11/21/2004 7:43 PM Page 1

There’s No Place Like a Nursing Home:

An Important Message for

Long Term Care Insurance Professionals

Contributed by Karen Shoff, MSW, MSG, LUTCF, CTM

“I hate it here, I want to come home.”

Until last month, John Burns, 93, was a healthy, active man who did all the shopping, errands, and cooking for himself and his wife, Emma. Then he broke his leg and ended up in a nursing home.

“John, I can’t take care of you at home,” Emma told him. “I’m not strong enough to do it myself. Where would we get the money to hire help for you?”

The reality of his situation hits John like a ton of bricks. Emma is right  she can’t care for him at home. But two weeks in the nursing home have made him desperate.

“I feel like I’m in jail! I need to come home!” John pleads.

Emma visits daily, bringing food, books, and other tastes of home. She watches helplessly as her husband moves from feelings of longing for home to desperation and then, utter hopelessness. His vitality ebbs away, and John finally dies after six months in the nursing home. Deeply depressed, Emma dies three months after John’s passing.

* * *

This true story of John and Emma Burns (not their real names) is all too common. Millions of Americans are robbed of dignity as they spend their final years as nursing home “hostages.” But according to Gallup, an overwhelming 87% of Americans would rather receive care at home. In fact, the lower quality of nursing home care, added to the depression most patients feel in this setting, means that entering a nursing home often shortens one’s very life.

For the past 30 years, I have been in the field of aging. First, I worked as a social worker in nursing homes, and later with the elderly as a gerontologist. Based on my extensive experience, I can assure you that the institutional nature of nursing homes simply does not now, and never will, allow them to offer dignified care. There is no solution to the indignities of life in a nursing home, except to plan to avoid them completely.

Most Americans (including many of my fellow agents) don’t realize what it’s really like to live in an institutional setting. This must explain why our professional literature is entirely upside down! I frequently see suggestions that we sell plans based on nursing home costs and the average length of stay in a nursing home (under three years). Additionally, I see prominent references to a “continuum of care,” with home care ranked at the lowest level and nursing homes at the top. This advice is diametrically opposed to the best interest of most people! How can anyone suggest that a nursing home offering three hours of direct care in a 24-hour period from low-paid and overworked staff is superior to a private caregiver giving full-time personal attention at home.

It is high time for all of us to crawl out of the dark ages of long term care planning. Remember that we are selling Long Term Care Insurance, not “Nursing Home” insurance. Our goal is to help clients avoid nursing homes and use their long term care insurance benefits to receive care, in a location of their own choice.

We can have a life-changing impact on our clients’ futures. All Americans, of necessity, must plan ahead in order to receive future care at home. I have written a book, There’s No Place Like a Nursing Home to sound the alarm! To quote a recent New York Times book review by Fred Brock, “This is a very helpful and ultimately optimistic book.…”

The book reveals:

  • What nursing homes are really like
  • Why home care is the highest level of care
  • The four unanticipated causes of nursing home placements

For example, the story of John and Emma Burns illustrates one of the most common causes. The couple had no money to pay for care at home and Mrs. Burns was too old and weak to give the care herself. Medicaid offered Mr. Burns his only option — a nursing home. Had the Burnses known about and purchased long term care insurance several decades earlier, they could have paid for caregivers. He would have been able to remain at home in dignity, without becoming a burden on his wife.

  • There are four critical and potentially life-saving steps that are necessary for clients to take in their middle years to avoid nursing homes forever:
  1. Long Term Care Insurance (LTCI)  Unless one is extremely wealthy and willing to part with that money for caregivers, LTCI will be the foundation of a realistic plan for receiving care at home.
  1. Geriatric Care Management A private geriatric care manager (GCM) will set up care at home and assist in finding and supervising caregivers. Having a GCM on your side is critical for people who have no relatives living nearby.
  1. Putting Wishes in Writing, Legally What if your client can’t speak for himself or herself after a medical crisis? Putting wishes in writing legally ensures that everyone knows exactly what type of care your client wants.
  1. Allies to Support Clients’ Plans One person designated to carry out your client’s wishes may give up when the hospital staff puts on the pressure and says that a nursing home is the only option! Two or more people can stand together to insist that the client’s desire to go home is not compromised. Urge your clients to create allies by making sure that their families, doctors, care manager and others know what they want.

There’s No Place Like a Nursing Home will equip you with the specific professional information you need to help your clients plan ahead to receive superior care in the comfort of their own homes.

When presenting the cost of care, instead of giving the average daily cost of a nursing home, show the cost of hiring caregivers at home. Rather than discussing the average length of a nursing home stay, explain that often, home care begins sooner and lasts longer (after all, most people admitted to nursing homes have already received some care at home). In addition, prepare proposals that include 100% of the nursing home benefit payable to caregivers at home.

Giving them a copy of There’s No Place Like a Nursing Home will be one of the best gifts possible. Clients who use it as a planning guide will achieve fuller, happier and more dignified lives — secure in the knowledge that they will never become a burden to those they love.

There’s No Place Like a Nursing Home by Karen Shoff (Invisible Ink, 2003; $12.95) is available by calling 1-800-BookLog, online at and at Barnes & Noble bookstores. Bulk rates are available by contacting the author at (310) 581-8080.

BIO

Karen Shoff, MSW, MSG, LUTCF, is a social worker, gerontologist, and Long Term Care insurance specialist. Her work in nursing homes led to her lifelong mission of protecting her clients, family, and now all Americans from the humiliations of institutional life.

Karen is a member of MDRT, a spokesperson for the California Partnership for Long Term Care, a public speaker and member of Toastmasters International. She is Senior Partner at Shoff and Shoff Insurance Agency, LLC in Santa Monica, California, and has been in insurance sales since 1982. You can email Karen at or call her at (310) 396-3413.

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C:\MSOFFICE\WINWORD\Book\Probe Article Sept 03.DOC © 2003, Karen S. Shoff