BY JANET MARSHALL

Carol Ewing is in the business of helping people find long-term care. But when her own mom urgently needed around-the-clock help, Ewing felt as frazzled at times as someone who'd never given long-term care a thought.

Her mom died in February, after five wrenching years in which Ewing and her family arranged for in-home care, even when her mother's life savings ran out last fall.

"The last several months of last year were the most difficult time I have ever experienced, and I'm in this business," said Ewing, president of Bridges Senior Care Solutions in Fredericksburg.

Ewing has concluded that long-term-care insurance is the best way to ward off stress and financial ruin in a person's later years. She said she and her husband have bought policies for themselves, at a cost of more than $400 a month between them.

But only one in five Americans can afford long-term-care insurance, according to the American Association of Homes and Services for the Aging.

For people without the insurance, and without a big nest egg, the options are limited when it comes to long-term care. They include:

Spending down your assets and becoming poor enough to go on Medicaid, which will then pay for a nursing-home bed but probably not for long-term care in an assisted-living center or in your home.

Having loved ones care for you, perhaps moving or otherwise altering their lives to tend to you.

Having a combination of care, such as help from family plus time in an adult day-care center (where annual fees average about $14,000 in Virginia).

Getting an in-home caregiver for an average cost of $17 an hour in Virginia. That's nearly $40,000 annually for 44-hour-a-week care, says Richmond-based Genworth Financial, which has studied the costs.

Ewing, because of her ties to the business, managed to find caregivers to tend to her mom for $10 an hour. "I was lucky," she said.

People shouldn't have to be lucky to get affordable care, said Cheryl Matheis, senior vice president of health strategy for the AARP.