The Senior Citizen Boom : Health: Long-term home nursing care has its advantages, but Medicare and most private insurance carriers do not pick up the tab.

If you are old, become sick and want to recover at home, is there good, affordable nursing home care available in the San Fernando Valley?

Good care is not a problem, said to Nancy Wexler, a gerontology therapist whose Encino practice includes helping families find appropriate care for the elderly infirm.

“There are several good agencies who will supply nursing care in the home,” Wexler said. You can either go to gerontology specialists for help finding home care, or you may inquire from friends, the patient’s doctor or a hospital, she said.

The problem appears to be affordability.

The advice from area gerontologists and the health care community is, don’t count on the government or insurance companies to pay for home care.

It is often not an option because of prohibitively high costs and the reluctance of insurance carriers to cover it, according to Jon Pynoos, a director of the Andrus Gerontology Center at USC.

Gayle Boland, administrator of Advanced Nursing Services, which has four offices in the Los Angeles area including one in Studio City, says most nursing agencies routinely try to bill Medicare and private carriers for home services but are often turned down.

And no matter how well-off you are financially, the idea of having to pay spiraling home-care costs is very frightening, says Sherman Oaks resident Dorothy Thompson.

Thompson, 75, was well provided for by her late husband, a successful architect. The home in the hills that she and her husband built in 1948 is paid for. She has many friends and was, until recently, active at St. Michael and All Angels Episcopal Church in Studio City. She is well covered by Medicare and Blue Cross, which she has had for more than 25 years.

At least she thought she was well covered.

In March she caught the flu, which by May landed her in St. Joseph’s Hospital in Burbank. Her seven-day stay cost $1,000 a day, all paid by Medicare and Blue Cross.

By June, pneumonia put her was back in St. Joseph’s Hospital. Again, her seven-day stay cost $7,000 and was paid by insurance.

Then she went home and required nursing care. Only the nurse’s first four visits were paid by insurance.

“All of a sudden I was paying out of my own funds,” she said.

Thompson confesses that regulations set by the government and private insurance carriers about what they will and will not pay are complicated and frequently changing. They are almost impossible to monitor.

The bottom line, she said, is that no matter how well situated you are financially, a catastrophic illness is catastrophic. “Having your first brush with the complications of insurance coverage really can be frightening,” she said. “You start to wonder about what would happen if . . . “

One of the tragedies of modern senior life is the fact that Medicare and policies meant to take up the gaps in Medicare coverage do not pay for long-term home nursing care, according to Wesley J. Smith, an attorney specializing in problems of the aged and author of “The Senior Citizens’ Handbook.”

Smith says that unless a patient is practically a pauper and can qualify for Medicaid, it is almost impossible to receive any governmental assistance.

“The government just doesn’t want to pay for home care, even though it may be less expensive and certainly beneficial to the patient,” USC’s Pynoos said.

The cost of full-time home care--estimated at about $2,000 per month by the Health Insurance Assn. of America--is a lot for most American families to shoulder without help.

Lori Frias, who runs the Valley office of Advanced Nursing Care, said many people are disappointed to find that their private medical insurance or Medicare will not pay for home nursing. “And many times they assume there will be coverage, and then they apply and find it isn’t there.”

It’s a real shock to the families, she said, because some insurance companies will say they can’t tell you how much they will pay until you set up the program and turn in the bills. Then when you turn in the bills, they don’t pay anything.

Frias said most people think insurance will pay for home care because the alternatives are so much more expensive. She said that is not true.

Home care may be less expensive than a hospital or even a nursing care home, but it’s not inexpensive.

Frias said the going rate for a full-care registered nurse in the Valley is $32 to $42 an hour, depending on the agency supplying the nurse. A licensed vocational nurse, who can look at an intravenous line but not touch it, costs between $24 and $27.50 an hour. For a certified nurse’s aide, she said, the cost is between $12 and $14 an hour, and all the CNA can do is take blood pressure and do personal care tasks. No injections.

The cost became uncomfortably clear to Frias when both of her grandparents became infirm. “My grandfather is 81 and has an abdominal aneurysm, and my grandmother has Parkinson’s disease. They both need help.”

Frias and her mother, Gayle Boland, who are both involved with home nursing care, knew what the costs would be.

They did what anyone else must do in that situation. They tried to bill the appropriate insurance carrier but could only get limited reimbursement. So they pay for a part-time nurse out of pocket, and they all help to take care of the elderly couple.

Gerontologist Pynoos at USC said the situation is unfortunate.

“Private health care organizations are not comfortable with the concept of home care because there are too many variables,” he said. “It’s too unmanageable.”

Even the insurance programs that are meant to completely augment the Medicaid coverage don’t address the home care situation, he said.

He added that those insurance companies that do offer coverage are often erratic in what they will and will not pay for, and under what circumstances.

The gerontologist’s harshest criticism, however, is aimed at the government.

“It is unconscionable that this country, with all its wealth, does not offer adequate health coverage to those who are elderly and sick. Almost every other major nation in the world offers comprehensive health care for their older citizens. In this country, the only way most elderly can afford to pay their medical bills is to sell off all their assets.”

Dorothy Thompson, sitting in her home in Sherman Oaks, thinks about that too.

“I have begun to worry about what would happen if I suffered a long-term disability. Would I have to give up my home and go in a nursing home? Would I end up selling the home I’ve lived in for 42 years to pay for medical costs?”

Thompson said it is frightening.

“But think about the people who are old and have nothing. Think how frightened they must be,” she said.