Publications on Long-Term Care

This review of existing estimates confirms an upward trend in the number of facilities, beds, and residents in residential care alternatives to nursing homes, often collectively referred to as "assisted living." Estimates vary substantially, however, depending on the methodology and the type of data used. Key sources of differences are population included (i.e. aged, all ages); definition used to identify assisted living, and for population-based surveys that include both community and facility settings, survey-specific definitions of "facilities" and whether settings identified as assisted living are limited to those meeting the survey-specific facility definition. Greater disagreement exists with respect to trends in the number of nursing homes and users, even between estimates from the same data source.

Older adults with disabilities increasingly are entering residential care alternatives to nursing homes. This study used Medicare Current Beneficiary Survey data for 1992-1998 to compare the characteristics of nursing home and alternative facilities and residents. The proportion of elders in alternative residential care settings increased from 0.8% in 1992 to 1.3% in 1998, and characteristics of facilities and their residents suggest that alternative settings are caring for a more disabled clientele over time. Blacks, long under-represented in nursing homes, increased as a proportion of nursing home residents, but growth in alternative settings was disproportionately among whites and others. Further research is needed to understand the implications of these trends.

As the nation grows older, it's time to find a better way to care for those who need help as they age. The financial, emotional, and physical costs of providing long-term care often overwhelm families. Unpaid family members supply most of it, struggling to balance these duties with work and other responsibilities. A year's stay in a nursing home averaged $78,000 in 2007, and public assistance is not generally available until residents have exhausted almost all of their financial resources. Policymakers should encourage Americans to prepare for their own long-term care needs or create a larger role for government financing

A longitudinal survey of parents of enrollees in the Los Angeles Healthy Kids Program has found that the program had significant positive impacts on children’s health and access to care. Children experienced improvements in access to and use of ambulatory, specialty and dental care; reduced unmet need; increased parent confidence in getting care and satisfaction with quality; and reduced financial worries. Most important, children’s health status improved, as perceived by parents and according to several measures. Healthy Kids covers uninsured children below 300 percent of poverty who are ineligible for Medicaid or SCHIP, and primarily serves poor, undocumented Latino children.

Panelists discussed the needs of the frail elderly and homeless populations, the missing pieces in housing options, design solutions that can improve accommodations, and ways to better a delivery system that is highly fragmented across jurisdictions and target populations.