Elder care consultant Martha Grove Hipskind of Cary speaks and writes about aging issues for families and offers services and advice to families and organizations.

For most people, the phrase "long-term care" connotes an immediate, powerful image: nursing home. At the time Medicare and Medicaid came into being during the mid-1960s, there were few options other than home or nursing homes for older adults with chronic conditions, and there was an underlying stigma attached to families that could not or did not take care of their own.

From that time on, there has been a continual evolution of services and care settings that fill every imaginable niche between home and the nursing home. This wide array of options is called the continuum of care and includes such things as senior centers, medication management, emergency response systems, companion care, home health care, adult day programs, care management, home-delivered meals, retirement communities, assisted living, respite care and hospice. Placing these options on a continuum reflects the transition among senior adults from complete independence to greater needs for assistance.

It would be fair to say that today in Wake County anything is possible in terms of meeting needs for supportive care, whether in your own home or one of the many senior living communities. When it comes to making a plan and choosing options for your family, there is no one right answer. What will typically narrow the consideration immediately is the discussion of what these options cost. They cost a lot -- a lot more than many senior adults can afford or are willing to spend, given the uncertainty of how long they will live.

During 2003 and early 2004, a working group of area experts and providers examined issues related to economic self-sufficiency as part of the Wake County Aging Plan. During our early conversations, we found the continuum concept to be useful in understanding that our senior population can be placed in the progression from those who will qualify for full government assistance at one end to those who can pay privately for any and all services at the other end. In between are the majority, who will never qualify for assistance and who will not have sufficient resources for the care and services they need.

The Aging Plan contains a call to action: "This leads to a situation in which there are ample resources available for the few who can afford them, some for those who are extremely poor, and little or nothing for those in between. This is true in health care, in long-term care, in housing, etc. Somehow our society must find ways to address the needs of this large group of people, who in their working lives made up the backbone of our community."

The senior population in Wake County is growing faster than in any other North Carolina county. By 2020, our total population will grow by 56 percent while our senior population will grow by 150 percent to 116,674 adults who are age 65 and over. This is a significant market that should command high interest from those who have the vision and the resources to plan for the unmet needs of those in the middle.

For anyone who would like to continue this conversation, the GOLD Coalition (Growing Older Living with Dignity) has been charged with moving the Wake County Aging Plan forward from paper to reality and would welcome your participation and review of the entire aging plan via www.goldcoalition.com.

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