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Long-Term Care for the Elderly

Long-Term Care for the Elderly Book Cover

"This book is a primer that provides an overview of long-term care, including what it is, why it is an important policy concern, and the key issues that policymakers, providers, consumers, and other stakeholders are struggling with today and will confront in the future."

Today, 6 million people age 65 and older need long-term care. By 2040, once the entire baby boomer cohort has grown elderly, that number could be 21 million.

Every year Americans spend over 182 billion public and private dollars on services and supports for chronically disabled elders. This is projected to nearly double by 2030 to $341 billion and to grow to $684 billion once the last baby boomers have turned 85. And these estimates don’t include the $375 billion in unpaid care family and friends provide—including foregone wages that would have helped support Medicare and Medicaid.

Still, most people have not saved enough to cover long-term care, and only a minority have long-term care insurance. At the same time, the economic downturn has depressed the 401(k)s, IRAs, and housing equity many were counting on to fund retirement. Further, Medicare and Medicaid are being targeted in the federal budget war, and shrinking state budgets have compelled 25 states and the District of Columbia to cut home care services and nursing facility payments.

In this environment, policymakers, providers, researchers, and consumers themselves strive to fashion a comprehensive long-term care system out of our present patchwork of federal, state, local, and private organizations. Though the Affordable Care Act makes home and community-based services available to more people and includes Community Living Assistance Services and Supports (CLASS), a voluntary long-term care insurance program, the vision of an affordable, consumer-directed, community-based, integrated delivery system staffed by a quality workforce is far from assured.

Long-Term Care for the Elderly sets forth an evidence-based research and policy agenda to identify the financing and delivery approaches that optimize quality of care, quality of life, and cost outcomes. Examining the Affordable Care Act, Robyn Stone evaluates initiatives such as the Program of All Inclusive Care for the Elderly (PACE), EverCare, the Home-Based Primary Care Program (HBCP), the Federal Coordinated Health Care Office, and the Center for Medicare and Medicaid Innovation. Also discussed are significant policy interventions to expand the supply of caregiving professionals; encourage workforce education and training; and make long-term care jobs more attractive. With Stone’s guidance, the vision of a long-term care system for 2030 could become a reality.


Long-Term Care for the Elderly, by Robyn Stone, is available from the Urban Institute Press (ISBN 978-0-87766-770-4, paperback, 172 pages, $26.50)

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