WASHINGTON -- Millions of families are beginning to grapple with the one major health expense for which most Americans are not insured: long-term care.
About 10 million seniors currently rely on others for daily care, such as help getting dressed, preparing meals or taking medication. That number will only increase as more of the nation's 78 million baby boomers enter old age. Nearly 7 in 10 people will need some form of long-term care after turning 65, according to the Georgetown University Public Policy Institute.
"Nobody wants to go to a nursing home, it's the last resort," says James Firman, president of the National Council on Aging. "People want to stay in their own home, and if they can't, they want to go to a place where they can get assistance but that still feels homelike."
Nursing homes are the most intensive form of long-term care, including round-the-clock medical supervision. That level of care comes with a steep price tag: the average cost of a semiprivate room last year was $81,000, according to a survey by insurance provider MetLife. A private room ran more than $90,500.
Fortunately most seniors won't require extended nursing home care. Only 5 percent will need five years or more in a nursing home.
Less intensive alternatives include home-care services that offer help with meals and household chores, and boardinghouses where a small number of seniors live with on-site caretakers. But like nursing homes, these services aren't covered by Medicare, the government's health care plan for seniors, or private health insurance.
"The issue is that these are long-term costs and almost all of it comes out of pocket," says John Migliaccio, director of research for Metlife's Mature Market Institute. "It's important to have some idea about what it will cost dad, mom or your husband to get the care they need."
Insurance policies for long-term care are available, but only about 5 percent of U.S. adults have them. Most families don't plan for long-term care because often the need comes unexpectedly: an elder takes a bad fall or suffers a stroke. Cost is another issue, because policies can run $1,000 to $8,000 a year, depending on the seniors' age, health and other factors.
"The people who can really afford long-term care insurance often have enough fixed income that they don't really need it," says Bradley Frigon, vice president of the National Academy of Elder Law Attorneys.
Groups like the National Association for Professional Geriatric Care Managers recommend that families discuss various options for long-term care and how to pay for them -- before they become necessary.
"Once you're already sick that's not the time to start changing doctors, moving to a new place and depending on your kids," says Bunni Dybins, a senior care adviser with LivHome in Los Angeles.
Here's a quick look at some senior care services to consider:
Medical alert systems
Perhaps the cheapest and least intrusive option, seniors can use medical alert systems to get assistance in the event of an emergency. Services like Philips Lifeline and Life Alert consist of a necklace or wristband with an emergency button. When pressed, a dispatcher who has access to the senior's profile and medical history is called. Depending on the situation he or she will call a neighbor, family member or medical center. Services generally cost between $30 and $50 a month. Some companies also offer extra motion-sensor technology that automatically contacts a dispatcher if it detects the user has fallen. For more, visit: http://www.lifelinesys.com/content/home.
Adult day care
Much like day care for children, adult day care generally operates during business hours Monday through Friday, providing activities and meals for seniors. Perhaps most importantly, these facilities enable caregivers to go to work, run errands or simply take a break.
"Three-fourths of the care people receive in this country comes from spouses, kids and other relatives," says Firman. "The challenge there is to make sure those caregivers don't burn out, and adult day care becomes an important respite during the day."
The average rate for adult day care last year was $70 a day, or about $18,000 annually. Licensing and certification requirements vary by state and county. More than 5,000 centers run programs across the country and can be found through groups like the National Adult Day Services Association. The group recommends visiting potential centers and going through a checklist of options and amenities, including door-to-door transportation and accessibility. For more, visit: http://www.nadsa.org/consumers/site-visit-checklist/.
Home visiting services
For seniors who want to stay in their homes, visiting services can provide assistance with everything from preparing meals to physical therapy. The typical cost of a home-care service last year was $20,800, at a rate of 20 hours per week. Most companies offer both homemaking services and medical assistance, which is usually billed at a higher rate.
National companies like Visiting Angels and Home Instead generally cost more, but provide prescreening and background checks for all employees. Hiring a private caregiver can be less expensive, though you may have to do more work in terms of performing background checks and tax requirements, since you are hiring them as an employee. The government offers a website for locating eldercare services in your area: http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx.