She helps him go to the bathroom. She dresses him and turns him at night to avoid bedsores. When they go out, Peggy seeks out places with family bathrooms so she can go in with him.

"It's physically tiring and mentally tiring too. You have that responsibility that when he's with you, he's yours completely," she said. "It's not fun. It's very expensive and it's very draining. ... But what are you going to do? That's life."

Peggy, a bank auditor, bought long-term-care insurance for

the couple when Tony had his first stroke more than a decade ago. The insurance covers most of the $1,600 monthly cost of Tony's adult daycare and allows Peggy to keep working.

But if Tony should need care beyond what Peggy and the daycare center can provide, the couple will be in a bind. Their insurance will only pay for half of the cost of a $7,000-a-month nursing home. Insurers have refused to sell her more coverage and the Mo'ili'ili couple have no children.

"How will I come up with $3,500?" she said. "I suppose I have to use my retirement money. But if I use my money for him, what will I have?"

Limited income

Money is a major concern for most elderly. In Hawai'i, almost half of those age 65 and older have an annual income of less than $15,000 and 13 percent make less than $5,000.

That's a fraction of the money needed to pay for long-term care. The cheapest long-term-care housing option is adult residential care homes, where families take in and care for seniors and prices start at $24,000 a year. At the high end are nursing homes, facilities that provide comprehensive chronic care for seniors, but they charge upwards of $84,000 a year.

The option of staying at home and having someone come in to help can be just as expensive depending on the hours and level of care needed. Prices start at $12 an hour for a personal-care assistant to at least $25 an hour for registered nurses. For a senior who needs 24-hour supervision, it would cost at least $8,640 a month for the least skilled care.

That's why most of the elderly in Hawai'i end up in the care of a family member or friend.

In Noll's case, she can't afford any option other than taking care of her mother herself. So at 6 a.m. every day, Noll fixes breakfast and does laundry. When she's not in class, she's doing homework and chores while keeping one eye on her mother to make sure she doesn't wander off. In the evening, Noll makes dinner and then helps her mom take a shower. Her mother doesn't like getting her face wet, so Noll washes her hair separately in a sink. Finally she brushes her mother's dentures and sees her off to bed.

Noll hasn't a clue what she'll do if her mom's health deteriorates and she needs around-the-clock skilled nursing care.

"I'll be out of luck," said the Kaimuki resident, who is single. "I'm going to have to deal with it as it comes."

Noll's mother — like many aging parents — doesn't have enough assets to pay for her own long-term care.

Savings don't go far

While many seniors have some retirement savings and possibly equity in a home, it doesn't go far with the high cost of care.

The median household net worth — all assets, including home equity, minus debts — for those age 65 and older was about $180,000 in 2001 nationwide.

"I'll be out of luck. I'm going to have to deal with it as it comes." Debbie Noll | right, about what she'd do if her mother, Janice, left, needed full-time skilled nursing care. Photos by Deborah Booker • The Honolulu Advertiser

Debbie Noll provides full-time care for her mother, Janice, who suffers from Alzheimer's disease. Twice weekly, the daughter gets a break when the mother goes to an adult daycare center.

"Long-term care is a crisis. It's a crisis because nothing has been planned for," said Pat Sasaki, director of the state Executive Office on Aging. "Government today cannot afford to be the savior."

Medicare, the federal program that provides health insurance to seniors regardless of income, is not designed to pay for an extended stay in a nursing home. At best, it can cover part of the first 100 days of care.

Medicaid, a state-run program that provides medical care for low-income families, can pay for long-term chronic care. But the income and asset tests are such that many people have to impoverish themselves to qualify.

In the case of Noll's mother, she's ineligible for Medicaid in part because her medical expenses do not exceed her $1,000-a-month Social Security income.

Even the limited assistance provided by Medicaid may not be sustainable.

There are 39,000 aged and disabled people in Hawai'i who get some form of Medicaid. If you qualify, the program pays for everything — from prescription drugs and doctor visits, to nursing-home care. The cost to the state is soaring, in part due to the high cost of new treatments.

The state set aside approximately $652.1 million for Medicaid last fiscal year, up 49 percent from four years earlier. Hawai'i has faced two Medicaid shortfalls — when budgeted money couldn't cover actual costs — in the past five years.

"Every state, not just Hawai'i, experiences rising medical costs," said Lillian Koller, director of the state Department of Human Services. "The rising cost has an impact on taxpayers. We're the ones subsidizing that cost. We're paying for Medicaid customers to get this care for free."

While that's true, Hawai'i faces a unique challenge. Its senior population, already the longest-lived in the nation, is growing at a faster pace than in other states.

The state has gone from 7 percent of the population being over 60 years old in 1970 to 17 percent in 2000. And by 2020, one in four people will be age 60 and over.

"It's a strain on government. These are going to be what we call the budget busters."

The picture isn't much better for the nation as a whole.

Social Security is the main safety net for many elderly. Eighty percent of seniors nationwide say Social Security is their primary source of income.

But by 2018, Social Security will be paying out more than it collects from taxes and will have to start drawing on its reserves, according to the U.S. comptroller general.

With government pockets pinched, where can seniors turn to in their waning years? For many, it's their 'ohana.

"A good deal of elder care comes from the family," said Cullen Hayashida, co-host of "Kupuna Connections," an 'Olelo TV program for seniors that debuts Wednesday on Channel 56. "So don't get a divorce and have a good family."