As many Americans grow older, they are faced with the decision of where they will live out the remaining moments of their life. Most of them will choose between home health care and nursing home care. It is projected that between 2010 and 2035 the baby boom will become the senior boom. Twenty percent of the population will be 65 or older versus the 23 percent now.

Factors that may effect an elderly person's decision is the services provided, the cost, and how the elderly person will pay for the costs. For adults ages 65 and up, medical expenditures average about $5,300 annually, and for those adults over the age of 85, about $9,100 annually. Some people might pay for their services out of their own savings. Others will buy huge insurance policies. Still others will get help in paying their medical bills with Medicare or Medicaid.

Insurance companies are pushing consumers to buy long-term care policies. The evidence suggests that they are succeeding. More than 1.5 million policies have been sold to date, which is up from 815,000 in 1987. Some 130 companies now offer coverage, either as a separate policy or as a part of a life insurance contract. This is up from 75 companies in 1987. Insurance companies can offer policyholders a choice of benefits for nursing home care that typically range from $40 to $120 daily. If home care coverage is sold as part of the policy, the dollar benefit is often half that for nursing home care.

Policies generally pay nursing home benefits for a minimum of one year. Insurers also offer 2, 3, 4, 5 and 6 year plans. Others will pay for as long as 10 years or for the rest of a policyholder's life. While most nursing home stays are short--the average is only 19 months--longer coverage can protect policyholders and their families against the financial ravages of a catastrophic illness that might go on for several years. For policyholders who can afford to pay for several days or months of care from their own savings, a loner waiting period can mean a lower premium. Consumers often are given little choice. Instead, agents will make the selection for them, based on what that particular company wants to sell. Most policies have "level" premiums, that is, they do not rise with the policyholder's age.

A 65 year old who buys a long-term care policy today may not need it for 20 years. A nursing home that costs today's average of $86 will cost $228 twenty years from now.

Everyone who applies for insurance is not guaranteed that they will receive an insurance policy. Your chances of being accepted depend on your health. If a person has had a stroke, diabetes, multiple sclerosis, recent cancer surgery, asthma, macular degeneration (an eye disease), severe high blood pressure, or Alzheimer's disease, most insurance companies will no want to insure that person. However, several insurers will accept people with health problems but will charge them more or offer slimmer benefits. Some insurance policies, along with Medicaid and Medicare, only cover certain areas in home care or nursing home care.

The majority of policies are restrictive, particularly in the area of custodial care, the kind most people are likely to need. Custodial care includes bathing, personal grooming, dressing, and sometimes meal preparation. Other policies are "service" based. That means policyholders must obtain services from providers that meet qualifications set by the insurance company.

Nursing home care costs between $30,000 and $40,000 a year, or about $2,500 a month. The expenses keep climbing at least 5.5 percent a year. Part A of Medicare partially defrays the cost of a stay in a skilled nursing facility, which is one that provides intensive medical care. But most people with long-term disabilities, such as strokes or Alzheimer's disease, require only custodial care which Medicare does not cover at all. Overall, policies have already soared from $36.4 billion in 1980 to $99.8 billion in 1989, as more Americans became eligible.

Most people envision home care as someone coming to a person's house to perform custodial duties. But most insurance companies do not mean that at all. Some insurance policies pay for just registered nurses, licensed practical nurses, or physical therapists. Some only cover for health-aids, and some just pay for homemaker services. Home health care costs about $60 per visit.

To summarize the services of each, nursing home provide around-the-clock care and supervision to an elderly person by trained, licensed personnel. Home care can provide nursing services at home. A nurse, therapist, or health aid can be at an elderly person's home at any time during the week, depending upon the health and needs of the individual.

The elderly person should be involved in the decision-making process. An elderly person's decision can offset some of the stress associated with translocation if they decide to move out of their house and into a nursing home. A family might be concerned about moving their loved one into a nursing home. They might be worried about their loved on becoming disoriented in the new surroundings.

The Pepper Commission considers financing home and community-based care a top priority. At the same time, it acknowledges that not all persons enter a nursing home to die; many return home after relatively short stays and need resources to maintain their standard of living. Many more may be able to afford to return home if their financial resources are not consumed by the nursing home stay.

Based on this information, one might feel that home health care would be more efficient than nursing home health care for an elderly person.