Should you buy long-term care insurance?

When Santa Rosa financial planner Greg Randall initially sits down with a client, he likes to ask a question: What's your plan if you should end up in a nursing home and have to pay $100,000 a year for five years?

For Randall, it's not an academic question. He watched his grandmother end up in a nursing home after she suffered a major stroke, a calamity that ended up draining all her assets.

"This is what propelled me to come into this business," said Randall, who also is vice president with the Redwood Empire Estate Planning Council, a group that promotes planning for the future.

The result of financial planning for some will be to purchase long-term care insurance, which can cover care both at home and in nursing homes. Others will seek different options, including taking steps to set aside more money in case of a health emergency.

On first blush, saving for long-term care may seem an unlikely choice for most middle-class Californians. The average cost of a nursing home in Sonoma County is $107,620 a year, according to the state-controlled California Partnership for Long-Term Care.

But skeptics of long-term care insurance suggest that many seniors would get more bang for their bucks by going without such coverage.

For those who want to explore long-term care insurance, the main advice is to do it now. Insurance companies in recent years have become much more restrictive in who they will write policies for, and many seniors who try to get coverage are turned down for health problems, said Jesse Slome, executive director of the American Association for Long-Term Care Insurance.

"The biggest mistake that they make is that they wait," Slome said.

He encouraged consumers to find an agent who has written at least 100 long-term care insurance policies and who can offer at least three different companies. Rates and options can vary widely among companies.

He also maintained that some coverage is better than none. He outlined three options for obtaining $164,250 worth of benefit coverage for a 55-year-old adult. The average cost ranged from $1,010 for a basic policy to $2,110 for one that comes with an annual inflation factor of 3 percent.

Insurance actuaries have estimated that 35 percent of clients will get paid on a claim for a long-term care policy that requires the buyer to pay for the first 90 days of care before eligibility for coverage.

A different approach is advised by Prescott Cole, a senior staff attorney at California Advocates for Nursing Home Reform. He cautioned consumers against being swayed by some of the dire-sounding statistics that are used by both government and the industry.

For example, the state's California Partnership website says that 56.4 percent of Americans who enter a nursing home will be there for more than a year, with the average stay of 2.3 years. In contrast, Cole pointed to the state Office of Statewide Health Planning and Development, which reports that in 2012 only 6.3 percent of patients had stayed a year or more in a nursing home at the time of their discharges.

Partnership officials defended their statistics, maintaining the discharge data can't account for patients who had multiple stays.

For those interested in such insurance, Cole advised them to work hard to understand the details of the policy, especially "when does it pay and when does it not pay."

Also, he said, consumers must understand that the insurance companies can raise rates every year. After purchasing a policy, many have found it difficult to walk away because of all the money they have spent on the policy over the years.

As a result of recent rate increases, Cole said, some seniors are "hanging on by their fingernails." Of the coverage, he warned, "Once you're in, you're in."