So you thought the political battle to
include a long-term care insurance
program as part of the 2010 health care
reform was heated? It looks like a cakewalk
compared to the actual implementation.
By Liz Smith
26 CONTINGENCIES NOV|DEC. 11
KSENIA PALIMSKI / SHUTTERSTOCK
By Doug Andrews
N MOST OF THE WORLD’S developed countries, the
population is aging. Yet while multiple surveys indicate
that people areconcerned about the potential costs of
long-term care and believeits cost should be shared by
the individual and the government, few national social
insurance programs cover the nonfinancial personal assistance and
chronic health care support that long-term care involves.
While only a subset (though, perhaps, a significant subset) of the
elderly will require long-term care, the costs can be financially devastating. Insurance is an ideal means for covering this risk. But to
guarantee success, government must play a part as well.
Defining the Problem
Unfortunately, there’s no common defi nition of what exactly constitutes long-term care. And there are considerable di;erences from
country to country as to which long-term care services are eligible
As a starting point in any definition of long-term care, however, we
can point to activities of daily living, referred to as ADLs. Although
di;erent names may be used to describe them, the standard six ADLs
are: bathing, dressing, eating, getting in or out of bed, walking across
a room, and using the toilet. Disabilitynormally is defined in terms of
a minimum number of ADLs a person is unable to performwithout
assistance. But the number varies. Some policymakers consider adults
with at least one ADL restriction to be severely disabled, whileoth-ers reserve that distinction for individuals who report di;culty with
three or more ADLs. To qualify for benefits in the German social insurance system, an individual must need help with at least two ADLs.
Another measure is instrumental activities of daily living, referred to as IADLs. IADLs include a wide range of tasks, including
shopping, preparing hot meals, using the telephone, taking medications, managing money, as well as functional limitations such as
di;culty in bending, reaching, and stooping.
Scotland’s 2002 legislation implementing free personal care at
the point of delivery defines personal care as including help with
personal hygiene, continence management, assistance with eat-
ing and mobility, counseling and support services, assistance with
NOV|DEC. 11 CONTINGENCIES 27
26 covering the cost of Long-term care As the world’s population continues to age, many countries are being forced to grapple with making
long-term care affordable. Is it possible?
By Doug Andrews
34 A Good Death End-of-life counseling was demonized during the recent debate
on health care reform. But studies
have shown it to be a both cost-effective and compassionate option.
By Heather Jerbi
40 David Graham Phillips and the Great American Insurance Novel Well-publicized financial shenanigans prompted a
devastating portrait of the life insurance industry in
a muckraking 1907 novel. Once widely acclaimed,
the novel’s crusading author is now almost
By Daniel D. Skwire