Long-term care costs can get pretty hefty, starting with housing.

Nursing homes start at about $230 a day or $7,000 a month in Hawai'i, with additional rehabilitation services costing extra. The frailest seniors who need the most comprehensive chronic care check into nursing homes.

Adult residential care homes, or facilities that take in small groups of seniors, charge less but many don't offer skilled nursing care. They typically cost at least $2,000 a month.

Assisted-living facilities, generally for independent seniors who may need a few services such as laundry and meal preparation, cost an average of $3,112 a month in Honolulu, according to a survey by Met Life.

Retired actor James Carroll, 87, lives at such a facility — The Plaza at Punchbowl. For a two-bedroom, two-bathroom unit, he pays $4,750 a month. Sprightly and cheery, the visually impaired senior can live by himself. The Plaza makes his life easier by cooking and cleaning for him.

He's paying for the apartment out of his savings and hopes it will last.

"Statistically, I should be ready to finish," Carroll said. But then, "my great-grandpa lived to be 107."

For seniors who live with family members and only need to be watched during the day, one option is an adult daycare centers. Prices start at about $50 a day. An adult day healthcare center, which provides nursing supervision and rehabilitation services, costs at least $75 a day.

If the senior prefers to stay home, hiring a personal care assistant can cost between $11 and $15 an hour while on the high end, a registered nurse charges at least $25 an hour.

James Carroll, a retired actor, reads Shakespeare with UH student Joseph Tomita. Carroll's apartment in an assisted-living facility includes cooking and maid service in its monthly fee. Rebecca Breyer • The Honolulu Advertiser

Getting assistance

So where can seniors turn for financial help?

Medicare, a federal program that provides health insurance to seniors age 65 and over regardless of income, pays only for the first 20 days of nursing home care. But you must be hospitalized for at least three days beforehand and a doctor must verify that you need rehabilitation after hospitalization. For the next 80 days, you pay $114 day (for 2005) and Medicare covers the rest. There is no coverage after 100 days.

If you buy Medicare supplemental insurance, offered through most insurers, it covers your $114 co-payment.

Medicaid is a state-run healthcare program for the poor, which does pay for long-term nursing home care. But it's not easy to qualify.

If you're single, you cannot have more than $2,000 in assets, excluding your main residence, cars, funeral plan, burial plot and other personal items, according to Med-QUEST, a division in the state Department of Human Services that administers Medicaid. Medicaid also may place a lien on your house.

If you're married, you can qualify only if your spouse has less than $95,100 in assets, not including the primary residence, cars and a few other items. If your spouse dies first, the assets are transferred back to you. You have to find a way to whittle your eligible assets to $2,000.

In addition, your monthly income — say from Social Security and a pension — must be less than your monthly medical expenses if you're institutionalized. If you're not in an institution, your income cutoff is $912 a month if you're single, and $1,217 if you're married. If your income exceeds the limit, you must have enough medical expenses to reduce your income to $418 a month if you're single and $565 if you're married.

If you prefer to receive care at your house or at an adult residential care home, apply to Medicaid's waiver programs — such as Nursing Home Without Walls and Residential Alternative Community Care. However, there may be a waiting list.

If you think you can simply transfer your assets to your children and qualify for Medicaid, guess again. The state takes a dim view of people who purposely hide assets to get on the system — you could be rejected.

A waiting game

Jane Higa, 75, of Palama knows firsthand how tricky it can be to qualify for Medicaid.

Her elderly father was hospitalized for three weeks and was about to be discharged, but he was too frail to go back home. The family didn't have money to pay for a nursing home, so they left him at the hospital at a cost of $500 a day. After 2› weeks, his savings were depleted.

Higa applied for Medicaid, but she had to wait six months before her father was approved. In the meantime, the senior citizen was transferred to a nursing home, which took his Social Security paycheck. Higa said she couldn't pay the facility, but her father was allowed to stay until Medicaid kicked in.

"You fill out the form and wait," she said.

Grace Kam is counting on government benefits given to veterans to pay for nursing home care, should she need it in the future.

Her husband, a veteran, passed away 29 years ago.

"Right now I'm not ready for it, for a nursing home," said the 83-year-old as she leaned on a cane. When she is ready, "I hope I can get some help."

But the U.S. Department of Veterans Affairs provides only limited nursing home care — and only to veterans, not spouses.

For the VA to pay for a nursing home, a veteran needs to be moderately to severely disabled and the ailment must have occurred during active duty, said Fred Ballard, a VA spokesman. The VA rates the level of disability; to qualify, a rating of 70 percent to 100 percent is required.

Your employer, unless it's the federal government, won't be much help when it comes to paying for long-term care.

Businesses generally don't offer long-term-care insurance. And health insurance doesn't typically cover long-term-care costs for chronic conditions.

If you can't qualify for government aid, the last resort is to try to pay for long-term care yourself.

Buy coverage early

An increasingly popular option is to buy long-term-care insurance, if you can qualify and can afford it. Monthly premiums vary widely, depending on your level of coverage, age, health, gender and other factors. In general, the earlier you buy the insurance, the less expensive it is.

For a 40-year-old nonsmoker in good health, State Farm charges a premium of $100 a month on a long-term-care policy that would pay $250 a day for three years. There is a 90-day waiting period before benefits kick in. Benefits increase by

5 percent per year to account for inflation. The same policy for a 50-year-old would cost $119 a month. At age 65? $282 a month. For a 70-year-old, it's $460 a month.

Make sure the insurance company is financially strong so it'll be around in 20 or 30 years when you need your benefits. Check its credit rating as compiled by companies such as A.M. Best, Moody's, Standard and Poor's, and Fitch.

Tom Oshiro and his wife bought long-term-care insurance through the Hawaii Government Employees Association.

The 64-year-old bought the insurance two years ago after being rejected when he approached insurers himself. Oshiro's health problems disqualified him from many policies, but the union's plan accepted every member at the time he applied.

Another option for seniors with equity in their home is the reverse mortgage.

A reverse mortgage is a loan that lets homeowners age 62 or older borrow against the equity without selling, giving up title or taking on a new monthly mortgage payment.

The loan can be taken out in a lump sum, fixed monthly payment, line of credit or a combination. The loan amount depends on the borrower's age, current interest rates and value and location of the home. The loan isn't repaid until the borrower moves out. Any remaining equity is given to the homeowner's heirs or estate.

Others like Higa, whose father eventually got help from Medicaid after a six-month wait, hope the government will step in when they run out of money. Higa says she can't afford long-term-care insurance and won't have enough in savings to pay for a nursing home. She's also not counting on her children to help her.

"We contributed (taxes) to the state," said Higa, "And I feel they should help us."