Long-Term Care

Today, an increasing number of Americans need long-term care. Unprecedented growth in the elderly population is projected for the 21st century, and the population age 85 and older--those most in need of long-term care--is expected to outpace the rate of growth for the entire elderly population. In addition to the dramatic rise in the elderly population, a large portion of the long-term care population consists of younger people with disabilities. The importance of long-term care was underscored by the 1994 congressional debate over health care reform and, more recently, by the "Contract with America," which proposed assistance such as tax deductions for long-term-care insurance and tax credits for family caregiving. This report (1) defines what is meant by "long-term care" and discusses the conditions that give rise to long-term care need, how such need is measured, and which groups--young and old--require long-term care; (2) examines the long-term care costs that are borne by federal and state governments as well as by families; (3) addresses strategies that states and foreign countries are pursuing to contain public long-term-care costs; and (4) discusses predictions by experts on the future demand for long-term care.

GAO found that: (1) long-term care is designed to help people with chronic conditions compensate for limitations in their ability to function independently; (2) the need for long-term care is not determined on the basis of a diagnosis or illness alone; (3) of the over 12 million Americans requiring long-term care, 60 percent were elderly; (4) people in need of long-term care primarily require nonmedical assistance with daily living activities; (5) 70 percent of the $108 billion that was spent on long-term care in 1993 paid for institutional care; (6) Medicaid and Medicare are the two largest government payers of long-term care; (7) families pay over one-third of long-term care costs and can purchase private long-term care insurance to help with the financial burden, but they also suffer nonmonetary burdens in caring for relatives; (8) states and other countries have been working on new ways to control long-term care costs, including service delivery models that emphasize home and community-based care, capping budget and provider fees, consolidating program administration, and using case management more often; and (9) the number of people needing long-term care is expected to increase, although the extent of future long-term care needs is uncertain.