You awake at 3:00 AM, drenched in sweat, paralyzed and unable to remember the name of -- or call out to -- your spouse of 20 years.

Four days later, in the Neurological Intensive Care Unit, your attending physician explains that you've had a "cerebral vascular accident," a stroke. Talk will soon turn to post discharge planning, skilled nursing facilities, adult day care, speech therapy, and the "spend down" of your life savings. Your children, scattered across the country, and with families of their own, are torn between the need to protect the continuity of their own lives, and their roles as potential caregivers.

As the bills for the skilled nursing care and medical equipment begin to pile up, and the expanded world you were part of begins to shrink, claustrophobia sets in and your feelings of helplessness turn to despair and panic -- like a person who is slowly being pulled into a piece of farm machinery; the outcome inevitable, but powerless to intervene.

Welcome to the world of long-term care.

"There's a train wreck up ahead waiting to happen, Mr. President, and I'm afraid it's going to be ugly" I said to Jimmy Carter during a phone conversation we had in 1998 on the subject of aging and long-term care.

Today, more than 70 million Baby Boomers are passengers on that train - a train with no engineer or brakeman, traveling hundreds of miles per hour faster than it was designed to.

As the train continues to pick up speed, three of the nation's largest nursing home chains have recently sought protection from their creditors in the courts, citing that Medicaid cutbacks have created "an untenable and severely prejudicial financial environment."

Even the insurance industry is beginning to show signs of concern. The recent announcements that Fortis and the Travelers were selling their LTC insurance divisions sent shock waves through the financial services sector.

Do I have your attention? Good, because now that I've taken the time to painstakingly lay the groundwork, it's time to tear down the entire foundation and tell the truth.

This nation's current long-term care crisis has little to do with long-term care. Oh, the metaphorical train is real alright, as is the unnecessary suffering of countless elders who will live out their last days in abject despair.

But the real crisis we face is one of aging, a human condition for which we have very little tolerance or empathy.

In America, the natural cycle of birth and death has been replaced with slick ads from 35-year-old Madison Avenue executives. Even the cover of Modern Maturity now touts provocative glossies of Susan Sarandon and Sophia Loren as examples of 21st Century gerontological miracles.

In a tradition that predates time itself, we age, preparing for the day when we will completely and irrevocably surrender. And yet, despite the certainty of the process, we battle in ways that would embarrass even Dylan Thomas.

What is the "essence" of the problem? Frail elders are not hearty producers or consumers. We understand the logic of the marketplace, but we draw a blank when it comes to primordial imperatives. In short, we embrace the 80-year-old who is still a successful entrepreneur - until he or she becomes weak or frail.

Last week I spoke at length with Chief Oren Lyons, Faithkeeper, Turtle Clan, Onondaga Nation, Haudenosaunee, about the subject of aging and our elders.

Chief Lyons, now 70, said, "...when an elder speaks they carry an authority and wisdom that only comes with age and experience - when the sharp emotions of youth are worn down and rounded. There is a standard in the Natural World, where the elders always are, in which they are perceived as leaders. In a buffalo herd, the eldest is the leader. In the forest, the oldest, largest trees are the most fruitful and productive. They are the great seed bearers.

If you look only to the Natural World, you will see the value that nature places on aging.

In many of today's industrial nations, they generate their power and authority from youth - they build their foundation on the strength of their young, and this is a great loss; a great disconnect between that society and their elderly"

When we embrace the vision of Chief Lyons, we celebrate commencement: our elders graduate from "disposable" to "human being."