sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that four out of every ten people who reach age 65 will enter a nursing home at some point in their lives. Roughly 10 percent of the people who enter a nursing home will stay there five years or more. Based on projections of needs in long-term care (LTC), the US 1980s demonstrations of versions of Nursing Homes Without Walls (Senator Lombardi of New York) for elders in the US were popular, but limited: On LOK, PACE, Channeling, Section 222 Homemaker, ACCESS Medicaid-Medicare, and new Social Day Care. The major argument for the new services was cost savings based upon reduction of institutionalization. The demonstrations were significant in developing and integrating personal care, transportation, homemaking/meals, nursing/medical, emotional support, help with finances, and informal caregiving. Weasart concluded that: "Increased life satisfaction appears to be relatively consistent benefit of community care" and that a "prospective budgeting model" of home and community-based long-term care (LTC) used "break-even costs" to prevent institutional care. Long-term care costs A recent analysis indicates that Americans spent $219.9 billion on long-term care services for the elderly in 2012. Nursing home spending accounts for the majority of long-term care expenditures, but the proportion of home and community based care expenditures has increased over the past 25 years. The US federal-state-local government systems have supported the creation of modernized health care options, though new intergovernmental barriers continue to exist. The Medicaid and Medicare health care systems in the US are relatively young, celebrating 50 years in 2015. According to the Health Care Financing Review (Fall 2000), its history includes a 1967 expansion of to ensure primary and preventive services to Medicaid-eligible children (EPSDT), the use home and community-based Medicaid waivers (then HCBS services), Clinton administration health care demonstrations (under 1115 waiver authority), the new era of SCHIP to cover uninsured children and families, coverage for the HIV/AIDS population groups, and attention to ethnic and racial-based service delivery (e.g., beneficiaries). Later, managed care plans which used "intensive residential children's" options and "non-traditional out-patients services (school-based services, partial hospitalization, in-home treatment and case management) developed "behavioral health care plans". In 2019, the average annual cost of nursing home care in the United States was $102,200 for a private room. The average annual cost for assisted living was $48,612. Home health care, based