“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.