"This step is a call to action for providers here and around the country," Carbonell said. "Anything that can be done to not damage the infrastructure of the family and the home or force Americans to spend down to poverty so they can receive Medicaid is not only what we need to be promoting, it's what the new wave of baby-boomer senior citizens is demanding."

This next generation of seniors is activist and all about getting what they want, she said. They are "engaged in the course of their lives and the course of programs they participate in. They are the first generation actively engaged in getting and staying fit. They are much more nutrition-conscious and involved in the notion that staying healthy is mostly up to them, not to medical professionals.

"And, as the next generation of elderly, they are out to change the course of the medical care of seniors and will once again empower common sense," she said.

More than $34 billion could be saved annually from the $208 billion spent each year on senior services nationwide.

The average annual cost of in-home services is $3,700; the average nursing home cost is $72,000. For every person in a care facility, 19 people could be cared for at home.

Carbonell predicted that more than 200,000 of the nation's elderly could be diverted from nursing-home care and from Medicaid services over the next decade.

"These aren't estimates, they are real and the results are achievable," Carbonell said. "Those 10 years are the small window we have before the largest wave of baby boomers hits."

The idea of a freeze of state appropriations is being seen as just more writing on the wall for care centers in Utah and around the country.

Organizers of the Utah Health Care Association's 45th annual convention next week in Sandy have allocated several hours to discussion of the issue.

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E-mail: jthalman@desnews.com