The H.R. Doctor Is In
Long Term Caring
 Periodically
the HR Doctor opens a professional fortune cookie and finds
messages predicting things to come. Like the Chinese
restaurant counterpart, these messages are sometimes so
general that you can read into them anything you wish to see.
This time the HR fortune cookie was very clear. It said "Get
in line early to buy long-term care insurance!"
Most people reading this article
have a life span averaging more than 76 years. Advances in
science, and in medicine in particular, are adding to that
life span by about two years per decade. When HR Director
George Washington was gainfully employed, the life span was
about 45. In other words, during the life of the American
Republic, we have added an entire generations worth to the
lifespan!
Its not surprising then that of
all the benefits an employer can offer, increasingly, the most
valuable for many people will end up being long-term care. We
may not like to think about it, but those first years of life
in which we relied on parents, or perhaps a single parent, to
wipe the drool from our mouthes, change our diapers, move us
from place to place and keep us safe, will be repeated later
in our lives for even more years.
It is likely that a child born
today will spend more time taking care of the parents than the
parents spend taking care of the child.
For county governments in
particular, this is going to become as serious an issue as any
we face. This past decade, we have been in a "bed race" to
determine if we could build jail beds faster than the number
of people who check in at the Hotel California County Jail.
The HR Doctor predicts that the next bed race will be to
determine how many long-term care beds can be built at local
government-financed care centers.
The HR Doctor had the honor to
serve as vice president for human resources for the University
of Miami/Miami-Dade County Public Health Trust, one of
Americas largest public hospitals. In addition to more than
1,500 beds of traditional hospital care, the Public Health
Trust operated about 300 long-term care beds.
No matter how compassionate the
staff, no matter how caring top administrators like wonderful
Sylviane Ward might be, the result is if you dont make plans
to keep some elements of your future within your own control,
you may find that the years of drool being wiped from your
chin, diapers being changed, mobility help, and safekeeping
for you personally will be in the hands of strangers. For a
nation of people who put independence on a museum pedestal as
the cornerstone of our entire society, this is a particularly
sad prospect.
In the HR Doctors frequent
visits to the long-term care facilities at Jackson Memorial
Hospital in Miami-Dade County, a particularly striking and
frightening revelation was apparent. While the average age in
a nursing home in the United States is about 80 years, at
Jackson the average was about 45 years. Young people were
there who will be spending decades receiving long-term care at
local government expense because they were momentarily stupid
enough not to wear seat belts while driving, or a helmet while
riding a motorcycle. It immediately made the HR Doctor realize
that the real people suffering from very serious brain
dysfunction were very likely the members of state legislatures
who voted to repeal helmet laws under lobbyists pressure. Let
them visit Jackson and then decide if they voted
wisely!
So what can you do as an
individual and as a public official?
The first thing is to be a
personal role model for protection against the long-term care
need. Besides the obvious (i.e., always wear your seat belt or
a motorcycle helmet) begin exploring how to implement a
long-term care benefit for local government employees. The
agency doesnt have to pay for it. The benefit could be paid
by individual employees. In the future, it will be something
we can pay for with pre-tax dollars.
The HR Doctor offers some basics
to think about as you explore the rather confusing world of
long-term care:
1. Make the benefit available on
a group rather than on an individual basis. Group rates will
be significantly lower and the often extraordinarily high
commission rates found in individual policies will be much
lower as well. Many individual policies may have commission
rates equal to 60 percent or more of the premium paid. That
could turn into 15 percent or thereabout in a group
policy.
2. Insist on guaranteed issue
for employees. That means employees signing up during open
enrollment or when they first become employed will be eligible
for the benefits regardless of their existing, or pre-existing
conditions.
3. Some policies will allow the
relatives of employees, such as parents, children, or siblings
to join the plan, although not on a guaranteed issue basis.
Insist on that feature.
4. Ask a lot of questions
including who will make the decision that I am eligible for
the benefit. Usually eligibility is determined by the loss of
two or more activities of daily living (ADLs). Such basic
activities include feeding, continence, mobility and bathing.
Look for a policy which makes you eligible with the loss of
two ADLs, rather than three or more. Look for a policy where
the judgment about ADL loss is made by your own physician, not
the company itself.
5. Look for a policy that would
allow benefits to be paid in cash directly to the employee
rather than being paid to an institution, such as a nursing
home.
6. The most frequent caregivers,
especially in the future, may well be family members,
neighbors, or friends. Look for a policy that will pay
benefits for home health care by EITHER licensed professionals
or non-licensed caregivers, chosen by the employee.
7. Explore whether the employer
could pay for the cost of a very basic minimum level of
coverage. Often when an employer is willing to pay for a
minimum policy for a group, the rates for the entire group,
and for subsequent enhancements to basic coverage paid by the
employee, will be significantly cheaper.
8. The insurance world is
changing just as fast as the world of high technology, the
entertainment industry and agriculture. That is, we are seeing
the conglomerate giant corporate takeovers of what were once
smaller, more independent organizations. Look for a company
with a long history of financial strength and stability. In
other words, look for a company which, itself, is unlikely to
go on life support or be pronounced clinically or financially
dead before you are.
9. A waiting period or
elimination period is common. This is the time after becoming
eligible when benefits are not yet going to start. Limit such
a waiting period to 90 days or less.
10. Finally, look for a company
that explains its product in very clear language, written more
from the standpoint of the consumer than from the standpoint
of the company defense attorney. The most effective companies
will offer consumer education that goes well beyond scaring
the hell out of employees about how five minutes after they
reject the idea of buying long-term care coverage they will
have a stroke or be severely injured in an auto
accident!
Given the current state of the
federal governments zeal to borrow money for current needs
without equal attention to how this debt will affect future
generations, it is unlikely that a federal program, such as
yet another Medicare extension, will be forthcoming or
comprehensive. If you cant rely on the federal government to
step in with help, and if you dont want to saddle your own
children with a family version of the huge national debt, then
explore long-term care coverage as a 21st century benefit
which will be just as important tomorrow as health insurance
and retirement savings are today. Be a visionary and explore
the possibilities now!
Meanwhile, lets agree to meet
for lunch 20 years from now in our respective nursing home
cafeterias to discuss whether the predictions in this article
have come true, and whether you have taken steps for yourself
and your agencys employees to be better able to control their
destinies under circumstances we have trouble imaging right
now. Ill be the one at the corner table eating applesauce and
jello Ð but also sipping a Guinness and eating
chocolate!
May you have few cares in the
long term!
Phil Rosenberg
The HR
Doctor
http://www.hrdr.net/
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