Growing older presents many challenges. Perhaps none is more frightening than the insecurity of how we will pay for what we need. Will we need nursing home care, or will we be able to live independently into our 80s or 90s? Will our Social Security benefits be enough and will our savings last? Will we have good quality health care that we can afford?

These are all questions that need to be asked. Too often families find themselves in a crisis with little idea of the resources and services that are available for seniors and how they will pay for those services. All of a sudden it is discovered that Mom or Dad can no longer live alone and that there is no one to act as a full-time caretaker. It is then that families get the shock of what is available and how much it costs. Decisions such as whether to place Mom or Dad in assisted living or a nursing home or to seek in-home services must be made quickly.

We must educate ourselves on the system of services in our communities. For those with high incomes and significant assets, there are many choices available. For individuals living below the poverty level, there are programs and services available as a safety net. But for those with income above the poverty level and modest savings, there are far fewer choices.

A senior who can no longer live alone must have income below $14,202 per year (this includes Social Security, pensions, etc.) in order to get help paying for the cost of an assisted-living facility. For the person whose income is just a little higher, there is no assistance or funding available, and he will not be able to afford the private pay rate that can add up to several thousand dollars a month. The family is then faced with whether it can afford to pay for the cost of this care. Families are sometimes forced to seek out nursing home care in order to receive assistance through Medicaid because of different eligibility rules. This is more expensive and often not the most appropriate type of care.

For the person who wants to remain in her own home, there are similar obstacles. There are programs to help those with low income as an alternative to nursing home care, but for those with higher income, the cost of in-home care can be prohibitive -- often $16 to $20 per hour or more, depending on the type of care needed. Medicare provides very limited home-health benefits, and Medicaid provides those benefits only to those with incomes below the poverty level of $9,804 per year and very limited savings. For a person living at home with income just above this amount, the deductible can be thousands of dollars before Medicaid coverage would kick in.

We will need creative solutions that allow for a combination of private pay and public subsidy for people who don't fit the traditional "low income" criteria. This type of approach can achieve the benefits of keeping people in their homes and communities longer and increasing choice for consumers.

The reliance on programs designed to help only those technically below the poverty level will not serve our senior adults well in the years ahead. The majority are neither very low income nor very wealthy. The majority of seniors are in that large middle group of people who have contributed much to our society and now need some help to get adequate housing and health care and to live as independently as possible.

As top retirement destinations, North Carolina and Wake County will experience dramatic growth in the number of senior adults in the years ahead. We must ensure that we are ready to meet the needs of tomorrow's seniors.

Get $150+ in coupons in every Sunday N&O. Click here for convenient home delivery.