She's unsteady on her feet and has battled numerous health problems, including diabetes, congestive heart failure and chronic obstructive pulmonary disease. Her son shares a home with her in Cicero, but even with his help and the assistance of a part-time caregiver, she has not been able to manage.
Vitko, 83, knows she is better off in the nursing facility and would like to stay there.
"The only thing is, the insurance has run out and I have to figure out a way to pay for it," said her son Carl, who said the situation is stressful financially and emotionally. "It breaks my heart because I didn't want her there. I would love to have her at home."
The last thing on most people's minds when they're young and healthy is contemplating what life might be like when they aren't. But as they age, they are likely to need costly help, whether it is specialized nursing care, in-home caregivers or assistance with the simple tasks of daily life, like getting dressed in the morning.
The wealthy can afford to pay for such things, and the poor can qualify for coverage through the federal Medicaid program. It is the nation's expansive middle class that can fall between the cracks when it comes to long-term care, experts say.
Even those who think ahead often don't save enough because they are struggling to make ends meet.
"People buy insurance for their life because they know they are going to die, for their car because they know that can get in an accident and for their health because they know they can get sick, but people don't tend to buy insurance because they think they are going to need someone to help them take a bath," said Phyllis Mitzen, co-program director of the Center for Long-Term Care Reform at the Health and Medicine Policy Research Group in Chicago.
An initiative that would have incorporated long-term care into the Obama administration's health reform plan was scrapped in October after actuaries determined that it would not be financially self-sustainable over the long haul. The Community Living Assistance Services and Supports Act would have created a voluntary, self-funded, employer-based insurance option to help people save for long-term care.
In announcing its demise, Health and Human Services Secretary Kathleen Sebelius wrote in a letter to Senate leaders that the problem was not going away.
"By 2020, we know that an estimated 15 million Americans will need some kind of long-term care, and fewer than 3 percent have a long-term care policy," she wrote. "These Americans are our family, our friends and our neighbors. If they are to live productive and independent lives, we need to make sure that they have access to the long-term care supports that make that possible."
Costs to society also are expected to skyrocket. Without insurance coverage or personal wealth, Sebelius said, "more Americans with disabilities will rely on Medicaid services once their assets are depleted, putting further strain on state and federal budgets."
In Illinois, nursing home care averages about $79,000 per year for a private room and $61,000 for a semiprivate room. The annual cost for care in an assisted living facility averages about $41,000, and home health aides cost about $21 per hour.
Most people assume Medicare will pay the bills, but the program covers long-term care only under certain conditions and for a limited time. While Medicaid covers long-term care, beneficiaries have to be poor or willing to "spend down" their assets to be eligible. Private insurance can be expensive and excludes applicants with serious medical problems.
As a result, many families pay out of pocket until they exhaust their resources and then turn to Medicaid. That's the situation the Vitkos find themselves in.
"People are forced into poverty," said Jonathan Lavin, president and CEO of AgeOptions, the Area Agency on Aging of Suburban Cook County. "We have people transferring assets so they can get into the Medicaid program. We've asked family caregivers more than anyone should really ask them to do. We've never sorted this out. It's a major concern that … there aren't enough resources available."
In Illinois, the state is establishing a long-term care insurance partnership program to encourage people to buy private insurance and think about their future needs.
"If you get into the program and buy a special type of long-term care insurance, it will allow you in a legal way to keep your assets, dollar for dollar equal to the amount of benefits you get from your long-term care insurance, and still legitimately qualify for … Medicaid," said Julie Hamos, director of the Illinois Department of Healthcare and Family Services.