The number and proportion of older Americans are rising rapidly and are expected to increase into the middle of the 21st century as Baby Boomers reach age 65. Medicare has been the traditional health care insurance for the elderly. Medicare was enacted in a health care climate of acute care and hospitalization. Chronic disease is the major health care cost of the 21st century with the need for long-term care growing rapidly. Medicare was never designed to pay for long-term care and custodial services. The limited scope of Medicare coverage is a problem now and will be a greater problem in the future. Long-term care is a personal responsibility and requires planning ahead. Nurses offer strategic solutions to meeting present and future needs by serving as educators, advocates, coordinators of resources, and activists working on many levels to influence care for the elderly now and in the future. This article focuses on the origins of traditional health care insurance, current and projected costs of long-term care, the current role of the government and private sector in financing long-term care, and nursing initiatives for the individual and community.