Question: My wife and I have gotten off to a late start planning for what will happen if one of us gets sick and requires care in a facility. We have looked into long-term care insurance and, based on the cost of the premiums at our ages (73 and 71), we think we will only be able to cover one of us. We realize we will be taking a gamble, but are there any statistics out there that can guide us on which one of us to cover? If not, is it wise to reduce the monthly benefits and try to cover us both for less than we may need?

Answer: According to statistics, the number of nursing facilities and beds increased by nearly 20 percent between 1987 and 1996. And, with increased life expectancies and a fast-growing senior population that will have more functional and cognitive impairments that require care, experts predict that the demand will justify the addition of hundreds of thousands of new nursing home beds in the next five to ten years.

Today, as in the past, more than two-thirds of all nursing home residents are women, and women tend to live longer than men. Therefore, it would seem that if financial considerations require you to choose between purchasing coverage for a healthy husband or a healthy wife, the wife would be the best bet; however, we believe making your choice on this basis alone would be a sheer gamble. If you must make this decision, you should consider each of your health histories, along with your finances.

We don’t think it’s wise to reduce the daily covered rate to less than both of you would need in order to cover you both. You may look to remove some bells and whistles from the policy and adjust the elimination period, however, to find your best bet. It is important to remember when purchasing long-term care coverage that the cost of the annual premium is often less than the cost of one month in a nursing facility.

You may wish to go to our useful links page on nextsteps.net and look for the Medical Expenditure Panel Survey (MEPS, where you can find some statistics that may aid you in making your decision.

Question: My mother has been in a nursing home for five years due to her dementia. In addition to what we anticipated was normal for the aging process, we have noticed lately that her dental hygiene has gotten much worse. After spending the vast majority of the money she and my Dad saved, she is receiving Medicaid, and there is very little extra money available. Is the dental deterioration normal?

Answer: According to our research, including communication with nursing home administrators and nurses, it is not unusual to see poor dental health in nursing home residents, especially those who have been diagnosed with dementia.

In fact, a large percentage have lost all of their teeth, and many with some teeth left have decay and plaque accumulation that leads to other problems, including broken teeth, gum infections, and decay. Some seniors with untreated dental problems or ill-fitting dentures isolate themselves due to embarrassment.

And worst of all, the vast majority of seniors with these problems are not being treated despite the fact that some dental conditions, left untreated, can lead to malnutrition.

A number of residents who take prescription drugs may be affected by “dry mouth” that, in turn, can cause oral disease because saliva is necessary to help fight germs, assist with digestion, reduce acids, and facilitate the rebuilding of tooth enamel. And those with debilitating illnesses -- such as MS, stroke, and arthritis -- have difficulty handling toothbrushes. Using dental floss is generally out of the question, and those with dementia who require assistance with everyday hygiene generally get little, if any, from overworked staffers.

Gum disease and oral cancer are often found. Medicare, the federal government’s health policy for seniors, does not pay for regular dental care for seniors. Medicaid -- the combined state and federal health insurance program for those with low income and assets – pays for dental care in some states, but not in others, at very low rates of pay to dentists.

Taking the NextStep: Given the draconian Medicaid budget cuts suggested by the Bush administration (which many governors appropriately disagree with), it does not appear that dental reimbursement will get any better. Therefore, knowing that the problem exists, those of our readers with loved ones in nursing facilities may wish to call on private dentists and dental assistants who can assist with the required, yet ignored, dental care of our seniors.