That is not an easy task. She can't even get him up the steps of her Kane'ohe townhouse to the shower. She bathes him in the garage with a garden hose while he sits in his wheelchair. When she must leave the house, she prays nothing happens while she is gone. Hiring help, particularly nursing aides, is simply too expensive.

"The system is made for only two people: the wealthy and the really poor," she said. "My furniture has termites. My townhome could use some repairs. But taking care of my dad has taken everything I have. It's just drained me totally."

Ishikawa is typical of a growing number of baby boomers in Hawai'i and across the country who are caring for aging parents. Her problems and challenges are typical, too. She scrambles to navigate a maze of personal and bureaucratic challenges, including planning for the future and finding outside help.

Making plans in advance for one's own life and those of aging parents is a key imperative for the boomer generation. In Hawai'i, where the population of older people is growing faster than in many other states, the rising toll of aging is a personal and systemwide crisis in the making.

Ishikawa is sharing her story because it serves as a cautionary tale: Those who fail to look ahead will suffer more difficulties as they age, shifting the burden of their survival from themselves to their children and to taxpayers.

Challenges ahead

In the next 15 years, 30 million people in America will turn 65, on top of the 40 million who already are 65 and older. Itt means more people competing for healthcare in a system that can barely handle today's level of demand.

Hawai'i will be among the states experiencing the worst of the crisis.

Life expectancy here is 80 years, three years longer than the national average. It's a dramatic increase from 1910, when the life expectancy in the islands was less than 44 years. In Hawai'i, those 65 and older are expected to make up more than 18 percent of the population by 2020. And the number of frail elders who are 85 and older could quadruple over the next 50 years.

The irony is that while health-care technology and life expectancy have soared, so has the price of living longer. Americans 85 and older consume health resources at a rate of more than $16,000 per person per year, American Demographics estimates.

There's also an incalculable emotional toll on family members who, like Ishikawa, bear the brunt of caring for their elders.

As Ishikawa sees her future, it is clouded by the burden of caregiving. And she isn't alone with that feeling of dread.

"I have no plans for myself," she said. "I was so busy caring for everybody. I never finished college. I was taking care of Dad."

She was in her 20s when her mother died. Her role now as parent to her parent has affected every facet of her life, from raising two kids (now 21 and 33) on her own to becoming a teacher's aide with no prospects for a carefree retirement.

Her father Carlos, an Army veteran and former boxer who worked for a tile company and did construction jobs, now has severe emphysema. He's 6 feet tall, but only weighs about 130 pounds. Still, 52-year-old Ishikawa can't lift him. When he fell in the middle of the night last month, hitting the bed frame on his way to the floor, she had to call an ambulance. When he came home from the hospital, she went back to the routine of caring for him.

Ishikawa does it because she loves her dad. And because her modest earnings and her dad's limited retirement income don't allow for many options. Paying an aide to come to their home would be too costly.

She works part-time as an educational assistant at He'eia Elementary, but often takes family leave to care for her father when his health problems flare up. Her father receives about $25,000 annually in Social Security and retirement benefits, with an additional $1,200 monthly in workers' compensation. What Ishikawa wants is a program that will help pay for home-based care, so that she can live with her father, but also go out to work.

Facing the future

Money, or lack of it, is one of the biggest hurdles for Ishikawa and others sacrificing their own careers to take care of their relatives.

Lot Lau, who answers Honolulu's Elderly Affairs Division hot line, hears from frustrated callers every day. They complain about unaffordable housing or waiting lists for such requirements as transportation and home services.

Hawai'i is not going to be ready for all of the needs an aging population has in the future, Lau said. "It's not ready now."

But while savings and public funding are part of the picture, planning and communication within the family are also key.

People need to take personal responsibility and face the future, whatever their financial circumstances, said Karen Miyake, Honolulu's county executive on aging. That could start with families discussing their preferences, such as where and how parents want to live once they have to give up some of their independence.

"When people haven't communicated or thought about what's going to happen, then there's a lot of stress in the family," she said.

That discussion should happen around the time a parent retires and continue on a yearly basis, said Percy Ihara, a host of "Kupuna Connections," a community television series dedicated to seniors and their families (7:30 p.m. Wednesdays, beginning Dec. 15, on 'Olelo's Channel 52).

"You've got to talk about who's going to take care of you, where you are going to live and how you're going to pay for it," he said. "It's something a lot of seniors don't want to talk about."

A public concern

Greg Marchildon, state director of AARP Hawaii, says something must be done to deal with the graying of Hawai'i — and fast.

"We are way behind the curve for what we're going to need to do in 20 to 30 years," he said. "We're going to need a lot, and quickly. We need to start making bold decisions quickly."

The pieces of the puzzle include government support for transportation and long-term care, community programs and the personal changes people should make to stay healthy longer.

"It's not just an issue for state government, but also business, even the tourism industry," he said. Each set of services comes with a big price tag, he said.

"We need to rethink development strategy, reconfigure our communities to address people living there in the next 30 years," Marchildon said. "People need to be able to go to the store, see their doctor, sit on the lanai. If we don't create a safe and healthy environment, we create an isolated society."

State and county executives on aging say they're doing what they can to provide information and resources.

But federal money for aging is based on population size rather than the growing needs of the population, said Pat Sasaki, executive director of the state Executive Office on Aging.

So who should be responsible for the problems we face when it comes to an aging population? Our families? Our government?

"In the end, the government and society is the place of last resort for people as they age," said Gov. Linda Lingle. "Everybody hopes their own children — their own family — will help care for them, but it just doesn't always work out that way."

Society must adapt

Preparing for an aging society is everyone's responsibility, said Sasaki of the state Executive Office on Aging.

Sasaki thinks it's important that individuals and society help the elderly keep their independence, be safe and healthy, and lead dignified, meaningful lives.

"I believe the three R's of aging — respect, recognition and responsibility — are key to successful aging," Sasaki said. "These are values that begin from childhood and sustain most people throughout their lifetime."

That has been what Helen Uehara has tried to teach her children.

Uehara, 60, of 'Aiea, took early retirement from her nursing job in 1995 when her mom came down with cancer. Her disabled brother already had suffered a stroke in 1992 and was bed- and wheelchair-bound. Then her father got ill.

Some days she'd spend most of her time making phone calls and cutting through red tape. Her brother, who had many medical problems, qualified for services — but her parents did not.

Her children and siblings would help out with the care, but it was draining, and they couldn't afford to hire out help.

"Unless you've got money, the cost of bringing in respite is very high," she said. "It was limited choices. It came down to a matter of respect for my mom and dad, and if we're still healthy, we'll take care of them."

Uehara's mother died in 1997, at 72. Her father passed away in 2001 at 84. Her brother has also passed away, and Uehara now spends her days caring for her grandchildren.

She and her husband, Eugene, 64, bought long-termicare insurance, trying to spare their own children from the problems they faced.

She worries about other families who aren't prepared and about parents who will be neglected.

"It's become, I believe, a social problem," she said, "because these people are in harm's way."

Taking it on personally has been a burden and a blessing for her.

"I've learned to be compassionate and to be humble," she said. "We are all moving in the same direction. Do we want to be treated with dignity and respect, or do we want to be treated the opposite?"

Keeping hope alive

Bernadette Ishikawa figures it would cost her at least $15 an hour for a nursing assistant to help her with her father. She can't afford that.

So she puts on latex gloves, suctions her dad's throat, and performs tasks that make her appear as though she's a professional.

She'd invite legislators into her home to see what it's like, if they'd come, she said. She's even written to Oprah, suggesting she do a program about caring for seniors.

All she wants is a little relief. A good night's sleep. No worries.

"I never thought about these things when I was young," she said, "because you don't think about getting old when you're young. There is no future for me right now. When my dad is gone, then it will be time to plan my future."