The spectrum of elder-care facilities in Hawai'i presents the full range of experiences, some of them managing quite well to stay afloat financially. But the struggles of Lunalilo Home, a fee-for-service adult day care center of long standing, illuminates a social landscape in which care of elders is becoming challenging.

Lunalilo Home, the state's oldest adult care home, is asking its residents and their families to pitch in more money to keep its doors open.

Home officials say that in some cases residents are qualified for admission based on financial circumstances that later change, and families become unable to pay a full share. They add that a trust fund helps cover such shortfalls, but overall the home is operating at a deficit.

Among the observations that could be extracted from this case is the inescapable fact that overhead costs of operating full-time residential facilities can easily outpace revenue, and that families are finding elder care bills more difficult to pay than ever.

The state's network of senior care needs to be reinforced, if it's expected to sustain the demand that will come with the growing population of Hawai'i's seniors.

At larger-scale residential facilities such as Lunalilo, multiple revenue streams have become necessary to cover operating expenses. And gathering various senior care services together creates a hub that can only strengthen our elder care safety net.

Palolo Chinese Home is one center that is serving as a model for future senior service hubs. With state and private support, the home has expanded from a private care-home operation and now offers "Meals on Wheels" nutritional outreach services adult day care and overnight respite care to the community.

In addition, the home partnered with the John A. Burns School of Medicine to initiate the Hawaii Neighborhood Outreach to the Aged Program. This program provides services that allow seniors to live independently in their own homes. It's an initiative that should be replicated in other communities.

"Aging in place" could be supported in other ways, involving county authorities as well as the state. Zoning code and building code changes that encourage families to accommodate seniors at home is an area that deserves special attention. Senior advocates in Maui, for example, are seeking a revised housing standard in new construction.

The Kupuna Caucus at the Legislature is reviewing social initiatives that will enable Islanders to care for our seniors. This is critical work for the coming lawmaking session.