Long-Term Care: Consumers, Providers, Payers, and Programs
Publication Date: March 2007
Publisher: Library of Congress. Congressional Research Service
Author(s):
Research Area: Health
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Abstract:
Long-term care refers to a broad range of health and social services needed by people who are limited in their capacity for self-care due to a physical, cognitive, or mental disability or condition that results in functional impairment and dependence on others for an extended period of time. The need for long-term care affects people of all ages -- children born with disabling conditions, working-age adults with inherited or acquired disabling conditions, and the elderly with chronic conditions or illnesses. The need for long-term care services is generally measured, irrespective of age and diagnosis, by a person's inability to perform basic activities necessary to live independently. While the likelihood of needing long-term care assistance occurs more frequently with increasing age, advances in medical care are enabling people of all ages with disabilities to live longer.
About 9.4 million adults, or 5% of the adult population, receive long-term care services in the community or in institutions. About 1.1 million children living in the community have long-term care limitations. While the lifetime risk of individuals using long-term care services varies greatly, a team of researchers has estimated that 69% of people turning age 65 in 2005 with a moderate level of need will use some care before they die; 31% will not need any care.
Regardless of age, people receiving long-term care assistance are more likely to live at home and in community settings rather than in institutions. Adults with long-term care limitations are more likely to live in poverty than people without limitations. Most care received by people with disabilities is provided by informal providers -- family and friends -- who give care without compensation. Formal care providers range from institutional settings and other residential care facilities to a variety of organizations that provide a wide array of home and community-based services. Accessing and arranging formal care services, delivered through multiple providers, can be complex and confusing for individuals and their families.
National spending on long-term care in 2005 is estimated at $206.6 billion. Medicaid is by far the largest public program that covers long-term care, paying for almost half of the nation's long-term care services, primarily institutional care. Medicare covers post-acute services in skilled nursing facilities and in the home for certain Medicare beneficiaries. In addition, the Older Americans Act (OAA) and the Social Services Block Grant (SSBG) support a wide range of home and communitybased long-term care services. Each of these federal programs has differing characteristics, program goals, eligibility requirements, and covered services, which often results in an uncoordinated service delivery system for individuals and families seeking assistance.
In order to assist Congress in future policy deliberations about long-term care services and supports, this report discusses selected characteristics of long-term care consumers and providers. It then describes payers and selected programs that finance long-term care services. This report will be updated occasionally.