Facts on Long-Term Care

• Who needs long-term care?
• Who pays for long-term care?
• What is the role of Medicaid in long-term care?

What is long-term care and who needs it?

• About 10 million people need long-term care. Although the risk of needing long-term care increases with age—the elderly are about 10 times more likely to need care—nearly half are under age 65.
• People with long-term care needs are older, more likely to live in poverty, and are in worse health than those not needing long-term care. Women are more likely to need care than men.
• The majority—83 percent—of people with long-term care needs live at home. Three-quarters of people living at home rely exclusively on care assistance from family members, friends, or volunteers. Only 8 percent of adults receiving care at home rely exclusively on care provided by paid professionals.
• Recent trends, including the growing awareness that it is important for people to have control over their care, increased availability of settings other than nursing homes, and technological advances that enable people to better manage at home are helping improve the lives of people with long-term care needs. Even so, people with long-term care continue to face barriers to receiving care—one in five community-dwelling adults with long-term care needs do not receive enough assistance.
  

Who pays for long-term care?

• Unlike medical care, long-term care is not widely insured. As a result, the financial burden falls upon people with the misfortune to need long-term care.
• Medicaid – a safety net for many individuals with long-term care needs and limited resources – is the largest payer of long-term care services, financing 44 percent of national long-term care spending in 2001.
• People with long-term care needs and their families spent $38.9 billion out-of-pocket – 23 percent of national long-term care spending – for long-term care in 2001.
• Despite the preference of people with long-term care needs for home and community-based care, institutional care accounted for the majority of both national – 65 percent – and Medicaid – 71 percent – spending for long-term care in 2001.

What is the role of Medicaid in long-term care?

• Although the elderly, blind, and disabled only make up about one-quarter of Medicaid beneficiaries, spending for them accounts for 71 percent of Medicaid service dollars.
• Access to Medicaid long-term care services varies across the country in part because states have the flexibility to choose the amount of resources devoted to long-term care. For instance, the proportion of Medicaid long-term care spending devoted to home and community-based care ranges from 55 percent in New Mexico and Vermont to 6 percent in the District of Columbia.
• The largest share of Medicaid spending for home and community-based care – 65 percent – is for home and community-based waiver programs.
  • Although over half of waiver program participants in 1999 were frail elderly or the elderly with disabilities, this group represented only 21 percent of spending for all waiver program participants.
  • People with mental retardation and developmental disabilities accounted for 38 percent of participants, but 75 percent of waiver program expenditures.
• State Medicaid programs have been at the forefront of expanding options for community-based care. In 2002, some 41 state Medicaid programs provided coverage for services in Assisted Living Facilities for just over 100,000 residents compared with two years earlier, when 29 states were providing these services for about 60,000 people.