The problems Sheila Zakre of Concord encountered while trying to secure quality home care for her aged mother through a state program could be an aberration. Client satisfaction surveys conducted for care-giving agencies suggest it is, and we certainly hope so. Zakre, whose account appeared in last Sunday's Monitor, described cursory case management, untrained staff, unexpected cancellations and a high turnover rate - 13 different home health care workers in five weeks. The Department of Health and Human Services' "Choices for Independence" program, created to save taxpayers money while allowing the elderly and disabled to stay in their own homes, won't succeed if her experience is common.

In the near future the baby boomers now caring for their aged parents will need assistance themselves. The problem is national. It's been exacerbated by the mobility of today's population and a societal unwillingness to value the service that home health workers provide. What would you want to be paid per hour to change adult diapers?

New Hampshire faces a bigger problem than most. The state's over-65 population is growing twice as fast as the population overall. That's why the Department of Employment Security predicts that home health care worker will be the state's fastest growing occupation in coming years. But people who work in that field earn on average just $10.50 per hour. A 2008 survey by UNH's Carsey Institute found that two-thirds of home health care workers get no paid time off, and one-third have no health insurance. The work is hard, the hours irregular, the pay poor. It's no wonder that turnover rates are high.

State efforts to deal with a potential crisis in long-term care can't be adequate when states themselves are going broke. Congress has before it one of the last pieces of legislation championed by the late Ted Kennedy, the Community Living Assistance Services and Supports Act. It would create a federally-run form of minimal insurance designed to keep seniors in their own homes longer and reduce Medicaid costs. Workers would automatically be enrolled in the insurance program but have the ability to opt out.

The act calls for charging workers, through payroll deductions, premiums in the $125 per month range. In exchange, after a five-year vesting period, they would get a lifetime guaranteed payment of $50 to $75 per day to help pay the cost of purchasing home health care services should they become disabled.

Enacting such a proposal is not without fiscal risk. Deficit hawks worry that while the insurance program would take in billions more than it pays out in its early years, it could require federal subsidies later. That risk exists. But it now costs an average of $70,000 per year to stay in a nursing home. Seniors must spend down their assets - unless they've succeeded in sheltering them - and bankrupt themselves before the federal Medicaid program will pick up the tab. But most do, which is why state and local taxpayers, through Medicaid, pay half of all nursing home costs.

Private long-term care insurance is not an option for most people. While premiums are perhaps affordable when someone is young, they escalate rapidly with age. Policy-holders may find that they've paid for decades but can no longer afford the premiums when they get close to needing them.

The CLASS Act won't solve the nation's long-term care problem. But the few hours of daily care it would cover would make it possible for some people to stay in their homes rather than a nursing home. That care would be paid for with their money, not that of taxpayers, who would save every day a potential Medicaid recipient is not institutionalized.

The legislation, which is included in the House version of the health care reform bill, isn't perfect. But the potential number of people who will soon need assistance with life's everyday tasks is staggering. If nothing is done, it's not just the elderly and disabled who will be worse off - it's everyone.