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But Medicaid is available only to people who are poor or disabled or who have exhausted their personal assets paying for health care. For middle-income people, it's common to have to get rid of assets, or "spend down," to qualify for such state "special assistance."

To qualify for the level of care known as assisted living through Medicaid, an individual cannot own assets, other than a home, of greater than $2,000.

Income, which you can't "spend down," is also a factor. To receive Medicaid for assisted living, an individual can have a monthly income of no more than $1,183.50. "If the person is at $1,185, it isn't like they can get the help -- they are just flat-out not eligible," said Liz Scott, adult economic services director for Wake County Human Services.

"The most difficult part of this is for people who need assisted living," Scott said.

By a quirk in the law, an individual with a slightly higher income, $1,400 to $1,500, can qualify for Medicaid-paid nursing home care, a more expensive and higher level of medical care than provided at assisted-living facilities.

"It's this whole Catch 22 about people often having to seek out a higher level of care than they need," Scott said.

William Marshall, the railroad retiree, doesn't need as much medical attention as nursing homes provide, his daughter said.

"There's nothing for people like Daddy that don't need a nursing home," Jones said. "He still has his mind, but he can't physically look after himself."

Marshall lived independently in the family home in South Carolina until about eight years ago. "He had a heart attack and then he was having anxiety attacks," Jones said. "He called the ambulance every other day."

Like many people in his situation, Marshall relied on his family to provide care, at least initially. "He moved up here with my sister, and she passed away," Jones said. "That's when I had to find him a place. I have to work. I'm working class."

One couple's story

Even for people who are in seemingly comfortable retirement, the possible need for long-term care can become a nagging issue: What if one partner in a marriage or relationship gets really sick?

Such thoughts sometimes cloud retirement life for Nat and Roberta Smith of North Raleigh.

"My best-case scenario is, nothing happens to us," said Roberta, 67, a retired nurse. "But that's like saying you're going to get to be 50 and never have a car accident."

The Smiths live in a leafy, '70s-era suburb and enjoy gardening, Encore classes at N.C. State University and travel. They have pension and Social Security resources and aren't by any means crying poor. But they worry that they could be wiped out if they had to pay for long-term care.

"If one of us had a stroke and needed care for a long time ..." said Nat, 66, a former lab manager in the NCSU zoology department. He stopped for a minute, thinking of their grown offspring. "Most of us don't want to be a burden on our children."

Perhaps, the Smiths said, they could convert some of their downstairs rooms into a large bedroom for whoever got ill. They could bring in home-health aides. But at $15 to $25 an hour, home health can get into real money really fast.

"You need to go ahead and make your plans, because you never know when you're going to need them," Nat said.

Experts say people such as the Smiths fit into that huge percentage of the older population -- people doing too well to be considered poor, but not nearly well enough to float through any and all perils in their senior years.

"It's a big issue, but it's also one that the legislature will need to address along with the department," said Lynne Perrin, chief of facility and community care, clinical policy and programs at the state Division of Medical Assistance. A change in eligibility levels would allow more older residents to get help from the state.

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