Long-Term Care for the Elderly:

Issues of Need, Access, and Cost

HRD-89-4: Published: Nov 28, 1988. Publicly Released: Feb 6, 1989.

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In response to a congressional request, GAO provided information on: (1) the estimated number of elderly persons needing long-term care now and in the next century; (2) the types of available long-term care services and access to them; and (3) public and private expenditures to finance and deliver long-term care.

GAO found that: (1) in 1985, of the 28.6 million elderly, an estimated 6.2 million to 6.5 million depended on others for help with their daily activities; (2) about 20 percent of the dependent elderly lived in nursing homes; (3) the dependent elderly population could increase to about 14.3 million by 2020; (4) nearly all of the dependent elderly living outside of nursing homes received all or some of their care informally from family and friends; (5) because the proportion of women working outside the home decreases the number of informal caregivers, a higher proportion of the elderly will need to purchase formal care, but may have difficulty affording it; (6) about 40 percent of the elderly with one or more activity dependencies still had unmet needs; (7) some dependent elderly needing formal care have to wait to obtain such care because of high nursing home occupancy rates and a limited supply of vacancies; and (8) individuals likely to wait the longest were those requiring extra care or those covered by Medicaid. GAO also found that: (1) public programs either provided only limited coverage or did not cover long-term care needs; (2) Medicaid funded about 50 percent of the nation's nursing home care, but only 12 percent of home health care; (3) in 1985, public and private expenditures for nursing home care totalled about $36 billion, while expenditures for home health care totalled only $9 billion; (4) Medicaid covered about $17.2 billion of public expenditures for nursing home care, while Medicare covered about $2.3 billion of home health care expenditures; (5) families' out-of-pocket expenses totalled about $20 billion; and (6) alternative delivery demonstration projects have shown that the substitution of home- and community-based care for nursing home care would increase both the quality of life and health care costs.

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