It seems to be the norm that older Americans and their families have to struggle to pay for care and housing. Planning for one's old age is a good idea.

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Evelyn Nappa is nearly 93, an Alzheimer’s patient who relies on a wheelchair to get around.

Lately her biggest challenge hasn’t been physical or mental, but monetary.

What’s problematic is continuing to have a pleasant place to live and be cared for.

It seems to be the norm that older Americans and their families have to struggle with care and housing.

Nappa’s daughter, Roslyn Duffy, sent me an email saying her mother had run out of money and turned to Medicaid to pay for her care, and that will mean moving out of a facility that no longer accepts Medicaid clients.

Medicaid doesn’t pay as much as some facilities charge private clients. Like most everything else, you get the quality you pay for, but it’s not something most people think about until they arrive at the point of having to deal with it.

Nappa was a stay-at-home mom of three children. Her husband died 25 years ago, and she lived alone in their home in Scottsdale, Ariz., until she had a stroke.

Her daughter brought her to Seattle, and she has been at a nice assisted-living facility in Maple Leaf, The Stratford, for almost three years.

Duffy told me that when she placed her mother, “I was very upfront with people that her funds were limited.” She said they told her that turning to Medicaid when her money ran out would be OK — but there was nothing in writing.

The money ran out, and Duffy said she got a letter in November saying the facility was changing its policy. It would no longer accept Medicaid.

Liz Taylor of Aging Well Consortium, is a writer and aging consultant who for many years wrote a column on aging issues for The Times. She told me Nappa’s experience isn’t unusual.

“Most care facilities in King County haven’t taken Medicaid for decades,” she said. Few adult family homes, retirement communities or assisted-living facilities do. Nursing homes do accept it, but they are not the first choice for many families, and not everyone needs that level of care.

Taylor said, “Seventy percent of people will need care before they die.” But people have two thoughts about that, she said: First, it’s never going to happen to them; and second, the government will take care of them.

Taylor blames government for fostering that impression and for not doing enough to educate people, but she also blames taxpayers for not adequately funding care for seniors who need some care, but don’t yet need a nursing home.

“People don’t want to hear the bad news that you have to pay for things,” she said.

Elder care around Puget Sound is some of the most expensive in the nation, Taylor said. Figures she gathered in 2010 show charges ranging from $4,000 to $9,000 a month at assisted-living facilities.

The Stratford, where Nappa lives, gets just under $2,000 a month for Medicaid clients.

The Stratford’s executive director, Rob Johnston, said Medicaid payments to assisted-living facilities are “many times half the [payments for] skilled nursing. If Medicaid paid a little more for assisted living, there would be people who could stay in assisted living longer instead of going to skilled nursing, which costs the taxpayer more.”

Johnson declined to speak specifically about Nappa’s case.

He and Taylor said people would be wise to get longterm-care insurance so that they won’t have to worry about money when they need care.

Duffy is a businesswoman herself, a parenting counselor and co-founder of The Learning Tree, a child-care center in Seattle’s Capitol Hill. Yes, she’s at the other end of the care system, which has its own access issues.

Duffy said The Learning Tree raises money to subsidize children from poorer families.

“These are life issues. We need to pay for them, and the amount the government pays is terrible,” she said.

She knows businesses have to turn a profit. But she thinks there is also a moral issue. “People who offer care at either end (of life), need to come up with strategies” to offset the lack of funding.

Duffy said she told the people at the facility, “I understand you need to change your policy, but change it going forward, and let my mom live out whatever time she has left.”

Nappa is still at The Stratford while Duffy looks for an alternative.

Don’t wait for a better funded Medicaid program with more choices; take a look at buying longterm-care insurance.

Jerry Large’s column appears Monday and Thursday. Reach him at 206-464-3346 or jlarge@seattletimes.com.