Long-Term Care

The number of persons who need long-term care depends on how that need is defined. A broad definition would include anyone who has difficulty performing a range of daily activities expected of his or her age group. In 1994 an estimated 12.8 million Americans of all ages said they needed assistance with everyday activities as a result of chronic conditions. The majority of Americans in need of long-term care, approximately 57 percent (7.3 million), were adults age sixty-five or older. Forty percent (5.1 million) were working-age adults age eighteen to sixty-four. Three percent were children under age eighteen who were limited in their ability to engage in play or school activities expected for their age due to physical or mental disabilities (GAO, 1994). In 1994 approximately 6.6 million persons age sixty-five or older received help with one or more daily activities (Kassner and Bectel). Many other adults live independently with little or no assistance from others.

The need for long-term care services in the United States is likely to increase dramatically as a result of an increasing older population. Individuals age eighty-five and older are the most rapidly growing age group in the nation. The eighty-five and older population is expected to rise from 3.9 million in 1997 to 8.5 million in 2030 and to eighteen million in 2050. Estimates of the number of baby boomers (Americans born between 1946 and 1964) who will need long-term care range from two to four times the number of disabled older persons in the late 1990s, depending on the impacts of medical advancements on increasing longevity and on treating and preventing disability (GAO, 1998). Indeed, the proportion of Americans age sixty-five or older with a chronic disability declined from 24 percent in 1982 to 21 percent in 1994 (Federal Interagency Forum on Aging-Related Statistics).

Although most older people do not need long-term care, older persons are the primary users of long-term care services. Three percent of all persons age fifty and older, and 11 percent of persons age eighty-five and older, receive help with two or more daily activities (Kassner and Bectel). An estimated 39 percent of persons who turned sixty-five and 56 percent of persons who turned eighty-five in 1995 will use a nursing home during their lifetime (Murtaugh et al.). The average length of stay for nursing home residents sixty-five years and over is 290 days, but half stay no more than about two months (63 days) (Gabrel).

Women have a longer life expectancy than men and are more likely than men, at every age, to have a disability (Kassner and Bectel). Older women also tend to have lower incomes and are more likely to live alone than older men. As a result, the majority of nursing home and home care users are women. In 2000 women comprised an estimated 58 percent of the population age sixty-five and older and 70 percent of persons age eighty-five and older (Federal Interagency Forum on Aging-Related Statistics). Women accounted for about 75 percent of nursing home residents aged sixty-five and over (Gabrel) and 70 percent of older home care consumers (Munson 1999).