Long-Term Care: Who Gets It, Who Provides It, Who Pays, And How Much?

TLDR

Long‑term care in the United States serves 10.9 million community residents—half nonelderly—and 1.8 million nursing home residents, most of whom are elderly, with 92 % of community residents receiving unpaid assistance and paid services largely funded by Medicaid and Medicare. Nursing‑home residents cost five times more per person and drive national expenditures threefold higher than community residents, indicating that reallocating spending across settings could yield substantial savings or enable service expansion.

Abstract

Long-term care in the United States is needed by 10.9 million community residents, half of them nonelderly, and 1.8 million nursing home residents, predominantly elderly. Ninety-two percent of community residents receive unpaid help, while 13 percent receive paid help. Paid community-based long-term care services are primarily funded by Medicaid or Medicare, while nursing home stays are primarily paid for by Medicaid plus out-of-pocket copayments. Per person expenditures are five times as high, and national expenditures three times as high, for nursing home residents compared to community residents. This suggests that a redistribution of spending across care settings might produce substantial savings or permit service expansions.