If you believe the state's inability to pay its $90 million monthly Medicaid bill to provide health care for the poor has nothing to do with you and your family, think again. Hawai'i's middle-income residents — including people who own their homes and have money in the bank — are closer to Medicaid than they imagine.

The reason is the skyrocketing cost of long-term care, one of the greatest threats to the financial security of Hawai'i residents, both working and retired.

In 2009, Genworth's annual cost of care survey pegged the median room rate for a private nursing home in Honolulu at more than $123,000, the fifth highest in the country. Hawai'i also has the nation's highest nursing home occupancy rate at 95 percent. The shortage of nursing beds is so severe that some Island residents have been placed in care homes on the Mainland.

The escalating cost of elder-care services threatens to cripple the retirement plans of Hawai'i's middle-income population. That would be tragic for individuals and families, and bad for taxpayers, too. Should middle-income residents be forced to impoverish themselves in order to qualify for Medicaid, the burden on the public will increase.

One sensible approach to this challenge is for the state to support the development of home and community based long-term care services. Home-based care is cheaper than institutional nursing care, and a majority of residents surveyed say they prefer to stay in their homes anyway.

That's why AARP Hawai'i strongly supports the passage of legislation that would support the Kupuna Care Program for the next fiscal year. The Senate Human Services Committee estimates that an additional $2.9 million is necessary to restore the program's ability to address the needs of our underserved elderly.

Kupuna Care is a statewide, no-frills program that provides basic services to the elderly so they can live at home. Services include adult day care, personal care, help with chores, home-delivered meals and transportation assistance.

A more cost-effective alternative to Kupuna Care does not exist, and long-term care is too costly for families to go it alone.

Unfortunately, while the demand for long-term care services has grown steadily, the state has not been consistent in providing support. Our population over age 65 increased by 15 percent over the past eight years, but the Kupuna Care budget has remained flat.

As funding shrivels, services are cut back with sobering effects that strip people of dignity. On Maui, personal care, homemaker and chore services have already been slashed by 50 percent. Clients can have their laundry done and rooms cleaned once a month. Baths have been reduced by 25 percent. How many of us would be willing to step into the shoes of a Kupuna Care worker, face an incontinent 85-year-old and tell her that she won't have clean sheets or a bath until next week because there's no money to help her?

Consider the case of a client on the Big Island, a retired property manager completely dependent on $1,104 in monthly Social Security.

Progressive arthritis has put him at constant risk of falling and made the simplest tasks extremely painful. He has moved in with his son who serves as his caregiver, and to make ends meet, the son works 13-hour days. They have no money for personal or respite care.

That's where Kupuna Care steps in with bare-bones personal services. After recent budget cuts, this client receives greatly reduced services two times a week at a cost of $760 per month. That's compared to the $6,250 in monthly Medicaid costs if he were placed in a nursing home. Helping him at home results in an annual savings of about $65,000 to taxpayers.

Please support Kupuna Care by asking legislators to approve its funding. Hawai'i's elderly must have access to basic care services in their homes to maintain their health and dignity.