As the twenty-first century pushes forward, long-term care is an issue of major importance in American society. The impending aging of the Baby Boom augurs an enormous increase in the demand for long-term care services, even as other special populations-persons with developmental disabilities, the younger disabled, and persons with chronic diseases such as AIDS, emphysema, and diabetes will have on going service needs.
Assuming there is no change in age-specific risks of disability, it is projected that the nursing home population will double by 2030, and triple by 2050 (Freundich, 2014).There will be a large absolute increase in the number of older Americans needing long-term care in the decades ahead.
In 2010, 40 million Americans were age 65 or older. By 2050 that number is expected to jump to 88 million. Among these older citizens, only three in 10 will never receive long-term care services. The majority will get such care—though not necessarily in a nursing home or assisted living facility (Freundich, 2014). Long term care refers to a continuum of medical and social services de- signed to support the needs of people living with chronic health problems that affect their ability to perform everyday activities. Long term care services include traditional medical services, social services, and housing (AARP, 2017). The current definition of long-term care also includes services provided in the home by family members or paid caregivers. Adult day-care is also considered a form of long-term care (Freundich, 2014).
The cost will be huge. In addition to the increase in the number of people over 65, the number of people 85 and older is also predicted to jump dramatically. This is the “frail elderly” group most likely to need long-term care. In 2010 there were 5.5 million of these older people, but by 2050 there will likely be 19 million (Freundich, 2014).
With these demographic shifts we are faced with two major issues. How will the nation pay for the care? How will the care be given and in what type of setting?
The total U.S. long-term care spending is substantial. That total reached $210.9 billion in 2011, about 1.4 percent of the gross domestic product. But even if it doubles, that U.S. spending is predicted to be in line with long-term care costs in other developed nations, such as the United Kingdom, Germany and Japan, or between 2.5 percent and 3 percent of gross domestic product (Freundich, 2014).
In 1965, Medicare and Medicaid became the first public health insurance programs in the U.S. when they were signed into law by President Lyndon Johnson. Medicare was intended for individuals over 65 years old and those with end-stage renal disease, or kidney failure. Medicaid was intended to cover low-income individuals. But as of fiscal year 2014, long-term care services accounted for about a third of Medicaid spending, or $152 billion (McPhillips, 2016).
In the U.S. the government pays most of the cost for long-term care...