She works in her yard, maintains a garden, watches her diet and is waiting for her exercise group to get started at the FiftyForward Center in Madison.

Asked about long-term care insurance, Eva Mai Nelson says, “I’ve thought about it. I don’t think it’s worthwhile to buy at my age.” She’s 83.

Fellow exerciser Norma Ragan, 79, says she and her husband considered buying a policy a few years ago, when they were in their mid-70s.

“We talked with our son-in-law. He’s a good businessman,” she says.

He told them that at their ages, premiums would be very expensive and the benefits might not be worth the cost. With his advice, they decided to look to their savings if the need arises.

“I’ve thought about it but I really haven’t looked into it,” another woman at the center says. Others finishing lunch or waiting for exercise class simply didn’t want to talk about it.

But a don’t-ask-don’t-tell attitude toward paying for long-term care isn’t an effective strategy for the 75 million baby boomers, the oldest of whom will start hitting age 70 in 2016. In addition, nearly 10 million boomers are caring for elderly parents, according to the National Association of Insurance Commissioners.

People today are living into their 70s, 80s, 90s and beyond, says Jesse Slome, executive director of the American Association for Long-Term Care Insurance, which serves those who offer long-term care insurance.

“If you live a long life, the chances are enormously high you’re going to need some kind of care.”

No cookie-cutter solutions

Care for seniors can come from family members or from outside services such as adult day care, assisted living centers, home-care services and nursing homes.

The national average cost for a day of adult day care in 2013 was $61, according to information on the assistedlivingfacilities.org web site, based on the Genworth 2012 Cost of Care Survey of some 15,000 care providers. Other services come with higher price tags.

In Tennessee, for example, the median cost in 2013 for a month in assisted living was $3,304, the Genworth survey said. On average, says Gretchen Funk, FiftyForward’s care team director, people stay in assisted living for 24 months and in a nursing home for 28 months.

Of course, that’s just the average. Part of the difficulty in setting up a long-term care plan is the number of factors that have to be considered.

“Every person’s situation is different,” explains Hendersonville attorney Tim Takacs, who is certified by the state of Tennessee as an elder law specialist.

Are you married? Is a family member disabled? What kind of health are you in and are you likely to remain in? Do you have a lot or a little money? All of these variables go into the mix.

On top of individual differences among buyers, there’s great variety among long-term care insurance policies so it’s tough to compare apples to apples.

There are long-term care policies that charge an annual premium and provide different levels and terms of coverage, with or without inflation protection. There also are hybrid policies that require a large one-time premium but provide cash value that the policy holder can tap and a death benefit, Takacs says. These policies also can provide long-term care coverage through a rider to the policy.

Some consumers turn to whole-life insurance and other financial products to fund long-term care.

Takacs says that all of these variables make decision-making difficult, and intelligent consumers can find it hard to get a good gut feeling for whether long-term care insurance is a good deal. He doesn’t tell people to buy it or not to buy it; he tells them to work with a trusted financial adviser to determine what’s appropriate in their individual circumstances. He has no stake in their decision either way, he says.

“You only buy this policy once in your lifetime,” Slome says. “With long-term care insurance, it almost never pays for people to switch” because rates will likely be higher because you’re older and because new policy holders will have to be healthy enough for the insurance company to be willing to take the risk of having to pay for care.

Best time to buy

Those in the elder care field vary on when it’s best to buy long-term care insurance. For Slome, the sweet spot for buying long-term care insurance occurs between ages 55 and 65, he says.

“It’s not gonna get cheaper, and you’re not gonna get younger.”

Others, including Fifty Forward’s Funk, say to start looking in your 40s and 50s. Takacs recommends examining insurance needs throughout your life, insuring for loss of income in the younger years before considering how to pay for long-term care.

According to Slome’s organization, about 8 million people had long-term care insurance in 2008, and 400,000 new policies were being written each year. A recent study from Boston College indicated that 13 percent of single persons had long-term care insurance, fewer than the 20-30 percent for whom it would make financial sense.

The business landscape for long-term care insurance has been changing. Some companies have exited the business altogether and others have limited the number of new policies they’ll write.

In the past year or so, Takacs says, some companies have notified policyholders of large increases in their premiums and also said that to keep their current premium they’d have to accept less coverage.

Most companies stop offering LTC policies after age 75, Slome says, and half of those who apply after age 70 will be turned down.

Slome also believes that by the end of this year, it will be industry practice for insurers to turn down anyone who has been rejected by another insurer for long-term care coverage.

There’s no way around it – people have to take the time to set their own course in paying for the care they may need as they age.

“You really have to resist the blandishment of those who say you must buy it, and the advice of people who say that it’s never a good deal,” Takacs says. “It is a major financial commitment for people to make.”

He suggests starting with your own insurance agent and financial advisers when making a decision.

Picking an adviser

Slome’s organization recommends working with someone who has been in the long-term care insurance business for at least three and preferably five years or more. In addition, look for someone who sells multiple policies and has sold at least 100 policies so that they are familiar with common situations insurance buyers are facing.

Finally, he recommends finding a person who has been appointed to sell policies offered by multiple companies.

“Then they’re working for you,” Slome explains.

Sales commissions on long-term care policies are pretty much the same across companies, he says, but you don’t want a specialist who is locked into selling the products of only one company. That company’s offerings may not be right for you.

It isn’t common for agents to be appointed with multiple companies, because the agent has to be educated to be knowledgeable about several policies with different details.

Rosenberger

Peter Rosenberger is president of Standing With Hope, a ministry that helps provide prosthetics to the poor in West Africa. Rosenberg has been caregiver for his wife, Gracie, throughout their marriage.

She had suffered severe leg injuries in an auto accident before they met and married, and the injuries led to loss of her legs. As a caregiver, you automatically assume you will outlive the person you’re caring for, Rosenberger says, but it doesn’t always happen that way. How you plan to provide care will vary with your situation, but you must plan, he says. He is using whole-life insurance products in his financial planning.

He advises people to find a reputable financial planner, someone with a good firm and good references. “Any financial adviser worth his salt will be a patient broker. … You want someone who sees you for the long term, who will spend time with you” to get to know you, your style, your values and goals.

How you will pay for caregiving may change over time, as your financial means and your needs change. “You can’t always do what you want to do,” Rosenberger says, but you can continually make progress toward your goal. That’s why they call it financial planning – it’s a process, he says.

“It would be cataclysmic to my family if something happened to me,” he explains.

The cost of medical care for his wife has run into the millions. He and his wife have adult two sons. It would be unconscionable, he says, to leave them with nothing to fund care for their mother. For someone of modest means buying a very simple term life-insurance policy may be possible, he says.

Kathleen Phillips leads some seniors in a stretch during a Silver Sneakers class at FiftyForward Madison Station. — Michelle Morrow | The Ledger

In her practice with Healthy Minds Counseling in Knoxville, Diana Nelson sees many people caring for elderly parents and stressed out by financial concerns. She has found success stories among caregivers, even those of modest means. “Some people can make it through and take care of the elderly person,” says Nelson, a psychiatric nurse.

These are those who “tend to use their resources.” They’ll enlist others in the family to share in the care, insisting if necessary, and they’ll take care of themselves.

They’ve got some finances that allow them to go to the gym, for example, to take time out to recharge. “Those who are happier and more successful are using the resources they can to take care of themselves,” she says. “They’ve figured out a way to make things work.”

Some care options for people with modest incomes include day care for seniors and caregiver support groups. Alzheimer’s support groups can be very powerful and very helpful, Nelson says.

“When people go, they hear from others in their same situation,” she says. “My seniors tell me it’s very, very helpful.”