about the meaning of the wording in an LTCi contract, or whether that contract will protect you when you are in need (as you think it will) you'd be wise to get expert help deciphering the policy.

That said, here is the order in which to do your research:

1) Talk with your family about your decision to buy long term care insurance. Also, any friends who have a family member who has purchased LTCi in the past, and has gone "on claim", can be great resources. They've "been there, done that" and have experience with the claims process.

However, I would NOT recommend taking family members' or friends advice about which policy to buy. They are not qualified to help you. Sure, they would be able to steer you away from a particular company or policy if they have had significant problems during claims time, but deciding which policy would be the best considering your financial and health situations should be between you and a trained (and legally licensed) LTC insurance broker.

2) I suggest that you use a trustworthy Long Term Care insurance BROKER, not a captive agent. A captive agent only represents one company. That may be good for the company, but it certainly may not good for you. Make sure that your broker represents SEVERAL long term care insurance companies with the highest ratings. Any company considered should have a B+ rating or better.

How do you find an LTCi broker with integrity? Well, you can, but you do not need to go through an "established" insurance firm or agency. Just because a firm or agency is established doesn't mean every agent within that agency will be someone with whom you'd feel comfortable entrusting your future. There are just as many "sharks" inside insurance firms as there are outside of them. Interview brokers until you find someone with whom you enjoy good rapport.

I recommend that you begin by connecting with the Buyer's Advocate for free, no-obligaion comparison quotes

You want someone with experience, a deep knowledge of all the companies' policies that he or she represents, and a compassionate heart. Knowledge of policies will be helpful in finding the policy you most desire. Experience comes in very handy if you have health issues. An experienced broker not only knows which policy might suit your long term care desires, but also which companies' underwriters are the most lenient for your particular health problem. Of course, a compassionate heart is the soul of your relationship and should be a sought after and respected part of the equation.

3) After you have found a broker with whom you feel comfortable, then have a conversation about your financial and health situation as well as your preferences for long term care (nursing facility only, assisted living, home care, day care, etc). Check out what each policy has to offer and it's restrictions concerning things like restoration of benefits, how many ADLs are required to trigger benefits and whether there is the need for medical supervision. Also consider the various optional benefits such as inflation protection, non-forfeiture, etc.

Look over the sales brochures that your broker provides for you. There may be several company and policy options. The sales brochures will help you narrow down your decision as well as bring any question you may have to the forefront.

4) Read your Outline of Coverage. In Arizona, the law states that an outline of coverage must be given to every applicant. The Outline of Coverage must truthfully state the basics of the policy. Written in lay terms, the Outline of Coverage more intricately describes what the policy will cover, bit it's not a comples as the actual contract. From this, you can pretty much make up your mind about which policy you want. HOWEVER, an Outline of Coverage is a binding contract. It does not cover every aspect of the policy. The only way to be absolutely sure about the exact wording of your LTCi policy is to decipher the contract itself. READ THE CONTRACT! Again, if you are not entirely sure about what the wording means, then get a legal professional to explain it to you.

5) Depending upon your purchase time line (Do you want LTCi protection right now or can it wait a few days, weeks, months) you can request a sample policy from your broker. If you want to buy sooner than later, you can fill out an application. If you are approved, you will get your actual policy to review for 30 days.

In Arizona, there are no worries if you buy an LTCi policy first and look afterwards. By law, you have a 30 day "free look" period that you can use to pick your policy apart with the help of a good insurance contract lawyer. And it's not a bad idea to do so, if you have the money.

Before you start your buying process, call your Department of Insurance to verify that there is a "free look" period in your state.

Keep the envelope in which the policy was mailed and/or insist that your agent give you a signed receipt or delivery when he or she hands you the policy.

If you decide to return the policy, you must send it to the insurance company along with a letter requesting that the policy be canceled and your premium refunded. To make sure that the long term care insurance company received your letter and policy, send them both by certified mail and keep your mail receipt.

Keep a copy of your correspondence with the insurance company until the refund process is totally competed. The refund process usually takes 4 to 6 weeks.

With these steps covered you'll be set.

Why? For starters here are 10 good reasons:

1. The odds: The odds of your needing long term care are overwhelming: The odds of requiring long term care in your lifetime have now risen to 70 percent. That means that seven out of 10 Americans will use their policies - This is a far greater risk than an auto accident or a house fire. Most people wouldn't even consider being without homeowners and auto insurance, but there are far too many people who are not yet protected with long term care insurance.

2. Longevity: Folks are living longer. There are now more people over the age of 100 than any other time in history. Yet, we still have no cure for Alzheimer's, Parkinson's disease, Multiple Sclerosis or many other illnesses that can cause a need for long term care.

3. Independence: No parent wants to ever be a burden on their kids, especially if their kids are raising their own children. Baby boomers are called the sandwich generation because many are caring for an elderly parent with medical needs while putting a child or children through college. But most retirees want to remain independent as long as they can, even when it comes to such simple things such as driving themselves to doctor appointments and to the store.

4. Spend down: You run the risk of having to spend down your entire life savings for long term care needs before you die, leaving nothing to your heirs or worse yet, to your surviving spouse.

The most common governmental benefit is provided by Medicaid, and a married couple can have approximately $100,000 in savings while still qualifing for nursing home benefits through Medicaid. But a single person has to spend his savings down to $2,000 before he is eligible for those same benefits.

Even so, most parents would like to leave something to their family, even if it is just the value of their home for their survivors to sell and split the proceeds. Every generation feels that leaving a legacy is important, even if their children are already successful.

5. New statistics: Even though long term care is associated with seniors and retirees, Unum, a major LTC insurance carrier, reports that in 2006 almost 58 percent of LTCi claims were for people under the age of 65. The average claim for this age group lasted a year or longer. Unum's analysis showed that 30 percent were cancer claims, and more than 10 percent were claims resulting from strokes. Other leading sources for claims included neurological disease, dementia and multiple sclerosis. These data underline the fact that the younger someone is when they apply for LTCi coverage, the better.

6. Underwriting changes: Over the last forty years, insurance companies have found that many policyholders who purchased LTC coverage have kept these policies in force longer than insurers anticipated. In the past, many insurers priced their plans anticipating that a certain amount of policies would lapse, which would lead to extra profit for the company. But when the number of lapsed policies was less than expected, claims increased, forcing them to re-evaluate their underwriting guidelines.

7. Government encouragement: Federal and state governments are now pushing hard for people to purchase their own long term care policies. Obviously, if more people purchase long term care insurance, fewer people will tap into the Medicaid and welfare programs that are jointly funded by the federal and state governments.

Their strategy is three-fold: First, they have made it tougher to qualify for Medicaid. Strategies that elder law attorneys and certified estate planners were able to recommend in the past are now against the law. Second, some states promote co-op programs to encourage citizens to purchase long term care policies. In most cases, whatever the value that the policy would pay would be matched by the state in free, future, LTC benefits. Most states have a cap on benefits, but needless to say, it is a good value for the resident. Last but not least, tax-qualified long term care policies are tax deductible.

8. Legal changes: Again, the federal government and some states have now changed the rules on what Medicaid applicants can legally do to qualify for benefits. One of the major changes on February 2, 2006 was the enactment of the DRA (Deficit Reduction Act) of 2005. This extended "look-back periods" for gifting to five years from three years. Also on gifting, whether money or property - the penalty calculation would be figured from the date of application for Medicaid instead of from the date of the gift. Another difference pertains to the usage of life estate survivorship deeds. The law now treats these as if the gift never took place for Medicaid eligibility.

9. Estate recovery: If one needs Medicaid for their long term care needs, 49 out of 50 states now have laws to place a lien against the equity in one's home, so that when the Medicaid patient and their spouse, if applicable, pass away, the state will require repayment for the money they contributed toward their health care. And there goes any anticipated inheritance.

10. Health care flexibility: Home health care is by far one of the most popular settings for care. If at all possible, folks want to stay within the confines of their own home where they are comfortable versus living in an an institutional setting. With good home health care benefits available in most long term care policies, this choice can become a reality. We have seen folks use the home health care benefit of their policy to get a sitter or a home health aid to help them with their activities of daily living. Some of the more common illnesses were Alzheimer's disease, cancer, strokes, and stability and mobility issues.

With these reasons alone, you can easily justify long term care insurance for your future financial freedom and independence. It's prudent to gather as much information on statistics, laws and insurance in order to truly be prepared.

They had the foresight to buy a long term care policy 5-10 years ago. My first comment is: good for them. When you sit down and take a look at the premium for long term care at various ages, you quickly see that the younger you buy it the better. This seems obvious, but I am here to tell you that the premium differences are extreme. Take a look at the premium at age 45, for example, and compare it to age 65, the age where most people even start thinking about long term care.

However, (using Arizona as an example) 5-6 years ago nursing home expenses were about $120 a day. This works out to around $43,000 a year. Today, the average is $70,000 a year.

Upon becoming aware of this fact, many people want to take the steps necessary to get their coverage more in line with current costs. When they start looking around, they discover two things…

Because they are older, the premium is substantially greater. A lot of times, it is so high that it’s not even affordable.

Looking at similar coverage at an older age and seeing a higher premium makes sense, but there is another historical factor as well. Over the last five years, long term care premiums have increased about 40%. A lot of this had to do with initial insurance company pricing. The actuaries began their mathematical assumptions using statistics for the general population. In many ways, this was a stab in the dark. But they had to start somewhere. As time went on, they discovered that claims were much higher than their original projections. After an insurance company has enough business on the books for it to be statistically relevant, they start using actual experience.

So the people who want to bump their coverage up are generally looking at off-the-chart premiums-- both because they are older and the insurance companies have modified their pricing.

But depending on the situation, there may be a solution…

Many people have CDs and annuities. In most cases, the CD is considered “rainy day” or “emergency” money. The annuities are “non-qualified deferred annuities”. Most of the time, they are just sitting there, like the CD, but with a longer holding period in mind. Over 90% of people die holding the annuity “as is”; they are never converted to some kind of an income.

There are a few insurance companies that will allow you to transfer a CD or an annuity into a special combination annuity/long term care product.

It functions like an annuity in that it grows tax-deferred at an annually-set interest rate. However, if the person ever has long term care needs of any type (adult day care, respite care, hospice care, assisted living or a full blown nursing home) withdrawals can be made from the annuity. Generally funds can be withdrawn over a three year period. Keep this three year time frame in your mind—it will become very relevant in a minute.

So far, this doesn’t sound too much different than just withdrawing funds from an existing CD or annuity. But there is one key reason to make the exchange to an annuity/long term care plan. Some insurance companies will allow you to add a rider which provides lifetime coverage. This is a huge benefit for a couple of reasons…

First, most people have a 3 year or 5 year long term care plan. When the three or five years are up, that’s it. Second, medical advances are prolonging life. Is one kidney on the blink? No problem, a medical team will just insert a new one. Third, the biggest issue is not about general health, but just the opposite. A person could be blessed with good health, develop Alzheimer’s, live for many, many years and exhaust their entire estate on health care.

Now, let’s get back to the three years. The person has an (inadequate) long term care policy which is good for three years. They move their CD or annuity to this combination annuity/long term care plan which is good for three years as well.

Here is the key point. If they added the lifetime rider which kicks in after three years, they are good for the duration.

Last, let’s cover the “without paying premiums” part…

By moving a CD or annuity into this combination plan, the person has created another three year long term care plan. No outlay required here.

Adding the lifetime rider has a cost. But since it doesn’t start for three years, it’s like having a 3 year “waiting period” on a traditional long term care plan, as opposed to the typical 60, 90, 180 day wait. So the premium is quite low.

Second, the premium can be paid by withdrawing from the annuity itself. Today, a person would have to pay tax on the withdrawal (assuming there was a gain in the annuity), but after 12/31/09 withdrawals such as this will be tax free. This is a new provision in the Pension Protection Act of 2006.

If you find yourself underinsured and concerned, take a look at your situation and see if this approach may solve your problem.

A tall order, you say. Yes, but in certain situations all three of these can have a happy ending. Here’s a more than typical scenario…

Ruth is 88. She has been diagnosed with moderate Alzheimer’s. Other than that, she is in pretty good health for an 88 year old. Her doctor tells her she’ll live to 100.

Ruth has two children. Ben is an attorney and lives way across the country. Ruth has been living with Karen, her daughter, and Karen’s husband and three grandchildren.

Ben has already set up the paperwork and has power of attorney over his mom’s affairs. He has been handling her finances for the last couple of years from afar and that has worked out fine.

Ruth has become more forgetful recently and that has become more of a concern for Karen. On top of that, Karen just got a promotion that will entail her traveling out of town one or two days a week. She doesn’t feel it is right to shift the rising care needs of her mom to her husband while she is gone.

Bottom line: Everyone feels it would be better to move Ruth into a health care facility where she can be effectively cared for. Even Ruth agrees as the last thing she wants to do is be a burden on her family.

So Ben puts a pencil to Ruth’s financial situation. Here’s what he comes up with…

Ruth has about $450,000 of assets. Most of it came from the sale of her home which she lived in for 45 years. She has $800 a month coming in from Social Security and $1,200 a month from the telephone company pension where she was an operator for 35 years.

Karen has found the ideal care facility for her mom. It is close to their home and it provides all the care Ruth would ever need for the rest of her life. The problem is that it cost $5,000 a month. So she is short to the tune of $3,000 a month. But the problem goes deeper than that.

Even though Ruth has assets totally $450,000, it’s possible that she could eventually exhaust these funds. After all, other than Alzheimer’s, she has no major problems. What if her doctor is right and she does live to 100?

Karen and Ben love their mother and hope she lives to be 120, but these are simply the economic realities. However, there is another problem. Ruth’s life-long goal has been to be the one that educates her three grandchildren. It’s pretty easy for her to see that dipping into her estate at the rate of $36,000 a year is not only flirting with her ability to educate the grandchildren, but it is affecting her other goal of leaving her estate to Karen and Ben.

Ben schedules an appointment with his personal financial advisor and explains the dilemma. The first thing they look at is an immediate annuity. Ruth’s age would give her a good rate of return. The best quote to provide the $3,000 a month short fall for as long as Ruth lives comes back at $215,000.

The good news is that Ruth could live to be as old as Methuselah and the insurance company would send her a check for three grand a month. And $36,000 a year on a $215,000 “investment” is a 16.7% return on the money. Second, this preserves the balance of Ruth’s estate for her wishes. $450,000 less $215,000 is $235,000. That should educate the grandchildren and leave a little left over for Ben and Karen.

The bad news is that is quite a chunk out of the total estate. And if Ruth falls and breaks a hip and dies next year, the insurance company keeps the $215,000. Ben’s financial advisor tells him there are ways to set up different types of refund arrangements with the insurance company so the whole $215,000 doesn’t go down the drain, but these options cost more.

Is there a more efficient way? Maybe, read on…

Insurance companies issue what are called “medically underwritten” annuities. Generally there is no physical exam required, but the insurance company does take a look at the person’s medical history. The theory here is that people with health impairments have a life expectancy lower than the average for the entire population of people the same age. So providing the same monthly benefit can be provided with less money.

That’s exactly what happened when Ben’s financial advisor put in an inquiry on Ruth’s situation. $3,000 a month for life would take only $130,000.

So the shortage of $3,000 a month was taken care of. Ruth won’t ever run out of money. Now there is $320,000 to educate the grand kids and leave the rest to Karen and Ben. Nobody gets disinherited and Karen and Ben heave a sigh of relief knowing they will never have to use their own money to provide for Ruth if she lives as long as they hope.

The fact is that for a long time now Americans have often shifted the responsibility of care giving away from themselves and left it instead to others to provide. This could be members of their own family, or even the government. The point is that much of the public is just not in the habit of taking responsibility for their own possible need for custodial care.

In past years, it was just expected that spouses and children would care for the aged and infirmed. And many have done so while bearing immense financial, emotional and physical strain. The alternative has been to just let the state foot the bill and provide long term care in the most expensive and dreary of settings, a facility.

Times have changed though, and perceptions need to change along with it. The characteristics of family life has changed dramatically in the past thirty years or so, making the old out-dated assumptions of yesterday unrealistic in today’s society.

Consider for instance, that family dynamics today often mean that family members do not live anywhere close to one another. In fact, thousands of miles may separate them today. In addition, most families require both husband and wife to work full-time in order to make a decent living. Just trying to raise children in this atmosphere can be a real challenge for working age parents, but if you also insert the need to try to care for aging parents at the same time, the situation quickly becomes unmanageable.

Even if raising children is not involved, having a grown child available to be able to devote a large part of their time every day for years to care for a frail parent is increasingly becoming unrealistic. Those who do try to carry on in such a labor of love often become more ill than those that they care for, and many never fully recover from the experience.

So why not just rely on the good old government programs like Medicaid to take care of the problem? Well, that has been the fall-back position for many years now, and these programs are all showing the strain of such reasoning. In the near future the sheer numbers of baby boomer retirees will most certainly overwhelm the current capacity of the system to adequately provide any kind of reasonable care at the government’s expense. The only solutions left will be simple, either cut back the quality and quantity of care, or raise taxes to pay for the care that is needed.

Ironically, many of the same people who plan on just letting the government pay for their long term care needs are the very same people who loudly and strongly decry the taxes that they have to pay to allow the government to provide such care.

What is needed is a shift in thinking instead. It is important that each of us recognize the need to take responsibility for our own long term care needs just as we do for other health care and financial matters.