CONTINUING EDUCATION ALZHEIMERS DISEASE AND OTHER DEMENTIAS What

CONTINUING EDUCATION ALZHEIMER’S DISEASE AND OTHER DEMENTIAS What you need to know to help your clients Presenter Name Presenter Title Date LCN-2743520 -092419 For designation and state continuing education purposes only. Not for use with the general public. © 2019 Lincoln National Corporation

IMPORTANT INFORMATION This presentation is for educational and informational purposes only and not for the purpose of providing legal or tax advice. Further, Lincoln Financial Group provides the strategies and concepts herein for educational and informational purposes only. This information is not intended to be used with the public. Further, this information is not intended to constitute a complete description of all tax consequences regarding the subject matter covered and is presented with the understanding that neither Lincoln Financial Group, nor its employees, are being engaged to render legal or tax advice. While this seminar discusses general legal or tax aspects and concepts of financial or estate planning with annuities and life insurance, it does not discuss all aspects of U. S. federal income taxation that may be relevant to individuals in light of their particular circumstances and income tax situations. Lincoln Financial Group makes no representations as to the suitability for individual clients. Interested parties should seek separate tax and legal advice before implementing a plan or strategy of the type described in this presentation. This advice should also include the application of state, local and other tax laws and the possible effects of changes in the federal or other tax laws. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 2

INSTRUCTOR-STUDENT AGREEMENT 1. You must attend the entire presentation to receive course credit. The course may not end early. – If the course duration is 50 minutes, no breaks are allowed during the seminar. – If the course duration is 60+ minutes, a 10 -minute break is permitted per 60 minutes of instruction time. 2. Course credit is for 1 CE hour. – Please ask your instructor to confirm the states approved for this course. 3. Neither the company nor its products can be promoted during the class. – During the allotted class time, there cannot be conversations linking the course materials to any company marketing or recruiting efforts. If there are questions related to either our company or any of our products, you must wait to discuss with the instructor at the conclusion of the class. 4. Please fill out your attendance sheets now. – Kindly turn in your attendance sheet even if you do not have your license number. – If an attendance sheet is not received by Lincoln Financial Group, course credit cannot be given. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 3

“…I view [education] as the most important subject which we as a people can be engaged in. ” For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 4

AGENDA 1. 2. 3. 4. 5. 6. 7. 8. Dementia Prevalence Disease process Treatments and research Documentation requirements Funding for care and services Resources Quality of life For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 5

DEMENTIA Seniors are vulnerable because they • Have a nest egg • Own their home • Maintain excellent credit • Were raised to be trusting • Are less likely to report crimes • Often make poor witnesses • Believe the false claims of fraudulent products Source: The Federal Bureau of Investigation, www. fbi. gov/scams-safety/fraud/seniors. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 6

DEMENTIA Senility • Part of the normal aging process Mild cognitive impairment (MCI) • Mild but measurable changes in thinking Dementia • Not part of the normal aging process • Interferes with activities of daily living • Alzheimer’s disease can cause dementia Source: https: //www. alz. org/alzheimers-dementia/what-is-dementia. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 7

DEMENTIA About Alzheimer’s disease • Progressive, degenerative disorder that attacks the brain’s nerve cells • Loss of memory, thinking and language skills and behavioral changes • Most common cause of dementia in persons over age 65 Source: https: //www. alz. org/alzheimers-dementia/what-is-alzheimers For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 8

DEMENTIA The symptoms of Alzheimer’s Mood changes Unfounded suspicion Memory loss Confusion Difficulty speaking, swallowing and walking Source: https: //www. alz. org/alzheimers-dementia/what-is-alzheimers For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 9

THE PREVALENCE OF ALZHEIMER’S • Each day for the next 10 years, 10, 000 baby boomers will turn 65. * • Every 65 seconds, an individual age 65 or older is diagnosed with Alzheimer’s. ** • 1 in 3 seniors dies with either Alzheimer’s or another dementia. ** Sources: * https: //www. pewresearch. org/fact-tank/2019/07/24/baby-boomers-us-labor-force/ **https: //www. alz. org/media/Documents/alzheimers-facts-and-figures-infographic-2019. pdf For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 10

THE PREVALENCE OF ALZHEIMER’S Americans with Alzheimer’s 13. 8 million Millions of Americans 14 12 10 8 5. 8 million 7. 1 million 6 4 2 0 2019 2025 2050 Source: https: //www. alz. org/alzheimers-dementia/facts-figures For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 11

THE COSTS OF ALZHEIMER’S • Cost of Alzheimer’s-related healthcare services at $290 billion • The average unpaid caregiver devotes 1, 139 hours annually and gives up $14, 397 in income • 16 M unpaid caregivers, 18. 5 B hours worked annually (valued at $233. 9 B) • Caregiver financial losses – Absences – Swing shift work – Staff turnover – Workday adjustments – Training and productivity – Employee health issues How many of your clients will be affected by Alzheimer’s disease? Who will be their caregivers? Source: https: //www. alzheimersanddementia. com/article/S 1552 -5260(19)30031 -7/pdf For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 12

DISEASE PROCESS Alzheimer’s Association About this stage Preclinical Usually only identified in research settings; generally no symptoms are present and can last for years, even decades Mild cognitive impairment (MCI) Mild changes in their memory and thinking ability. Not everyone with MCI has Alzheimer’s disease. Mild dementia Often Alzheimer’s is diagnosed in this stage. Significant trouble with memory and thinking. Moderate dementia Individuals experience more confusion and forgetfulness and begin to need more help with daily activities and self-care. Severe dementia Mental function continues to decline and the disease has a growing impact on movement and physical capabilities. Source: https: //www. mayoclinic. org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448 For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 13

DISEASE PROCESS Mild stage Moderate stage • Wandering, getting lost, trouble handling money, repeating questions • Taking longer to complete normal daily tasks • Personality and behavior changes • Problems recognizing familiar faces • Inability to learn new things • Inability to perform multistep tasks like getting dressed • Damage to brain causing loss of control of language, reasoning, sensory process, thinking • Hallucinations, delusions, paranoia Source: https: //www. mayoclinic. org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448 For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 14

DISEASE PROCESS Accurate diagnosis only happens after death. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 15

TREATMENTS AND RESEARCH • While there are currently no treatments that prevent or cure Alzheimer’s disease, several groups of researchers have estimated the cost savings of future interventions that either slow the onset of dementia or reduce the symptoms. • Many researchers believe that future treatments to slow or stop the progression of Alzheimer’s disease and preserve brain function will be most effective when administered early in the disease process, either at the MCI due to Alzheimer’s or 23% preclinical stage. 43% 27% 48% 30% 28% Source: https: //www. alz. org/media/Documents/alzheimers-facts-and-figures-2019 -r. pdf For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 16

TREATMENTS AND RESEARCH Comparison with cancer Final stats for 2017 Alzheimer’s and dementia Cancer Number of deaths 261, 914* 600, 920** Cause of death rank 6 th*** 2 nd** Research funding $2. 5 billion† $5. 9 billion† * https: //www. ajc. com/news/health-med-fit-science/rate-dementia-deaths-has-more-than-doubled-cdc-says/r. T 8 bdwfp 2 Tz. Kew. AC 9 OLq. IN/ ** https: //onlinelibrary. wiley. com/doi/pdf/10. 3322/caac. 21387 ***https: //www. alz. org/media/Documents/alzheimers-facts-and-figures-2019 -r. pdf † https: //report. nih. gov/categorical_spending. aspx For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 17

DOCUMENTATION REQUIREMENTS Advisors and insurance agents should document client information • Salient points of meetings • Emails • Phone calls • Texts • Letters For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 18

DOCUMENTATION REQUIREMENTS Insurance agent associations and educational institutions can provide support • National Association of Insurance Commissioners (NAIC) • National Association of Insurance and Financial Advisors (NAIFA) • National Association of Professional Insurance Agents (PIA) • Association of Insurance Compliance Professionals (AICP) • Compliance & Ethics Forum for Life Insurers (CEFLI) • National Association of Independent Life Brokerage Agencies (NAILBA) For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 19

DOCUMENTATION REQUIREMENTS The client is most vulnerable to suggestions of others regarding • How their money should be managed • Who should be granted power of attorney • Who should be named as beneficiary Red flags • Abnormal activity • Unusual requests to cancel or change insurance policies For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 20

DOCUMENTATION REQUIREMENTS Association of Insurance Compliance Professionals® Code of Professional Conduct • Demonstrate knowledge of insurance laws and regulations. • Act professionally at all times. • Encourage and act on the spirit and letter of laws governing insurance. • Abstain from acts or the appearance of a conflict of interest. • Improve the regulatory compliance system. • Promote respect for the insurance industry and its SROs. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 21

DOCUMENTATION REQUIREMENTS Consequences • Fines • License suspension • Criminal prosecution • Combination of the above For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 22

FUNDING FOR CARE AND SERVICES Sources of funds for Americans ages 65 and older with Alzheimer’s disease and other dementias, 2019 11% 22% 51% 17% Medicare ― $146 billion Medicaid ― $49 billion Out of pocket ― $63 billion Other ― $32 billion Source: https: //www. alz. org/media/documents/alzheimers-facts-and-figures-2019 -r. pdf For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 23

FUNDING FOR CARE AND SERVICES MEDICARE Health insurance for • 65 -year-olds and above • Certain disabilities under 65 • End-stage renal disease Is not long-term care insurance MEDICAID Needs-based health coverage at any age • Client must have limited financial resources Does not provide in-home care Source: Centers for Medicare & Medicaid Services, www. cms. gov/medicare. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 24

FUNDING FOR CARE AND SERVICES — OUT-OF-POCKET AND “OTHER” Patients are responsible for out-of-pocket payments: $63 billion • Medicare premiums • Health insurance premiums • Deductibles • Copays Other sources of funding: $32 billion • Private insurance through employer, spouse, healthcare marketplace Source: https: //www. alz. org/media/documents/alzheimers-facts-and-figures-2019 -r. pdf For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 25

FUNDING FOR CARE AND SERVICES — PLANNING AHEAD ABRs = accelerated benefits riders Accelerated death benefits may be taxable and may affect public assistance eligibility. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 26

WHAT TO ASK CLIENTS…AND WHY • • Do your clients value guarantees? Which assets would they sell first when needing LTC? Is their family aware of their wishes? Would they rather spend life savings or plan now? By planning today, you can help your clients protect themselves, their loved ones and their assets. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 27

SELF FUNDING Client profile • Wants to keep money accessible • Doesn’t consider LTC a big concern Typical benefits Considerations • No risk of wasting premiums • Access to funds for any purpose • At risk of market fluctuation and principal erosion • No formal planning • Impact on spouse and family • Not tax-efficient For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 28

ANNUITY WITH LTC-RELATED RIDERS Client profile • Likes the idea of guaranteed lifetime income • Looking for tax efficiency • Does not want to use up retirement income on LTC expenses Typical benefits Considerations • Options for guaranteed growth of future income • Increased payments may be available in the event of specific care needs • Long-term care coverage specific to certain care needs For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 29

LIFE INSURANCE WITH ACCELERATED BENEFIT RIDER Client profile • • Primary need is a death benefit Likes the additional living benefit option Wants design flexibility Not inflation-sensitive Typical benefits Considerations • Larger death benefit • Cash value accumulation potential • • • No inflation protection Premiums may not be guaranteed Paid benefits reduce the death benefit Not partnership qualified Chronic or terminal illness-qualified riders For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 30

LIFE INSURANCE WITH LONG-TERM CARE SOLUTIONS Client profile • • Typical benefits • • Seeking guarantees Likes that there is a death benefit Has ability to pay single or limited pay Inflation-sensitive Considerations Return of premium Available inflation protection Death benefit availability Guaranteed LTC benefits, if premiums are paid as planned • Single premium or short pay required • Paid LTC benefits reduce death benefit • Not partnership-qualified For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 31

STAND-ALONE LONG-TERM CARE Client profile • Does not need additional life insurance • Prefers lower premiums • Inflation-sensitive Typical benefits • • Considerations Low annual cost Available inflation coverage Customizable Partnership qualified • • No death benefit* Premiums not guaranteed Client may never use coverage No cash value accumulation *Some policies may have provisions that provide for returns up to premiums paid out-of-pocket upon surrender or death. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 32

OPTIONS FOR CARE Assisted living Nursing home care Alzheimer’s and dementia daycare centers Home care Adult day care For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 33

A CARE PROVIDER SHORTAGE Consider these facts • The nation’s strained healthcare system is trying to keep sick seniors out of hospitals, assisted-living facilities and nursing homes and instead have them cared for in their homes. • A startling 75 percent of Americans over 65 live with multiple chronic health conditions, ranging from diabetes to dementia. • The U. S. spent an estimated $103 billion on home health care last year, according to the Centers for Medicare & Medicaid Services. • Overall employment of in-home aides is projected to grow 41 percent from 2016 to 2026 — translating to 7. 8 million job openings. Source: https: //www. cnbc. com/2019/04/09/us-home-healthcare-system-is-incrisis-as-worker-shortages-worsen. html For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 34

RESOURCES • • Alzheimer’s Association www. alz. org Alzheimer’s Foundation of America (AFA) www. alzfdn. org National Institute on Aging (NIA) www. nia. nih. gov National Institute of Health (NIH) www. nia. nih. gov/alzheimers For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 35

QUALITY OF LIFE Common signs and symptoms of dementia • • • Memory loss Impaired judgment Difficulties with abstract thinking Faulty reasoning Inappropriate behavior Loss of communication skills Disorientation to time and place Gait, motor, and balance problems Neglect of personal care and safety Hallucinations, paranoia, agitation You might observe that a person with dementia • • Repeatedly asks the same questions Becomes lost or disoriented in familiar places Is unable to follow directions Is disoriented as to the date or time of day Doesn’t recognize/is confused by familiar people Has difficulty with routine tasks Neglects safety, hygiene, and nutrition Source: “Understanding Dementia: Signs, Symptoms, Types, and Treatment, ” Help. Guide. org. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 36

THE ROLE OF THE ADVISOR What you can do • Talk with your clients about long-term care planning before they become ill. • Find the solution that is best for your client’s needs. • Educate the client about that specific product. Source: Lynette Gill, Life. Health. Pro. com. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 37

REMINDER Please complete your attendance sheets. This form must be completed in full, including your signature and the time the course ended. Turn the attendance sheet in to your instructor for CE credit. If the form is not received, CE credit cannot be issued. For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 38

S? N QUESTIO For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 39

Lincoln. Financial. com Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. 10/19 Z 02 Order code: CE-LTC-PPT 002 For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 40

THANK YOU For designation and state continuing education purposes only. Not for use with the general public. LCN-2743520 -092419 41