Few people can pay out-of-pocket for nursing home care; the specialized round-the-clock full-service costs can run up very quickly. People who have financial assets can pay on their own, but those assets get used up rapidly. For those who have limited assets (such as a small pension), there are a number of payment options.

Medicaid pays the expenses of nearly two thirds of all nursing home residents. It is distributed jointly by federal and state agencies Each state has a State Health Insurance Assistance Program (SHIP) that determines Medicaid payments. You can reach yor state’s SHIP by visiting the Medicare web site (www.medicare.gov). Medicare does not usually pay much toward nursing care; it functions as health insurance for those over 65, but not as long-term insurance. Check www.medicare.gov or call 1-800-MEDICARE to get clarification.

Medicaid does not cover assisted living or continuing care retirement communities. However, 22 states do offer assistance for these services under a program called Program of All-Inclusive Care for the Elderly (PACE). An individual must be at least 55 years old and be screened by doctors and other medical professionals to determine whether such care is available. For a list of PACE organizations state-by-state, visit the web site www.cms.hhs.gov/pace/pacesite.asp.

Private health insurance may cover some long-term care, but often it has limits. Managed care plans are useful only if the nursing home in question is covered by the plan. An option worth exploring is long-term care insurance. The costs vary, but the national Association of Insurance Commissioners (www.naic.org) offers information on long-term care including a free Shopper’s Guide.