America is rapidly moving to a two-tiered system of long-term care services. One provides a broad spectrum of services ranging from an optimal amount of high quality home care to elegant and well staffed continuing care retirement communities for those who can afford to pay; while the other offers very limited services ranging from a few hours of home care per week to often dreary, poorly staffed, nursing homes funded by Medicaid.

State and federal officials are about to implement newly legislated budget cuts that will further limit care options for those who rely on public funding for their care. Meanwhile, the pool of workers in the labor intensive, long-term care industry continues to shrink as the numbers of frail and disabled elders grows at an ever-increasing rate.

Many Americans still don