About one in five elderly Americans needs help with common everyday activities. The U.S. long-term care system has developed in a piecemeal manner, resulting in inefficiency and problems with access, quality, and financing. Public funding of long-term care is directed heavily toward institutionalization, especially nursing home care, which accounts for about 12 percent of public health care spending. Clinical practice guidelines focus on what works best in treating specific medical conditions, including many conditions prevalent in the long-term care population. Research Projects Settings for Care Nursing home care.
Nursing homes account for the greatest share of public and private spending on long-term care.
Care at home. Public programs in several States are studying alternative sites for long-term care. Informal care by family and friends or more formal home care delivery systems are alternatives to institutionalization that enable the elderly and disabled to remain at home, where most prefer to be. Further studies will examine how to contain costs and improve targeting of benefits as public programs extend coverage to include alternative care settings. Nearly one out of four caregivers needs to alter work hours, take unpaid leave, or even quit the work force to care for a family member.