Here's more disconcerting news, in case there hasn't been enough coming down the pike: Long-term care in Hawai'i costs way more than it does in most other places in America.

That's not exactly news to anyone living in Hawai'i, where residents pay a "paradise tax" on nearly everything. But the state has just received yet another reminder that long-term care — at least the institutional variety, in a nursing home — has risen beyond the means of most residents here.

The Genworth 2009 Cost of Care Survey, released last week, puts the median annual cost of a private nursing home room in Honolulu at $123,005, about two-thirds more than the median paid nationally.

That's a price point affordable by precious few, and the people in need of long-term care are anything but few in number. There needs to be more and better support for at-home care, the less expensive "aging in place" alternative.

The Long Term Care Commission, established by Act 224 that passed last year, is not due to propose legislation addressing the problem for another year. But it's already at work scoping out the problem, and it's huge.

The number of people age 65 and over, according to a preliminary commission plan, is expected to grow by nearly 80 percent in the next 20 years.

The burden of care of our aging residents is now borne almost entirely by unpaid family caregivers, because they already can't afford nursing homes. But even if they could, there are too few long-term institutional beds.

It's abundantly clear that Hawai'i needs creative solutions for this mounting challenge — and soon. What's critically needed is a community-based network of services that will help support at-home care of elders, and provide aid to family members who provide their care.

To that point, the state needs to maintain what community services now exist for the care of kupuna. The social services agencies that run senior centers and provide referrals and guidance to caregivers are under duress in the current economic doldrums. They should be a mainstay of the state's social services safety net and sustained, even in hard times.

In fact, the long-range goal should be to expand on them to better enable seniors to age in place, given that the cost of institutional care is so untenable. The state also must reorganize the administration of these services, now scattered across multiple government agencies, more efficiently.

That's the purpose of the LongTerm Care Commission, and the new numbers on the mounting cost of elder care underscore why its work is so important, for our kupuna and eventually, ourselves.