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KAI RYSSDAL: A nursing home, on average, costs $66,000 a year. That is far more than many can afford. Yes, you can buy insurance to help cover it or choose a place that's cheaper, but that can be . . . unpleasant. And besides, nursing homes just aren't what most people want. Last year a survey by the AARP reported 89 percent of people said they would much rather stay in their own homes. That is, if they could get help with what they can't manage. From the Marketplace Health Desk, Helen Palmer reports.
HELEN PALMER: 86-year-old Bill Herzog does 150 arm presses and leg presses every day, even though seven years ago a racing accident landed him in a wheelchair.
BILL HERZOG: I think it's contributing to my longevity even though driving a race car kind of slowed me up.
But he says that longevity is also thanks to his home care assistant.
BILL: I couldn't ask for anybody better than Lucy to be waiting on me.
Lucy Brown's a nursing aide. She's been helping Bill with meals and bathing and the like for six years. She works four 24-hour shifts a week
Bill's wife, Trish, says keeping him at home has literally saved his life.
TRISH HERZOG: To be very honest, I think if Bill were somewhere else, I don't think he'd probably be here today.
But this kind of care doesn't come cheap. Cheryl Smith runs Kansas City Home Care. That's an agency that supplies basic help and nursing assistance.
CHERYL SMITH: The typical average probably runs between $17.50 and $19.50 an hour through an agency nationwide.
That cost can be modest if you only need a couple of hours help a day. But round-the-clock care for Bill Herzog costs nearly $86,000 a year. Trish Herzog says they pay out of pocket.
TRISH: We're blessed to have the resources to be able to afford having in home care. :06
But few people are so blessed. Helping keep people in their own homes hasn't been a priority for public programs. Arpineh Kishishian is a clinical social worker in Los Angeles.
ARPINEH KISHISHIAN: The system is set up where unfortunately if you worked and saved and you don't qualify for any county welfare services you're pretty much out of luck.
Medicare doesn't cover long term care costs, only medical expenses.
You have to have virtually no assets to qualify for Medicaid. And that program typically covers a nursing home but not personal care in your home.
Last year's Deficit Reduction Act relaxed the rules though. Now states have more discretion in how they use Medicaid cash. The Act also set up new "money follows the person" grants. Those help states move people out of institutional nursing home care into the community.
CHERYL MATTHEIS: It's a large amount of money, $1.75 billion that will be spent over the next five years. States have to apply for these grants by Nov. 1 of this year.
Cheryl Mattheis crafts health strategies for the seniors lobby, AARP. She says it'll save money long-term if states grab this cash.
MATTHEIS: We all know and studies have shown that care in the home ultimately is less expensive than care in an institution, but we have to get to that point and we have to get over the start-up costs.
Like making homes safer for seniors. John Pynoos is a gerontology professor at USC.
JOHN PYNOOS: Grab bars are simple, relatively. They run from $30 to $80. Hand rails, they can run $50 to $200. We're not talking about huge expenses.
Frank and Josephine Booth needed some of those modifications to their modest house in West Hollywood.
Frank's blind, after an industrial accident in 1961. He has serious osteoporosis, he broke a hip in March. But he's still at home, thank to his employment with the state of California.
FRANK BOOTH: With the Public Employees Retirement System they had a long term care program.
Booth signed up for the plan when he was 59. Now he's 82 and he gets 32 hours of home care free every week.
BOOTH: It doesn't cost me a thing. And they pay up to almost $2,700.
That's every month.
Most long term care policies now cover home care. Experts like the AARP say they're a prudent investment -- if you can afford them.
But few of the graying Baby Boomers have bothered, so they may find themselves relying on their children for the kind of care they're now delivering to their parents.
In Los Angeles, I'm Helen Palmer for Marketplace Money.