Nearly half of U.S. adults over age 65 (18 million) have difficulty or receive help with daily activities, according to data from the National Health and Aging Trends Study. Nearly all who receive help in settings other than nursing homes including assisted living and other supportive care settings receive informal care, and about 30% receive some paid care. Those receiving assistance from paid, non-staff caregivers have especially high rate of adverse consequences related to unmet needs (nearly 60%). Nearly 3 million older adults live in settings other than nursing homes and receive help with three or more self-care or mobility activities, exceeding the level of need typically associated with eligibility for benefits under private insurance or public programs. A disproportionate share of this group is in the lowest income quartile. Although publicly and privately paid care continues to be an important source of assistance to older adults with extensive needs, the higher level of adverse consequences linked to unmet need among those receiving paid care warrants further investigation, particularly because of continuing shifts of long-term care from nursing homes to other settings.
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