on Retirement Selections from Society of Actuaries Monograph Managing the Impact of LongTerm Care Needs and Expense on Retirement Security A Holistic and MultiGenerational View Presented by Anna Rappaport and Karl Polzer ID: 803450
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Slide1
The Impact of Long-Term Care on Retirement
Selections
from Society of Actuaries Monograph: Managing the Impact of Long-Term Care Needs and Expense on Retirement
Security
:
A
Holistic and Multi-Generational
View
Presented by Anna Rappaport and Karl Polzer
Moderator: John Cutler. Esq.
Long Term Care Discussion Group
June
24, 2015
Slide22
Our Goals Today
SOA monograph
Presentations:
John Cutler
Anna Rappaport
Karl Polzer
Questions
Slide3Managing the Impact of Long-Term Care Needs and Expense on Retirement Security: A Holistic and Multi-Generational View
12 papers in response to call for papers
issued in 2013
Prizes awarded
(total of $
15,000)
Presentations at NASI and SOA 2014 Annual Meeting, and other venuesAll papers published by SOA in a monograph
3
Slide4SOA MonographManaging the Impact of Long-Term Care Needs and Expense on Retirement Security Monograph:
The
collection of papers in this monograph explores
the impact
of long-term care needs and expense on retirement security from a variety of aspects.
The
monograph can be found at: http://www.soa.org/Library/Monographs/Retirement-Systems/managing-impact-ltc/2014/mono-2014-managing-ltc.aspx
4
Slide5Big Picture
The
Impact of Long‐Term Care Costs on Retirement Wealth Needs
By Vickie
Bajtelsmit and Anna
Rappaport
How American Society will Address LTC Risk, Financing and RetirementBy John CutlerHow Adequate is Long‐Term Care Protection in Developed Countries?
By Doug
Andrews
5
Slide6Caregiving, Family, HealthImproving Retirement by Integrating Family, Friends, Housing and Support: Lessons Learned From Personal Experience
By Anna
Rappaport
The 65+ Age Wave and the Caregiving Conundrum: The Often Forgotten Piece of the Long‐Term Care Puzzle
By Sandra
Timmerman
Home Equity and At‐Need Annuities—A Dynamic Long‐Term Care Funding DuoBy Steve CoopersteinLong‐Term Benefits May Reduce End‐of‐Life Medical Care CostsBy Stephen
Holland, Sharrilyn Evered, and Bruce Center
6
Slide7Insurance BackgroundAn Overview of the U.S. LTC Insurance Market (Past and Present): The Economic Need for LTC Insurance, the History of LTC Regulation & Taxation and the Development of LTC Product Design Features
By
Larry
Rubin, Kevin Crowe, Adam Fisher, Omar Ghaznawi, Richard McCoach, Rachel Narva, David Schaulewicz, Thomas Sullivan, and Toby White
7
Slide8Ideas for the FutureFinancing
Future LTSS and Long Life Through More Flexible 401(k)s and IRAs
By Karl
Polzer
The American Long‐Term Care Insurance Program (ALTCIP)
By Paul
ForteHome Equity: A Strategic Resource for Long‐Term Services and SupportsBy Barbara StuckiAn Affordable Long‐Term Care Solution Through Risk SharingBy Kailan Shang, Hua Su, and Yu Lin
8
Slide9SOA Paper Call and Monograph: Questions addressed
How
can individuals and families protect themselves from the expense of LTC needs?
How can they protect against potential financial ruin?
How can advisors help their clients improve decision making?
Are their better ways to frame and communicate challenges and possible solutions?
Are there better product designs (private and public)?
Are there alternative financial approaches?
How can individuals and families finance LTC needs while addressing basic retirement income needs and asset protection?
9
Slide1010Long-Term Care and Retirement Security:
What
Are
the Issues?
Wealth needs of the individual, spouse and other generations of family are affected
Cost
of a major long-term care event: depletes retirement assets for families who purchase servicesImpact on the
surviving
spouse
Added responsibility and financial burden placed on caregiving family members
Health and long-term care costs over what is planned for, and they outpace general inflation
Increased longevity: greater likelihood of needing care
Limited participation by middle income earners in the private insurance
market
Also societal impact:
On
Social Security, Medicare, and Medicaid
Slide1111The Impact of LTC Costs on
Retirement
Wealth Needs
Authors: Vickie Bajtelsmit & Anna Rappaport
Background on retirement and long-term care
Discusses impact on women
Sets up four methods for private financing of long-term care Presents simulation research from SOA Retirement Adequacy Study
Provides areas for further
research
Discussion also includes limited findings from additional paper:
Improving Retirement by Integrating Family, Friends, Housing and Support: Lessons Learned From Personal Experience
Slide1212Background
Major
LTC event can devastate retirement security for most households. For households below median who need an extended stay in nursing home, Medicaid is probably only viable option.
Major private methods of financings LTC include insurance, savings, CCRCs, and use of home equity. Can be combined.
None of these match needs perfectly. Some have better chance than others.
Longest lived people most likely to have major needs.
By age 80, 1/3 have some disability and by 86, majority have disability.
Women have greatest challenges.
Slide13Four Options for Financing Care
Insurance
Savings
CCRC
Housing Equity
Prevalence
< 10%
15% of care pd out of pocket
Low, higher net worth only
Little use of reverse mortgages
When to do
While
still healthy
Ongoing – all ages
Time of entry and monthly
When needed
Match to needs
Depends on contract, situation
No direct match
Depends on contract,
situation
No direct match
Applies to
Middle and upper income
Higher income and net worth
Higher
net worth
All
levels who own home
13
Slide14Four Options for Financing Care (cont’d)
Insurance
Savings
CCRC
Housing Equity
Risks
Premium
increases, costs exceed limits, situation not covered
Investment risk, may not have enough
money, difficulty of managing assets
Monthly
costs can increase, bankruptcy risk, don’t know if needs covered
Equity unmatched
to need, illiquidity, interest rates affect reverse mortgages
Costs no LTC need
Premiums paid
None
Buy-in price, higher monthly premiums
None
Issues for surviving spouse
Reduces risk of asset depletion
Survivor may not
have enough assets left
Security of CCRC; higher monthly costs; possible
relocation
Survivor may not
have enough assets left
Taxation
Some policies tax advantaged
Most retirement savings tax deferred
Part of price = insurance premium
Gain
on sale of house often tax free
14
Slide1515Building Long-Term Care into Stochastic Retirement Modeling
EBRI mode
l
Aggregate approach
Focuses on entire population
Identifies % of population who will not have enough money
SOA Retirement Adequacy Study
Individual approach
Focuses on sample individuals near the middle
Estimates how much money a household needs for retirement success
Both studies
:
Shocks including long-term care are important
Long-term care is a major factor in inadequate assets
Slide1616SOA Study: Effect of LTC Insurance on Retirement Adequacy
Wealth Needed at Retirement in 000s
Base Case:
No LTCI
Buy LTCI for Both Spouses
Buy LTCI for Wife
Median family
Wealth at retirement: 50
th
percentile
$170
$227
$195
Wealth at retirement: 95
th
percentile
$686
$333
$338
75% family
Wealth at retirement: 50
th
percentile
$544
$599
$581
Wealth at retirement: 95
th
percentile
$1,011
$851
$871
Median family: $60,000 income and $100,000 non-housing wealth
75% family: $105,000 income and $250,000 non-housing wealth
Slide1717CCRC Observations
CCRCs can offer very positive experience and lifestyle for individuals with limitations, as well as good financial outcome, particularly for those who need care
There are several types of contracts – individual CCRCs often offer multiple options
A: Lifecare or extensive
B: Modified contract: Limited long-term care
C: Fee-for-service
D: Rental
Advantages are promoted, but the risks are not well understood
Usually paid for by “up-front” payment plus monthly charge
Amounts paid in can be used to pay current expenses – flow of new entrants vital for financial stability
Slide1818Fee Examples – based on a NC CCRC
Unit
and terms
Entrance fee
Monthly charge
Lifecare,
larger one bedroom, 90% refund (Type A)
$318,000 plus $46,000 for 2
nd
person
$2,400
to $2,700 plus $1,100 for 2
nd
person
Lifecare, larger one bedroom, declining
refund (Type A)
$185,000 plus $27,000 for 2
nd
person
$2,400
to $2,700 plus $1,100 for 2
nd
person
Fee-for-service, larger one bedroom,
declining refund (Type C)
$109,000 (no added entry fee for 2
nd
person)
$2,400 for person 1, and $485 for add’l person.
$4,400
per person in assisted living,
$5,700 per person in memory care,
$8,000 per person in nursing care
Fees seem to vary significantly by facility, some are for-profit and some not-for-profit, some have added support from contributions; what services are included also varies
Slide1919Comparison of Senior Housing Options
Independent Living
Assisted Living
Nursing Home
Meals/day
Often
1, varies
3+
3+
Personal care
No
Limited
Yes
Medication
mgt
No
Yes
Yes
Mobility ass’t
No,
but supports limitations
Yes
Yes
Activities
Yes, may be extensive
More limited
Appropriate
to situation
On-site nurses
No
Yes
Yes
Monthly costs (GAO
study – 2009)
$900 to
$2,700
$4,700 to
$6,500
$8,100 to $10,700
CCRC’s combine different levels of support.
These options are very different from active 55+ communities
Slide2020Conclusions/Issues for Action
EBRI
and SOA-RA models include long-term care and health risk in broader retirement simulation models. Many models exclude these risks.
Results are very different when these risks are included. Huge difference between 50
th
and 95
th percentile because of shocks.
If stochastic modeling does not include LTC, point out limitations and be careful how used
Planning strategies
like changing retirement age or reducing spending help at the median but can’t handle the full impact of shocks.
Advance planning for LTC very important for low and middle income households.
LTC insurance can be useful for those in middle-income brackets.
Slide2121Conclusions
Good
options
for care available
for affluent. Much more limited for those without money.
Be careful about paying entry fees.
CCRC is a major financial commitment, and may have some hidden risks.
Market is evolving and individual needs change.
Moving may involve major downsizing.
Living choices may
involve multiple transitions at unexpected times.
Better resources needed to evaluate alternatives.