Long-term care is a term used to describe assistance needed by and provided to client in a variety of settings over an extended period of time. It includes services and supports to help clients maintain and manage their health or personal care needs. With life expectancy increasing almost every in the United States (81.1 as of 2012, CDC), there will be a higher percentage of the population on long term care. Medicare and Medicaid are the two types of government assistance used to cover long term care cost. However, there are many private insurance companies in the U.S. that provide coverage for long term care. Genworth, Transamerica and Alive and Well are among those private companies. Clients purchase their policies before reaching age of retirement. Most long-term care is non-skilled personal care assistance, such as help performing everyday Activities of Daily Living (ADLs), which are:
  • Bathing,
  • Dressing (upper and lower body),
  • toileting,
  • Transferring (to or from bed, chair or toilet),
  • Caring for incontinence, and
  • Eating,
  • Indoor and Outdoor mobility,
  • Ability to: use the phone, shopping, meal preparation, laundry, transportation, money management.

In 2009, about 9 million Americans over the age of 65 will need long-term care services. By 2020, that number will increase to 12 million. In 2005, there were 37 million American of the age 65 and older, this number is expected t be as high as 81 million by 2050. These are the latest statistics on long term solution predictions. In 2002, 180 billion dollars were on long term care, 37.2 billion was paid by families for their loved ones in need of long term care. It is estimated that by 2050 the number of people using paid long term care services can be close to 27 million. While most people who need long-term care are age 65 or older, a person can need long-term care services at any age. Forty (40) percent of people currently receiving long-term care are adults 18 to 64 years old. 9% of people who buy their own long term care insurance drop their policies with the first year.


The need for long-term care help might be due to acute, chronic or terminal condition, disability, illness, injury or the infirmity of old age, . Estimates by experts are that at least 60% of all individuals will need extended help in one or more of the areas above during their lifetime. The need for long-term care may only last for a few weeks or months or it may go on for years. It all depends on the underlying reasons for needing care.
Temporary long term care (need for care for only weeks or months)
  • Rehabilitation from a hospital stay
  • Recovery from illness
  • Recovery from injury
  • Recovery from surgery
  • Terminal medical condition
Ongoing long term care (need for care for many months or years)
  • Chronic medical conditions
  • Chronic severe pain
  • Permanent disabilities
  • Dementia
  • Ongoing need for help with activities of daily living
  • Need for supervision
  • Cognitive decline
Long-term care services may be provided in any of the following settings:
  • In the home of the recipient
  • In the home of a family member or friend of the recipient
  • At an adult day services location
  • In an assisted living facility or board-and-care home
  • In a hospice facility
  • In a nursing home

The chart below indicates that as much as 22% of the population over age 65 could be receiving long-term care services. It should be noted however, that much of this care can be provided by an informal caregiver. That still may not be an easy task. About 61% of informal caregivers report providing at least 20 hours or more a week of care, and 27% provide more than 50 hours a week of care. At least 7% or more of the aging population is receiving care from formal caregivers in assisted living or in a nursing home. With an enormous number of baby boomers being retired right now, these numbers will significantly be changed in the next couple of years. It was predicted that payment in long term care can be as high as $346 by 2040. In addition, with the current proliferation of non-medical, paid home care services, probably a high percentage of those receiving care in the home are paying for the fulltime or occasional services of a formal caregiver.

Estimating The Number And Percentage Of Elderly Receiving Long Term Care
Living arrangement for care recipients over age 65
Estimated number of long term care recipients over 65 (in millions)
% of total care recipients over age 65
% of the total population over age 65



Age 65 And Older Population
(2005 Estimate: Census Bureau)

Medicare, Medicaid and private long term care insurance companies normally assesses the patients and their homes to determine what type of assistance that they need. They usually send a nurse to the patient's home to conduct the assessment. They require a detailed patient's medical history. They have several other areas of the assessment sheet to assess the patient's cognitive function. The nurse assesses the patient's level of ADL's. The nurses are required to propose a plan of care, and the insurance based their decisions on the nurse proposal and the patient's assessment.

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Web Resource:

America's Health Insurance Plans
America's Health Insurance Plans (AHIP) website has brochures and other information on long-term care insurance. You can also get this information by calling AHIP at 1-800-424-3410.

American Association of Homes and Services for the Aging
The American Association of Homes and Services for the Aging (AAHSA) offers a series of free "Consumer Tips" for finding home and community based services, assisted living facilities, nursing homes, and continuing care retirement communities. You can also use the AAHSA website to find a range of long-term care housing and services by state or ZIP Code. More information can be obtained by calling 1-202-783-2242.

American Association of Retired Persons
The American Association of Retired Persons (AARP) has brochures and other information on long-term care and housing options for older people. You can get this information by looking at AARP�s website or by calling AARP at 1-888-687-2277.

American Health Care Association
The American Health Care Association (AHCA) has information to help you understand the different types of long-term care, how to select the level of long-term care that is right for you, and what you should look for in a long-term care insurance policy. You can get this information by looking at the AHCA's website or by calling AHCA at 1-800-628-8140.

The Healthfinder website, run by the U.S. Department of Health and Human Services, offers reliable consumer information from the Federal Government and its many partners. The site contains information about finding government and nonprofit health and human services on the Internet.

Long-Term Care Ombudsman
Long-Term Care Ombudsman is an independent advocate (supporter) for nursing home and assisted living facility residents that works to solve problems between residents and nursing homes or assisted living facilities. Ombudsman can give you information about how to find a facility and what to do to get quality care. To find out more information, you can look at the National Long-Term Care Ombudsman Resource Center website or call 1-202-332-2275.

State Health Insurance Counseling and Assistance Programs (SHIPS)
State Health Insurance Programs provide links to SHIP counselors that can answer your questions and help you understand your health care choices, choose a Medicare plan and/or additional health insurance, and help you understand your rights and protections.
Please select your state/territory from the drop-down list to view your state's SHIP website.

Related Terminology

Medicare, Medicaid