reported using only informal care dropped from 51 percent in 1984 to 40 percent in 1994, while the proportion who reported using institutional care increased from approximately 26 percent to 30 percent during the same period. Elderly people using long-term care in 1994 were older than in 1984 (mean age up from 79.2 to 80.5 years) and more likely to be women, to be cognitively impaired, and to have a greater number of limitations with activities of daily living than those using long-term care in 1984.

The aging of the U.S. population and the projected growth of the oldest age bracket (85 years and older) will have a major effect on the demand for and supply of long-term care services and on the resources needed to provide those services. The implications of these changes are enormous as evidenced by the widespread public and policy focus on the elderly population in discussions of such care. The population aged 85 years and older is the fastest-growing age group in the United States, and it is the most rapidly growing age group among the elderly population (65 years and older). Most of the increase in demand for long-term care services is expected to occur when the “baby boom” generation enters the elderly ages. The first of this generation will reach age 65 in the year 2011 and the last will do so around 2030.

The older population today, on average, is in better health than its counterpart of a few decades back. Recent studies have reported declines in the prevalence of chronic disability among elderly people. Although their overall health has improved, many elderly persons are dependent and frail with one or more chronic conditions and the consequent disabling conditions that increase with age. Also, with life expectancies continuing to rise for most groups, a larger proportion of people lives to age 90 and beyond. Hence the absolute number of years that people with disabling conditions require long-term care is likely to grow substantially, even if significant declines in disability rates are assumed.

Although long-term care creates the image of an elderly person in a nursing home, it is not limited to the needs of older persons or to care provided in nursing homes. Needs can occur at any age. The number of children and adolescents with severe long-term health conditions, although small in comparison to the elderly, has grown substantially over the past two decades and will continue to do so. Advances in medicine and surgical technologies now allow many children who would have died in previous eras to survive to adulthood, although often with psychological and physical impairments. Continuing improvements in medical care that allow more children and non-elderly adults with serious congenital or chronic disorders and injuries to survive for longer periods also are likely to contribute to a growing demand for long-term care services.

Most formal long-term care service is provided through organized



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