His hand gripped the bannister with a slight tremor. "I just retired six months ago. One cruise, then this! We had so many plans. And how can I add four or five thousand dollars a month to our living expenses. We'll be broke in less than five years!"

Herman is not alone. You may face the same horrifying prospect; if not now, someday, and perhaps sooner than you think.

A study by the U.S. Department of Health and Human Services shows that people who reach age 65 face at least a 40% risk of entering a long term care facility. Although 45% of those nursing home stays last three months or less, more than one-third last a year or more; about 10% last five years or longer. In 1997, an estimated seven million people over the age of 65 needed long term care. By 2005, that number will increase to nine million, and by 2012, to 12 million.

Although the estimated national average cost for private patient care is on the order of $4,500 per month, in some parts of the country the costs can be twice that amount. Home care costs less, but is still costly. For an aide three times a week to help with dressing, bathing and preparing meals, the cost may be as much as $1,000 per month. Moreover, if skilled care is needed (like physical therapy), the costs are even greater.

Medicare pays for only 100 days of skilled and intermediate-level long term care, less than 2% of the total costs incurred. Private insurance pays a lesser percentage. The balance of the costs are paid from private savings and the various state-federal Medicaid programs.

Long term care insurance policies are actively marketed and serve this need well. More than 200 forms of coverage are now available. They remain, however, a minor factor compared to the total costs.

In California, Medi-Cal (this state's adaptation of the Medicaid program) is the only public health program that pays for long term care at the custodial level, or at the higher levels of care after the Medicare benefit expires.

Becoming eligible for Medi-Cal can require property transfers that are emotionally difficult for many. It can also lead to a sense of lost dignity. Consequently, Medi-Cal should be used only as a last resort. For many, however, it meets a critical need.

Often, Medi-Cal benefits can be combined with Supplemental Security Income (another state-federal program) to provide attractive benefits for a disabled person living in an assisted living facility (life care or room and board). For so long as assisted living meets the need, a long term care facility may be avoided.

In this book, you are provided with the background information needed in order to make an informed choice. Such critical decision-making must be based on sound information.

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