Old age. Frailty. Disabling accidents and illnesses.

These are grim subjects, and understandably many people avoid dwelling on the prospect of becoming incapacitated. But a new survey suggests employers can do a better job of communicating these realities to workers to promote long-term care insurance.

The study, by New York-based William M. Mercer Inc., surveyed 132 companies that offer LTC benefits. Sixty-six employers responded, 94% of which have more than 1,000 employees.

LTC programs were first offered in 1987, and the number of employers offering them has increased. But employee demand at those companies remains low to moderate, Mercer researchers found. At nearly half of the employers responding, less than 5% of workers have enrolled in LTC plans, and in a quarter of the cases, between 5% and 9% have signed up for them.

Long-term care programs usually cover extended stays in nursing homes and skilled home health care, as well as adult day care, and frequently respite care and unskilled home care. Although often thought of as a program for infirm, elderly people, the benefits also can be used by younger workers who have suffered accidents or catastrophic or chronic sickness.

"I think that employees are in denial for the need for such services," said Janice Stanger, head of Mercer's San Francisco-based long-term care task force. Or, many employees mistakenly think Medicare will cover the expenses for long-term care, she said.

Workers who make financial plans for retirement typically ignore the possibility of the "big wild card"-the need for long-term care, an expense that could wipe out savings earmarked for retirement, she said.

Many companies that offer LTC benefits could be making better efforts to teach employees why they are important, the survey indicates. Four out of 10 employers said that, given the chance to start over, they would communicate with employees more effectively during the LTC program's rollout and enrollment period.

"It's something that's very new and unfamiliar to most people," according to Ms. Stanger. "If the communication is not done right, you're going to get a pretty dismal participation rate."

Employers have not, however, gone so far as to encourage the purchase of LTC benefits by helping employees defray premiums. All but one of the employers responding to the Mercer survey require employees to cover all the costs of the benefit. The sole exception reimburses workers for 20%.

Despite provisions in the Health Insurance Portability and Accountability Act that give tax-favored status to companies contributing to LTC premiums, employers' reluctance to do so is understandable, because most employers are looking to trim benefit expenditures, Ms. Stanger said. Eventually more employers may begin to shoulder part of the LTC cost burden, she said, but that likely would come at the expense of other benefits that workers now receive.

The survey found that most employers with LTC programs introduced them either to offer leading-edge benefits to employees or because they could be offered at little cost to the company. Seventy percent reported they are generally satisfied with their programs, with 17% saying it is too early to tell and 13% expressing negative opinions about LTC.

A free copy of the survey, "State-of-the-Art in Long-Term Care Insurance," may be obtained by contacting Mercer's Business Development Group, 212-345-4109.