Last modified: Thursday, May 15, 2008 3:16 PM EDT NESI: A long-term plan for long-term care By Ted Nesi / Sun Chronicle Staff Long-term care: The term may not be familiar to you, but the concept certainly is. It's a catch-all phrase for how we provide for those who can no longer take care of themselves. Nowadays, nearly every family has made its own difficult decisions about long-term care, whether for a grandmother with Alzheimer's or a father who can no longer get around on his own. Almost 10 million Americans, two-thirds of them elderly, need daily help with life's basics, like eating, bathing, and dressing, according to Dr. David Stevenson of the Harvard Medical School. That includes more than half of citizens aged 85 or older. Most of these people are cared for at home by friends and family, and few of those who need paid services, like a home health aide or a nursing home, have insurance to cover it. Contrary to what many believe, Medicare and private health insurance almost never cover long-term care. Medicaid does, but only for those with very low incomes - and even that thin safety net is fraying, as health care costs explode and states slice their budgets. That leaves many seniors and their loved ones struggling to pay bills they never expected and for which they never saved. In 2004, the total cost of long-term care for each impaired senior in America was $15,000, according to Congressional Budget Office estimates - and that doesn't include the cost of care provided for free by family and friends. The challenge of long-term care is only going to grow over the next three decades, as the baby-boom generation reaches retirement age. (The first boomers started getting Social Security checks last January.) In 2000, senior citizens were 12.6 percent of the American population; their share will grow to more than 20 percent by 2040, according to the budget office. With people living longer - a blessing, in general - more long-term care will be needed for a longer period of time. And with more women entering the workforce, there will be a greater needed for paid care services, because women currently provide the vast majority of free, "informal" care. All in all, long-term care is a major national issue that will only grow more pressing in the years to come. It's surprising, then, how little the major presidential candidates have had to say about it. Hillary Clinton, whose campaign is slowly winding down, is the only candidate to offer a plan on long-term care, according to Stevenson. Her proposal includes a $3,000 tax credit for caregiving, a long-term care insurance tax credit, and stricter oversight of long-term care providers and insurers. "I don't think having my mother live with me is a burden - it's a joy," Clinton told an audience in Iowa last December, according to The New York Times. "But it isn't easy to do, and most families don't have a lot of options." She's right about that, and it would be good if her proposals sparked a national conversation about how to finance long-term care. For one thing, there are serious questions about the utility of long-term care insurance. Only a tiny number of seniors buy it right now, and it's one of the most profitable insurance products out there - no doubt because insurers are rejecting as many as 25 percent of long-term care claims, according to reports. That leads back to the key question: Who pays? Right now, the answer is a combination of government, individuals, and private insurers. But that's a system we've backed into, not one we've chosen. "As our population ages, we can't afford to ignore long-term care or to proceed without guiding principles," writes Dr. Stevenson. "The economic and personal costs of inaction are substantial, and developing effective policy solutions will become more difficult the longer we wait." Better, then, not to wait at all. It's time to come up with a national strategy for long-term care - and, speaking for my generation, it would be nice if the boomers helped us do so, while they still can. Ted Nesi (tnesi@thesunchronicle.com) is a Sun Chronicle staff writer.