fact that the population of individuals who need LTC services is large and growing. The associated costs of these services are great, and they are increasing as well. Thus, both U.S. policymakers and families are having to consider issues of LTC policy, as well as questions related to the utilization of chronic care services and expenditures for these services (Estes et al., 1993).


Typically, LTC is associated with the elderly, although many older persons never require such care. The percentage of people over 65 years of age is growing rapidly in the United States. In 1990, they represented 13 percent of the total population, but by 2020 they will account for 18 percent. The proportion of those over the age of 85 (the “oldest old”) is growing most rapidly of all. The number of people over age 85 is expected to grow from 3 million in 1990 to 8.1 million in 2030 and to continue to rise to over 15 million by 2050 (U.S. Senate, Special Committee on Aging, 1991).

In 1991, although only 2.7 percent (766,000) of elders between the ages of 65 and 84 lived in nursing facilities, nearly 18 percent (552,000) of elders 85 and older lived in nursing facilities. Less than 1 percent (216,020) of the elderly (65 and older) resided in B&C homes (Sirrocco, 1994). In the same year, it was estimated that 17 percent (5.3 million) of elders 65 and older living in their communities needed some assistance with an IADL or an ADL. Just over one million persons in this group needed assistance with three or more ADLs (AARP, 1994b).

Elderly residents of LTC facilities (nursing facilities, B&C homes, and other group residential homes) are the designated constituency of the ombudsman. An effective ombudsman strategy must be tailored to the characteristics of the group on whose behalf the ombudsman advocates.

Nursing Facility Residents

Nursing facility residents typically are female, white, and very old (in their eighties). These residents tend to suffer from multiple chronic diseases and functional impairments (AHCA, 1994). More than half enter the nursing facility from an acute-care hospital (Lewis et al., 1985). Under such circumstances, illness, time pressures, and constraints on available nursing facility beds means that they or their agents may not have the opportunity to select a nursing facility carefully. Too often, nursing facility residents have not chosen to enter a particular nursing facility or any facility at all (Coulton et al., 1989; Reinardy, 1992; Thuras and Kane, in press).

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