A study in the New England Journal of Medicine says that for a couple over age 65, there's a 50-50 chance at least one of them will spend a year or more in a nursing home.

That kind of care costs $5,000-$12,000 a month and, at that rate, a stay of several years could drain the resources of even relatively wealthy retirees. "It's a black hole," says Tom Rogers, a CFP and principal at Portland Financial Planning Group in Maine.

Rogers has seen those kinds of expenses lead to what he calls "the impoverished spouse syndrome." But other relatives can suffer, too.

"Often you see members of the younger generation get pretty worked up about spending $10,000 a month taking care of a parent with full-blown Alzheimer's who doesn't even recognize anyone," Rogers says. "It can really pull families apart."

The recently passed health-care reform bill provides for government-sponsored, long-term care insurance, but actual premiums and benefits, as well as the program's start date, have yet to be set. Critics, including many financial advisers, argue the plan is highly flawed and the promised reimbursements of $50 to $100 per day aren't enough to cover most nursing home care.

Private long-term care insurance can cost thousands of dollars a year, perhaps tens of thousands for people in their 70s. Some believe that most affluent people can cover their own costs with their savings, but Rogers bashes the myth that millionaires don't need the insurance.

"I guess I'd be comfortable with someone who has $4 million, and their spending under control, foregoing this type of coverage," he says. "On the other hand, if you have that kind of money the premium is not such a big deal. And if coverage would help out with family harmony, or just provide a psychological benefit, why not?"

There is a middle ground: partial coverage. Rogers points out that it's possible to save money on premiums by choosing a limited coverage period (perhaps three to five years), electing a long elimination period (benefits might not kick in until after 90 days of care), and reducing -- but not eliminating -- inflation protection.

An increasingly popular option is buying insurance with a lump-sum or 10-year term payment plan, as opposed to making annual payments for life. While that costs much more in the near term, it decreases the likelihood of being subject to a rate increase down the road. (Insurers can't raise an individual's premium, but they can, and do, petition states for policy-wide increases.)

And it buys a lot of security. "I've got some clients who are 60 now who signed up for 10-year payment plans at age 55," Rogers says. "So at age 65 they'll be set, and they won't have to worry about premiums in their retirement."

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