Because people are living longer, they and their families are having to struggle with the challenges of long-term care. Many seniors, especially those 85 and older, need help with activities of daily living such as bathing, dressing, meals, taking medications and getting around safely. What is a frail and/or demented elder who lives alone and has limited or no local family help to do?

Medicare does not cover long-term care at home on an ongoing basis. MediCal pays for nursing home care for those who qualify. Some seniors qualify for In-Home Supportive Services or the Veterans Administration's Aid and Attendance benefit. Those not eligible for such benefits may be living on modest Social Security retirement and may not be homeowners.

Seniors needing to pay out of pocket for LTC at home for months or years easily can deplete any savings and, against their strong preference to remain at home, be faced with applying for MediCal and moving to a nursing home. More people planning for their later years are acquiring LTC insurance that covers ongoing care at home or in care facilities.

Among those 85 and older, 24 percent of men and 8 percent of women will need help with activities of daily living, according to the American Association for Long-Term Care Insurance. Many may need daily help for years. Bay Area costs can range from $15,000 to $25,000 per year for 20 hours per week to $130,000 to $220,000 per year

The time to plan and apply for LTC insurance is when a consumer is likely to qualify, not when long-term care is needed. For free general information and help, call Health Insurance Counseling and Advocacy Program at 800-434-0222 or visit www.aging.ca.gov for information or a free downloadable copy of "A Consumer's Guide to Long-Term Care." Also visit the California Partnership for Long-Term Care at www.dhs.ca.gov/cpltc. For a free customized list of public benefits eligibility visit www.benefitscheckup.org. Or call your free local senior information and referral service at 800-510-2020.

Growing Older is written by Sandra J. Cohen, R.N., and Roger Cormier, M.A., of Cohen Cormier Home Care & Care Management, which provides care assessments, home care, placement assistance and care management. Reach them at 510-652-3377, 925-945-8855 or www.eldercare managers.com.