FIGURE 2.1 Age distribution of individuals in community settings in need of long-term care. NOTE: Children are those under 18 years old, working-age adults are those 18 to 64 years old, and the elderly are those 65 years and older. SOURCE: GAO 1995c.

half of the total population of home and community-based LTC users are elderly individuals (ages 65 and older) (see Figure 2.1). Most of the rest (two-fifths) are working-age adults (people ages 18 to 64); children under age 18 represent a very small segment of the total population of these LTC users (GAO, 1995c).

Just as the ages of the users of LTC vary greatly, so does the extent of their disabilities (IOM, 1991). Importantly, the presence of a disability does not automatically mean that a person requires outside assistance; an estimated 40.1 million Americans are living in the community with one or more disabilities because of a physical or mental health condition (Eustis et al., 1995). Some users, however, require 24-hour care that involves assistance with fundamental activities of daily living (ADLs) such as getting in and out of bed and administering complex medical procedures; others need only occasional help with such tasks as cleaning or going grocery shopping. Although all kinds of users can be found in both home and residential care settings, on the aggregate level some notable differences exist between the users in these two types of settings.