As if decimated portfolios weren t hard enough on investors, a new study released Tuesday indicates that even before the crash, a far higher percentage of folks were at risk for not having enough money for retirement than previously predicted.

The study from Boston College s Center for Retirement Research revises what s known as the retirement risk index basically the percentage of people who won t be able to maintain their standard of living in their golden years to take into account the cost of traditional health care as well as long-term care like nursing-home stays and home health aides. The revised calculations indicate that almost two-thirds of working-age Americans were already falling short of retirement targets in 2007, up from the 44% researchers had reported in a study just 19 months ago.

The study seems to confirm the warnings of some experts that even before the crash the picture was darkening for many retirees and that health-care costs were largely to blame. In recent years, medical costs have risen so fast that Fidelity Investments estimated the average 65-year-old couple retiring in 2008 would need $225,000 out of pocket just to cover their basic health needs in retirement. Meanwhile, private rooms in nursing homes have become 17% more expensive since 2004, reaching about $76,000 a year on average in 2008, according to Genworth Financial.

Those in the middle of the pack economically can be dramatically squeezed by these costs, says Anthony Webb, a co-author of the study. That s because those folks are too rich to qualify for Medicaid, which would pick up the nursing-home expense; Medicare, the health insurance program for seniors of all income levels, typically doesn t cover it.

Despite the alarming numbers, financial planners say retirees and future retirees can take steps to help insulate themselves from expensive late-in-life care. Long-term-care insurance, for example, will often pick up the tab for both nursing homes and home health aides, which typically cost about $20,000 a year. Premiums for long-term-care insurance averaged close to $2,000 in 2008, but they can be much higher for people who have health problems or are close to retirement.

Timothy Maurer, director of financial planning for the Financial Consulate, a planning firm in Lutherville, Md., says many of his clients will also opt to use their home equity as a down payment for a retirement community. Many of those facilities charge seniors set, locked-in monthly dues that cover the cost of any nurses needed to help with members care.

But experts caution there s no one solution for everyone. Some advisors will create a long-term-care plan for clients to determine if factors like family health history and relative wealth make long-term-care insurance a good investment, since only about a third of seniors will wind up spending one month or more in a nursing home. Maurer says he urges many upper-middle-income clients to get partial long-term-care insurance and then partially self-fund the rest of any needed medical assistance.

And since the industry has been hit with financial-strength rating downgrades in recent months, doing homework on the insurer you choose is critical, says Jeff Camarda, a financial advisor in Fleming Island, Fla. Companies like A.M. Best and Standard & Poor s regularly rate the insurers based on their financial strength, and Camarda urges clients to consider only top-rated insurers.