Elderly Population to Double by 2050, Will Need Long-Term Care Services

The National Center for Health Statistics (NCHS) has released an overview report regarding long-term care services in the United States. The study, which is the first of its kind, was conducted by the Centers for Disease Control and NCHS, and surveyed adult day services centers, residential care communities, home health agencies, hospices, and nursing homes across the country (collectively, “sector(s)”). According to the NCHS, the report, which is intended to act as a resource for policy makers, providers, researchers, and advocates, provides figures on supply, organizational characteristics, staffing, and services offered by long-term care services providers; and demographic, health, and functional makeup of long-term care services users.

Long-Term Care Services

U.S., state, and local communities provide long-term care services that assist the elderly, defined as individuals above the age of 65, and other adults who experience less autonomy for self-care through chronic illness, injury, disability, or other health conditions. Such services include: (1) assistance with daily living activities, such as bathing, using the restroom, and dressing; (2) instrumental daily living activities, such as housework and medication administration; and (3) health maintenance tasks that help people maintain or improve their “optimal level of physical functioning and quality of life.”

Raw Numbers

The study revealed that in 2012, approximately 8 million people in the United States received long-term care services from approximately 58,500 providers. The number of providers was broken down further by sector type: (a) assisted living and similar residential care communities accounted for 22,200 of the providers; (b) 15,700 providers were nursing homes; (c) 12,200 were home health agencies; (d) 4,800 were adult day services centers; and (e) 3,700 were hospices. In addition, in 2012, there were 1,383,700 nursing home residents, 713,300 residential care community residents, and 273,300 adult day services center participants. In 2011, according to the report, there were 4,742,500 home health agency patients, and 1,244,500 hospice patients.


According to the NCHS, the amount of money expended annually on long-term care services is estimated to be between $210.9 billion and $306 billion, and is an increasing concern for older adults, people with disabilities, and families. Further, the issue of rising costs is becoming a greater challenge for federal and state governments. Study results demonstrate that Medicaid finances the most long-term care services costs, followed by Medicare and out-of-pocket payments. However, financing sources may vary depending on the type of long-term health care provided. For instance, in assisted living, most residents pay out-of-pocket, but may receive a small percentage of Medicaid assistance. Conversely, Medicaid is the largest payer of long-term nursing home care, while Medicare pays for hospice costs and a main portion of “short-stay, post-acute care in skilled nursing facilities.”

User Rates and Demographics

In 2000, there were 15 million people who used nursing facilities, alternative residential care, or home care services. However, the number of users is expected to increase to 27 million in 2050. The study discussed the aging baby boomer population as a cause of the anticipated user increase in 2050. In addition, the NCHS noted that the elderly population, those individuals who are 65 years or older, is expected to rise from 40.2 million in 2010 to 88.5 million in 2050, demonstrating an increasing need for long-term care services in the upcoming decades.

Rates of long-term care services use were found to have ranged by sector and state. Whereas nursing homes showed the highest daily-use rate, followed by residential care, adult day services centers demonstrated the lowest use-rate overall. However, it was also found that nursing home daily-use rates were similar or lower than residential care daily-use rates in “about a dozen states.” Further, long-term care services use rates in individual states ranged from less than one participant per 1,000 in West Virginia, to 12 participants per 1,000 in New Jersey.

Adult day services center and home health users were demonstrably younger than other sector users. In addition, users were most racially and ethnically diverse in adult day services centers, in which it was found that: 20.1 percent were Hispanic and 16.7 percent were non-Hispanic black. Nursing home users were more likely than other sector users to have Alzheimer’s disease, other dementias, and depression, and required more assistance overall with bathing, dressing, toileting, and eating.

Provider Sectors

While most of the providers among the sectors were for-profit, adult day services centers were typically nonprofit. However, the number of users served varied by sector. Nursing homes tended to serve more than twice as many users per day than adult day services centers or residential care communities. Further, home health agencies, on average, served more users yearly than hospice. Results in most regions showed that nursing home beds significantly outnumbered residential care beds, except the West region, where the number of beds were comparable in nursing homes and residential care. The NCHS stated that the regional differences in bed numbers demonstrate geographic disparities in access to long-term care services.