Informal caregivingunpaid help primarily provided by spouses and childrenremains the most common source of long-term care for older persons with disability in the U.S. This report updates previously published trends in formal and informal care from the 1984 and 1994 National Long Term Care Survey. The earlier study found a significant decline in the number of family caregivers, accompanied by a significant increase in use of formal care from paid workers, especially in combination with informal care. Data for 1999 indicate that, contrary to the previous trend, formal care use fell dramatically between 1994 and 1999, while the rate at which spouses and children provided care remained stable. Increased reliance on only assistive devices or informal care accompanied the decline in formal care. In general, the greatest increase in use of assistive devices without help occurred among older persons with fewer informal resources and lower levels of disability.