In regard to the June 21 Press-Republican editorial "Prepare for cost of nursing home."

First of all, Medicaid, not Medicare pays for extended nursing facility care. People often confuse Medicare with Medicaid. Everyone over the age of 65 gets Medicare, regardless of income. It covers basic medical care and, in some limited circumstances, recuperative care in nursing facilities, but not the kind of extended stays discussed in the Editorial.

People qualify for Medicaid based mainly on low income, and people who need help with personal care often find they have to pay for it out of pocket until most of their money is spent. After that, Medicaid can take over the cost of their care for as long as they need it.

This means that people who save all their working lives to create a sound "nest egg" may one day have to use it for personal care needs resulting from disabilities they develop, often age related. You might say "that's what savings are for," except that even respectable retirement savings may not be enough to cover the years of care a person might need. Plus, as the editorial indicates, most older people who have substantial savings would like to pass at least some of it on to their children and grandchildren.

The editorial also only partly addresses this dilemma, because it only discusses nursing-facility care, with nothing said about home care. I say nursing "facility" and not nursing "home," because no matter how safe, pleasant and warm a nursing facility is, it is not a home. The residents do not own or rent the property. They don't control who comes and goes in it. Their most basic everyday choices are, to some extent, controlled by others. Their most intimate care is provided by people they did not hire and essentially cannot fire. A good nursing facility will allow a resident to have lots of personal things around them in their room ... pictures, special quilts, books, knickknacks ... some even allow pets ... but it isn't the home that most people spent a lifetime creating. Most people don't work all their lives, scrimp and save, pay for decades on a mortgage, fix roofs, mow lawns and tend gardens so that they can spend their last five to 10 years in a nursing facility, even a very nice one.

There are alternatives. Home care can provide help with bathing, grooming, dressing, cooking, cleaning, laundry and shopping. Physical therapy, help with medications, and special everyday medical routines can also be provided at home, if the right kinds of services are available and authorized.

Many homes can be made more accessible and safe with relatively inexpensive changes like grab bars and small ramps. Hardware and kitchen stores sell appliances and utensils designed to be easier to use for people with physical impairments. Emergency-response systems, such as "Lifeline," are available for people who live alone and are concerned about falling or other accidents.

All of these services come under the heading of "long-term care," and the cost issues are the same as they are for nursing facilities. You can pay out of pocket for home care from an agency or hire people on your own to provide the help you, personally, need. If or when you are eligible for Medicaid, it will pay for the medically necessary home care you need, for as long as you need it. In some parts of New York state, you can get home-care services as easily as you can get into a nursing home.

For more information on long-term care, I urge people to call NY Connects at either 518-565-4902, where you can get information on local services so you can plan for the kind of future you really want. I also urge you to contact our representatives in Congress and ask them to support the Community Choice Act. This bill would ensure that every American would be able to choose the kind of long term care they prefer when they need it, by requiring state Medicaid programs to cover home care, as Medicaid is already required to cover nursing facility care.

Andrew Pulrang is the executive director of the North Country Center for Independence in Plattsburgh.