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More than 10 million Americans require long-term care supports and services. Yet the system for delivering and paying for this assistance is deeply flawed. While most of the frail elderly and those with disabilities prefer assistance at home, many must live in nursing homes to receive Medicaid benefits, care coordination for those with multiple chronic illnesses is poor, and the system for financing care impoverishes many middle-income families. The national health reform debate allows policymakers to reconsider long-term care as well. This paper assesses proposals to restructure the delivery and financing of long-term care services.
As the population ages, demand for long-term care supports and services is growing. Today, 10 million frail elderly and adults with disabilities require such care. Nearly 80 percent is provided at home, much of it by family members and friends. In 2007, the cost of paid services was estimated at $230 billion, while the economic value of informal care may have approached $375 billion. As the Baby Boomers age, both demand for this care and its costs are expected to increase dramatically.
Today, most paid care is funded by government, through Medicaid and other programs. Less than 10 percent is financed by private long-term care insurance, and much of the rest is paid for out-of-pocket by families themselves.
Despite the considerable resources devoted to long-term services, many continue to receive poor quality care. As a result, policymakers are pursuing major changes in the way assistance is both delivered and financed.
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