Long-Term Care Homepage
Updated November 2010
Table of Contents
Other NCSL Long-Tem Care Pages
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According to the U.S. Department of Health and Human Services' Administration on Aging, persons 65 years or older numbered 38.9 million in 2008 and represented 12.8% of the U.S. population, over one in every eight Americans. This was an increase of 4.5 million or 13.0% since 1998, compared to an increase of 12.4% for the under-65 population. However, the number of Americans aged 45-64 – who will reach 65 over the next two decades – increased by 31% during this period. The United States' older population will significantly continue to grow between 2010 and 2030 as the "baby boomer" generation reaches age 65.
Older Americans face a number of health concerns. For example, 133 million Americans have a chronic condition like heart disease, arthritis, diabetes, or cancer; every 35 minutes, an older adult dies from a fall; and one in five older adults is caught in the grips of depression, anxiety, or substance abuse.
With an aging population and rising health care costs, states are looking for ways to increase quality and access for older adults and those with disabilities. States are paving the way with new strategies to reform their long-term care systems and are seeking higher quality, cost efficiency and consumer satisfaction.
Use, Cost and Financing
The growing cost of long-term care has stimulated policymakers to develop new approaches to control public expenditures and also has altered market strategies for providing that care. Accurate estimates of use and cost and identification of factors that influence care decisions provide the basis for designing new public policies and new market strategies to meet demand with fewer resources.
Access and Quality of Care
Concern for controlling the cost of long-term care has increased interest in ways to reduce home care costs by targeting home care programs to those who need the most care.
Organization and Delivery of Care
A wide variety of alternative health care settings and living arrangements for older adults have emerged over the past decade. Among these are adult day health centers, respite care, residential care services, assisted living, continuing care retirement centers (CCRC's), and other life care settings.
Special Populations
Long-term care services are required by several different populations, and the needs of these populations vary. In addition to the elderly, many of the long-term care users are younger persons with physical disabilities; persons with developmental disabilities (DD); and persons with chronic diseases such as diabetes, emphysema, and AIDS.
According to the Administration on Aging, in 2008, 19.6% of persons 65+ were minorities–8.3% were African-Americans. Persons of Hispanic origin (who may be of any race) represented 6.8% of the older population. About 3.4% were Asian or Pacific Islander, and less than 1% were American Indian or Native Alaskan. In addition, 0.6% of persons 65+ identified themselves as being of two or more races. Minority populations are projected to increase from 5.7 million in 2000 (16.3% of the elderly population) to 8.0 million in 2010 (20.1% of the elderly) and then to 12.9 million in 2020 (23.6% of the elderly).
Between 2008 and 2030, the white population 65+ is projected to increase by 64% compared with 172% for older minorities, including Hispanics (224%), African-Americans (120%), American Indians, Eskimos, and Aleuts (153%), and Asians and Pacific Islanders (199%).
In 2008, 39.1% of noninstitutionalized older persons assessed their heath as excellent or very good (compared to 60.7% for all persons aged 18 and older). There was little difference between the sexes on this measure, but older African-Americans (25.1%), older American Indians/Alaska Natives (23.2%) and older Hispanics (28.0%) were less likely to rate their health as excellent or very good than were older Whites (41.8%) or older Asians (35.2%).
In 2008, 19.6% of persons 65+ were minorities–8.3% were African-Americans. Persons of Hispanic origin (who may be of any race) represented 6.8% of the older population. About 3.4% were Asian or Pacific Islander,** and less than 1% were American Indian or Native Alaskan. In addition, 0.6% of persons 65+ identified themselves as being of two or more races.
Only 7.3% of all the people who were minority race or of Hispanic ethnicity were 65+ in 2008 (8.7% of African-Americans, 5.7% of Hispanics, 9.6% of Asians and Pacific Islanders, 8.4% of American Indians and Native Alaskans), compared with 15.7% of non-Hispanic whites.
Other Sources
The Administration on Aging has an excellent web page that has a wide range of resources on LTC programs, information about the aging network throughout the country (particularly Area Agencies on Aging), and statistics on the elderly, people with disabilities and long-term care at http://www.aoa.gov/.
The U.S. Centers for Medicare and Medicaid Services (CMS) has a wealth of information about HCBS long-term care. Highlights include a collection of links to policies, state profiles and best practices, and data sources on Medicaid LTC services. Go to http://www.cms.hhs.gov/.
The Office of Disability, Aging and Long-Term Care Policy has an extensive collection of reports, research and data sets on its web site: http://aspe.hhs.gov/_/office_specific/daltcp.cfm.
The Community Living Exchange Collaborative and the Home and Community-Based Services Resource Network has a useful and extensive array of links, which are regularly updated. Research reports, state best practices, HCBS conference materials, federal grant reports and other LTC data are at http://www.hcbs.org/.
Other good sources of information include The Robert Wood Johnson Foundation at http://www.rwjf.org/; the Paraprofessional Health Care Institute at the Henry J. Kaiser Family Foundation at http://www.kff.org/; and the Family Caregiver Alliance at http://www.caregiver.org/.
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