The longer Chris Cooper talks about his new book, Eldercare Confidential: Cautionary Tales for Adult Caregivers and Caretakers of Parents and Spouses, the darker his quips grow. Cooper, a Certified Financial Planner based in San Diego, says ignorance about the realities of eldercare abound, and that finding affordable, quality care for the elderly can be laborious and frustrating.

“When I was 19, I went to work in a nursing home and after that, I decided that when I retired, I better own my own nursing home,” says Cooper, 59, who is founder of Eldercare Advocates, which provides geriatric care management and long-term-care counseling.

Cooper’s long-term-care plan for himself is an ideal strategy: “I’ve had long-term-care insurance since I was 40. I also have wealth, I have empowered others to act for me when I can’t act for myself -- to be my fiduciaries -- and I have done estate plans, health-care directives and a will. I have the people in place  who have to carry these jobs out and who know how to get it done.”

In Eldercare Confidential, Cooper warns readers that the concept of lovely, healthy and mostly government-paid-for-homes for the elderly is largely unrealistic. He calls it the Shady Acres myth.

“Even if it did exist, you probably could not afford it. Most middle-income Americans are unaware of the crucial fact that the government does not generally cover long-term-care expenses. This can be distressing for the 6 million Americans age 85 and older, a number that will shoot up to more than 14 million in 2040,” Cooper writes.

Lack of knowledge about eldercare extends through the generations, Cooper says; in his practice, he regularly meets health-care workers who are unprepared to deal with the needs of their elderly parents.

“I’ve even dealt with doctors who get an attitude when I try to tell them how they must prepare for their elderly parents’ care. ‘I make enough money to pay for my Mom’s care!’ they tell me, and I say, “Great, let me see your financials, your will, your trust, etc. What happens if you die before your mother?’ They don’t think it out.”

In his book, Cooper includes contact information for 15 agencies and associations that provide information on issues such as aging parents and eldercare, Medicare rights, Alzheimer’s disease, nursing home abuse, elder law attorneys and long-term care financing.

He says that children of the elderly had best be prepared for resistance to a move to a nursing home or assisted living facility. “We helped a woman living in Chicago whose parents were living out in the country in Ohio, and even though the husband had been going downhill for three years, it was like pulling teeth getting him to move. He was falling a lot and his wife was showing signs of dementia. The daughter finally convinced him to move and when they did, he said ‘This is it! I’m spending my hard-earned money on this?’ When she told me this, I was taken aback. I’m at this 35 years and still surprised at what I hear,’’ Cooper said.

But avoiding the trauma and expense of moving to an eldercare setting by staying in the family home isn’t always feasible, Cooper says.

“Most people would like to age in place, but it’s an impracticality from two points of view: financial and social. When you age at home, all by yourself, you’re isolated and that causes loneliness, and you get depressed and you die sooner. We need to be able to live together, to have closer neighbors. Most of the United States is still rural and people live miles apart, which makes them dependent on automobiles, and when you get to a certain age, you can’t drive, which causes more problems.

“Financially, it’s very expensive to try to re-create home health care for one person: you need two persons for that care: one to do the work and the one to watch over the care. It’s better to live in a congregate area, like an apartment building or independent housing. I find that we are not really equipped in the United States to age at home. Even though home care agencies would like to sell you on that, it’s unrealistic: the (health care) workers often don’t show up, especially on night shifts and swing shifts.’’

Cooper says that until the United States “makes home health-care work a profession, it’s not going to work. Eighty percent of home care is done under the table, especially in the southern states, where it is still a form of slavery. In those states, the workers are told they get free room and board, so they should be available to work whenever they are needed. California passed a law that says you can’t make a home health-care worker work beyond 40 hours per week, even if they live with you. But in Louisiana, Mississippi and Alabama, there is still a lot of labor misuse and the wages are too low. At $15 an hour, you are barely making it and you can’t make it on that in San Diego,’’ Cooper says.

On the road, Cooper says he meets Canadian travelers and the conversation inevitably turns to the Canadian national health insurance system, which Cooper applauds. “In Canada, home health-care nurses and nursing homes are covered under their system. The Canadians are proud of their system and they don’t mind paying for it; they want it! Overall, health wellness is done better in Canada, Britain and Scandinavia than we do here,’’ he says.

Cooper says assisted living facilities emerged in 1981 as “a midpoint between home care and a nursing home. They have the advantage of offering autonomy to residents and on-staff caregivers who can help with housekeeping and taking medications.

He says that assisted living facilities’ monthly fees range from $800 to $3,000 and few subsidies are available. However, health insurance or long-term-care insurance may reimburse certain costs and some states and municipalities offer subsidies for low-income residents. Some residents may be eligible for Supplemental Security Income (SSI) or Medicaid payments.

However, Cooper says that the rising cost of assisted living may require more families to instead choose aging in place, home care or multi-generational housing, all of which have drawbacks.

Long-term-care insurance policies, introduced about 40 years ago, are the newest form of insurance and “the companies that offer it do not really know if the cost models are accurate,” Cooper says.

Because underwriters underestimated the rising cost of insurance and how much longer Americans would live, some companies have reneged on claims, leading to litigation. Some insurers have raised rates as much as 85 to 95 percent, Cooper says.

“Long-term insurance is still a viable option for many, although the number of insurers selling it has declined,” Cooper says. “Avoid purchasing policies from insurers who do not have a solid financial background and check into how many complaints have been filed against them for nonpayment.”

And, long-term care insurance is now restricted to a fixed time period and payout amount (unlimited lifetime benefits are no longer available), Cooper says.

With the turmoil in the long-term care insurance field, hybrid insurance policies have been introduced that are more flexible and promise no rate increases for the duration of the contract, he says. But Cooper warns prospective buyers to check with their financial advisor before buying, because policy details can be confusing.

He provides a chapter on understanding long-term-care insurance, with suggestions on how to deal with issues that affect your choice of a policy, including aging parents; passing on an estate; business succession; choosing between college versus retirement nest eggs; and the impact of lending money.

“Long-term-care insurance is expensive; however, it can be money well spent. The likelihood of needing long-term care at some point in your life is high -- government research shows that 70 percent of people 65 or older will need such care,” Cooper says.
 He thinks that there is another option to consider in the increasingly expensive and unwieldy area of caring for the elderly: a single payer system.

“I think it will happen when we finally come to the same realization that we have to provide Medicare for all! And I am a Republican, a conservative. We have to improve our system because the demand will be twice what it is now in 10 years. But this is how we do things in this country: we wait until the very end as it is about to explode and then we decide to fix it,’’ Cooper says.

Eldercare Confidential: Cautionary Tales for Adult Caregivers and Caretakers of Parents and Spouses, by Chris Cooper.  Indie Books International, LLC. $20.

Eleanor O’Sullivan is an award-winning freelance journalist who writes for Financial Advisor magazine.