The role of private market initiatives in helping to address the need for long-term care services has begun to receive widespread attention for a number of reasons. The longer life-span of many elderly people has created an unanticipated need for care that is straining both public and private budgets. This budgetary strain is getting worse because of the rapid growth in the elderly population, especially the oldest of the old (those eighty-five and over), who are the heaviest users of such services. Budget deficits have exacerbated the problem, making it difficult for public programs to respond to the increased need. At the same time, the financial position of many middle-class elderly has been improving. The hope of private market initiatives is that by providing options for consumers to protect themselves, they will better prepare for the risk of needing long-term care and by doing so relieve some of the strain on public budgets.