Long-Term Care

Long-term care (LTC) may well be one of the most important challenges of the 21st century. Life expectancy in the United States has been increasing ever since records have been kept. In 2000, the life expectancy for a male was 74.3 years and for a female was 79.7 years. Compared with life expectancies in 1900 of 46.3 years for men and 48.3 years for women, and in 1950 of 65.6 years for men and 71.1 years for women, the increases during the 20th century were remarkable.

But as James Fries noted in 1980 and Sidney Katz and his colleagues pointed out in 1983, adding years to life is only one part of the challenge. If humans' biological makeup were such that at 80 years of age all people would become frail, vulnerable, and incapable of living independently, then increasing life expectancy from 80 to 85 years would simply mean adding 5 years of frailty, vulnerability, and dependence to the final years of life. Quite frankly, who would want that? If, on the other hand, humans' biological makeup were such that all people would have 1 year of frailty, vulnerability, and dependence during the final year of our life—no more and no less—then increasing life expectancy from 80 to 85 years would mean adding 5 years of independent living to the final years of life. And who would want that? Quite frankly, just about everyone.

The actual circumstances seem to be somewhere in the middle. In general terms, for every 3 years of additional life expectancy we seem to gain, 2 of those years are years of independence and the 3rd year is one of frailty, vulnerability, and dependence. From another perspective, half of all people who reach 65 years of age will spend at least some of their remaining lives in nursing homes.

As a consequence of all these factors, these final years of frailty, vulnerability, and dependence of individuals give rise to the need for efficient, effective, and humane long-term care during those final years.