Demographic trends also have implications for the sites where care is needed. A growing percentage of older adults prefer to receive long-term care services in home and community-based settings, increasing the demand for care in these alternative settings. The delivery of long-term care will become especially complex as varying options for housing for older adults develop leading to demands for services in multiple sites.

In addition, sites of care for special populations will be affected by the aging trend. For example, in 2006, 3.7 percent of inmates in state and federal prisons and local jails were over age 55. By 2030 one-third of prisoners will be over the age of 55 (Enders et al., 2005). Also, in the next decade the number of veterans over the age of 85 enrolled in the VHA is expected to increase by 700 percent, and the utilization of long-term care services is expected to increase by 20 to 25 percent, with special need for community-based services (Kinosian et al., 2007). As Persian Gulf War-era veterans and veterans currently returning from Iraq and Afghanistan get older, their mental and physical impairments may persist, increasing the need for the care of older adults within the VHA system. The VHA has a remarkable history regarding the availability of a variety of geriatric care programs, including nursing home care, home care, palliative care, and acute care services for older adults; however, an influx of older veterans will surely strain this well-developed system.

Finally, members of the future older adult population may bring a different stock of health capital to their older years than the current cohort of older adults has done. Disability rates among older adults have been declining in recent decades (Freedman et al., 2002; Manton et al., 1997, 2006), in part due to the educational gains among older adults discussed