There is simply no escaping the reality of an aging population, particularly as it affects Hawai'i. In our island home, genetic and lifestyle factors combine to produce elders with longer-than-average life expectancies.

While that in itself is something to celebrate — people live on average to just under age 80, compared with almost 77 nationally — the fact remains that this state is ill-prepared to cope with an entire baby-boomer generation growing old at once. By 2020, one out of four people will be 60 or older.

The challenges include preparing people to finance some of the costs themselves as well as government picking up the tab for the needy. In addition, there are nowhere near the long-term care facilities needed to accommodate the people who will need them.

But among the most worrisome shortcomings is the work force, primarily the nurses needed in long-term care. Facilities can be built, but the lack of caregivers would set off the real crisis, given that every state in the nation will have positions to fill, and simply luring Mainland staff won't really be an option.

The entire range of professional skills will be needed, from doctors and advanced-practice nurses to the certified nursing assistants and other direct-care workers.

Hawai'i professionals have heard the call and are working on solutions, identifying the need for nurse educators as particularly acute. They've found some community support, but need much more.

At the University of Hawai'i, plans are in the works to develop a Geriatric Nursing Institute to strengthen curriculum and otherwise build the foundation for nurse training and recruitment. Unfortunately, the bill to establish the institute died in the 2007 legislative session.

In general, however, the Legislature has recognized the need and has supported funding for UH faculty needs and more. And in 2003, lawmakers established the Hawai'i State Center for Nursing to coordinate work-force planning, nursing research, and professional practice.

Last August, that agency linked with the HMSA Foundation and the Robert Wood Johnson Foundation on Hawaii Partners in Nursing, a two-year work-force development project, giving nursing students at UH, Hawai'i Pacific University and Maui and Kapi'olani community colleges work-study opportunities in long-term care facilities.

But because so many elders in Hawai'i are likely to "age in place" through home care, there's a distinct need for training and retention of the certified nursing assistants and others who provide direct care. The nonprofit Healthcare Association of Hawaii has been among those working toward this end with the "health academy" at Farrington High School promoting careers in healthcare among students; such efforts have shown some success and need expanding.

Finding ways of curbing the high attrition rate in this field will be essential, too. According to the healthcare association, among registered nurses in long-term care, there's an annual turnover of about 49 percent; among CNAs, it's closer to 71 percent.

It's a complex issue, with much to be done at the national level, too, including congressional initiatives to increase grant funding and to gather data on labor requirements so that educational institutions can respond. And there's plenty of room for community partnerships to help secure grants that will sustain this recruitment and training effort.

Hawai'i is on the front ranks of states that have made the need for long-term caregivers a priority, and the state needs to keep that focus. Ultimately, it will be our parents — and ourselves — who will be the beneficiaries of this effort.