Estimates from the new National Health and Aging Trends Study indicate that nearly half of Medicare enrollees age 65 or older had difficulty or received help in the last month with daily activities in 2011. Of those receiving help, 10% were in a nursing homes, 15% were in alternative supportive care settings, and the rest lived in the community (75%). Persons with low incomes were a disproportionate share of those receiving help with at least 3 self-care or mobility activities in settings other than nursing homes. Informal care, primarily from family members, was substantial164 hours monthly for older persons receiving help in the community and 50 for those in alternative supportive settings. Adverse consequences related to unmet need affected nearly a third of persons with difficulty or help in all settings other than nursing homes and nearly twice that proportion of persons receiving paid help in the community. Results suggest that policies to improve services and supports and reduce unmet need could benefit both older adults and those who care for them.