Projections from the U.S. Census Bureau indicate a rapid and extensive increase in the elderly population. In 2030, when all the baby boomers will be 65 and older, nearly one in five U.S. residents is expected to be 65 and older. This age group is projected to increase to 88.5 million in 2050, more than doubling the number in 2008 (38.7 million). Similarly, the 85 and older population is expected to more than triple, from 5.4 million to 19 million between 2008 and 2050. The number of people 85 years or older, nearly half of whom need assistance with everyday activities, will grow even faster.
Regardless of age, older people are more likely to receive long-term care at home or through community services rather than in nursing homes. Because the need for long-term care is expected to grow substantially in the future, this will place an ever-increasing strain on already burdened public and private financial resources.
Who Needs Long-Term Care?
People may suddenly need long-term care after a crisis occurs, but for many, the need develops gradually. Older individuals are the primary users of long-term services, because functional disability increases with age. In 2008, about 9 million Americans over the age of 65 required LTC services. By 2020, that number will increase to 12 million. However, while most people who need long-term care are 65 or older, such services can be necessary at any age. Forty percent of people currently receiving long-term care are adults 18 to 64 years old.2
According to the U.S. Department of Health and Human Services, the risk of needing LTC is fairly high. About 70 percent of individuals over age 65 will require some type of long-term care services during their lifetimes. Over 40 percent will need care in a nursing home for some period.
Factors that influence the risk of needing long-term care services include the following:
Risk generally increases with age.
marital status—Single people are more likely to need care from a paid provider.
Women are more likely than men to need long-term care, because women tend to live longer.
Poor diet and exercise habits can increase the long-term care risk.
Health and family history—A family history of poor health may increase the risk of needing long-term care.
From a medical standpoint and in absolute medical terms, long-term care is chronic care with the aim of management, control of symptoms, and maintenance of function. Chronic care differs from traditional acute care, which is medical care aimed at treating physical problems directly in an attempt to permanently cure or control them.
Long-term care may result to treat debilitating injuries (from a fall or other accident, for example), pulmonary and cardiovascular conditions, psychiatric disorders, kidney and liver malfunction, and similar problems. Degenerative conditions such as Parkinson’s disease and rheumatoid arthritis can summon the need for long-term care services. Patients with prolonged illnesses—cancer or heart disease, for example—or who are recovering from a stroke or severe burns often require LTC.
Alzheimer’s disease and other forms of dementia also contribute to the need for LTC and the growing population of LTC recipients. These conditions are characterized by the loss of or decline in memory and other cognitive abilities. Severe enough, they will interfere with daily life and one’s ability to function independently. The number of Americans with Alzheimer’s and other dementias is increasing every year because of the solid growth in the older population. This number will continue to increase as the baby boom generation ages. The Alzheimer’s Association estimates that 10 million baby boomers will develop Alzheimer’s disease in their lifetimes.4
1.U.S. Census Bureau News, U.S. Department of Commerce, 2008 National Population Projections, http://www.census.gov/Press-Release/www/releases/archives/population/012496.html, February 23, 2009.
2.U.S. Department of Health and Human Services, http://www.longtermcare.gov/LTC/Main_Site/index.aspx, February 21, 2009.
3.National Clearinghouse for Long-Term Care Information, U.S. Department of Health and Human Services.
