Long-Term Care

Long-term care (LTC) includes a wide variety of health and support services that are provided to the frail, the elderly, and individuals with chronic disease conditions and disabilities. LTC is largely personal, custodial, and unskilled care provided to those who cannot care for themselves for extended periods of time. The majority of those receiving LTC are the frail elderly who suffer from multiple chronic diseases. In the United States, about 60% of all individuals 65 years of age or older require at least some type of LTC services during their lifetime, and over 40% need care in a nursing home for some period of time. In 2006, there were 37.3 million people in the nation 65 years of age or older, or about one in every eight Americans. By 2030, the number is expected to grow to 71.5 million people, or about one in every five Americans. Although the family is the primary source of LTC, the increasing size of the nation's older population coupled with decreasing family size and high divorce rates will invariably increase the demand for paid LTC services.

The need for LTC services for people suffering from chronic disabilities is often estimated using the criteria of Activity of Daily Living (ADL) or the Limitations of the Instrumental Activities of Daily Living (IADL). The ADL criteria include bathing, dressing, getting in or out of bed, getting around inside, toileting, and eating; and the IADL criteria are light housework, laundry, meal preparation, grocery shopping, getting around outside, managing money, taking medications, and telephoning. According to the National Institute on Aging, in 2006, about 20% of all Medicare enrollees, including 5% who were institutionalized, had limitations in one or more ADLs. However, only about half of those individuals were estimated to be receiving personal care. The majority of those (65%) who received personal care obtained it from unpaid caregivers (i.e., spouse, adult children, other family members, and friends), about 26% received personal care from both unpaid and paid caregivers, and the remaining 8% received personal care from only paid caregivers.