This morning, I was on Diane Rehm’s NPR radio show talking about long-term care insurance.  The other guests–former Social Security Administrator Ken Apfel, Families USA executive director Ron Pollack, and Kiplinger’s Personal Financec olumnist Kim Lankford–and I agreed on one thing: Private LTC insurance is an appropriate tool for some consumers, but it is not a realistic alternative for many others.

The challenge is figure out how we can provide good quality care for those millions of people who can’t afford private insurance, are medically ineligible for it, or just plain won’t buy it.

We shouldn’t kid ourselves, that is most people. And in a new study, the Employee Benefit Research Institute (EBRI) laid out just how unprepared many Americans are for even a healthy retirement, to say nothing of one tha includes significant acute medical problems and long-term care needs.

EBRI found that nearly half  the time (44 percent) early and late Baby Boomers and Gen Xers (people born between 1948 and 1974), are likely to fall short of meeting their basic financial needs in retirement, including their nursing home or home health needs. Thanks to increased enrollment in 401(k)-type plans, that’s an improvement from the last time EBRI did this study a decade ago, but it shows just how serious this problem is.

Overall, the Boomers and G-Xers will need $4.3 trillion more to meet basic retirement needs than they are likely to have, according to EBRI’s Retirement Security Projection Model. The model simulates various lifepaths and figures the chances of retirees having enough money for the rest of their lives.

Not surprisingly, like many other studies of its kind EBRI finds that low income people are most likely to fall short. And the most at-risk are single women. For instance, among married early Boomers, each individual would need to add about $22,000 to their savings at age 65 to fill their expected financial deficit in retirement. But single women are likely to fall nearly $105,000 short.

EBRI figures that single men need to put aside an extra $32,000 at age 65 to support typical long-term care needs, while single women need to put away nearly $47,000.

Other studies come up with somewhat different estimates, but they all tell the same story. A very large number of us are woefully unprepared for retirement, including the likely need for some long-term care.

Insurance is the solution for some, more savings for others. But unless Americans begin to take their long-term care needs more seriously well before retirement they, and our country, are looking at a scary financial future.