US: Long-Term Care – Health Systems Facts

Population, Mid-Year 2019: 329,065,000
Projected Population Mid-Year 2030: 349,642,000
Percentage of Population Under Age 25 Years, Mid-Year 2019: 32%
Percentage of Population 65 Years Or Over, Mid-Year 2019: 16%

Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019: Data Booklet (ST/ESA/SER.A/424).
https://population.un.org/wpp/Publications/Files/WPP2019_DataBooklet.pdf
https://population.un.org/wpp/

Percent of Adults Aged 65 Years and Over Reporting To Be In Good Or Very Good Health (2015): 78.1%
People With Dementia Per 1,000 Population (2017): 11.6
Projected Number of People With Dementia Per 1,000 Population in 2037: 18.6
Long-Term Care Workers Per 100 People Aged 65 And Over (2015): 12
Long-Term Care Beds In Institutions and Hospitals Per 1,000 Population Aged 65 And Over (2015): 36.8
Long-Term Care Expenditure (Health and Social Components) By Government and Compulsory Insurance Schemes, as a Share of GDP (%) (2015): 0.5%

Source: OECD (2017), Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris. http://dx.doi.org/10.1787/health_glance-2017-en
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Formal Long-Term Care Workers At Home (FTE) (2017): 614,342
Formal Long-Term Care Workers At Home (FTE) Per 100 Population Aged 65 Years and Older (2017): 1.2
Formal Long-Term Care Workers In Institutions (FTE) (2017): 952,658
Formal Long-Term Care Workers In Institutions (FTE) Per 100 Population Aged 65 Years and Older (2017): 1.9
Long-Term Care Recipients In Institutions Other Than Hospitals (2016): 1,169,898
Long-Term Care Recipients At Home (2016): 3,705,808

Source: Organization for Economic Cooperation and Development. OECD.Stat. Last accessed Nov. 4, 2019.
https://stats.oecd.org/Index.aspx?ThemeTreeId=9#

“Currently, much of LTSS is unpaid (or informal) care provided by family members and friends.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.
https://www.cbo.gov/publication/55150

“Despite representing a small proportion of total Medicaid enrollees (5.9 percent in 2013), LTSS users represent a substantial proportion of Medicaid benefit spending (41.8 percent, or $167.7 billion in 2013). This includes spending on both institutional and non-institutional services (MACPAC, 2016b).

“As evident in expenditure data, LTSS for these populations can be very costly. Older adults and people with disabilities who rely on Medicaid to finance their care often “spend down” to Medicaid eligibility, meaning that they have exhausted their personal savings by paying out-of-pocket for care. Spending down is common among people using LTSS, particularly among those who require nursing home care. From 1996-1998 to 2008, nearly 10 percent of adults aged 50 and older spent down to Medicaid eligibility; more than half of these beneficiaries utilized personal care services, nursing home services, or both (Wiener, Anderson, Khatutsky, Kaganova & O’Keeffe, 2013).”

Source: Nga T. Thach, BS, and Joshua M. Wiener, PhD. An Overview of Long-Term Services and Supports and Medicaid: Final Report. RTI International for the US Dept. of Health and Human Services. May 2018.
https://aspe.hhs.gov/basic-report/overview-long-term-services-and-supports-and-medicaid-final-report

“Medicaid eligibility depends primarily on income and assets. In most states, people who are eligible for SSI are automatically eligible for Medicaid. SSI income levels are about three quarters of the federal poverty level. In general, aged, blind, and disabled beneficiaries may not have more than $2,000 in countable assets for individuals and $3,000 for couples, a level that has not changed since 1989 (Colello, 2017).”