Families and friends provide the bulk of long-term care services to people who need them. The remaining 10 million individuals live at home or in small community residential settings, such as group homes or supervised apartments. Most people needing long-term care are elderly, a total of about 7.3 million. Overall, approximately three-fifths of the long-term care population are elderly. 1.) Nonetheless, a sizable proportion of people needing long-term care is under age 65—about 5.1 million working-age adults and 400,000 children with long-term care needs either reside in institutions or live in the community. The most severely disabled population—those who need substantial assistance—comprises approximately 5.1 million individuals. In addition, estimates of future long-term care need among the nonelderly disabled are difficult to project. While the sheer number of future elderly is expected to drive up demand for long-term care services, projections of the number of elderly needing long-term care in the next century vary because of different assumptions about the future prevalence of disability. However, as members of this generation become disabled themselves and need assistance, they may have fewer family members available to care for them. Conclusions

The current long-term care population’s size and diversity have implications for how public and private programs are designed and administered. Within the long-term care population severity of need varies, with some people needing only occasional aid and a much smaller number requiring substantial assistance. We visited several state and local programs providing long-term care services for the elderly and nonelderly to identify disability groups currently receiving long-term care services, to examine the prevalence of their needs, and to learn about the diversity of long-term care needs within and among disability groups. These data will be published in an upcoming ASPE Research Note, “Population Estimates of Disability and Long-Term Care.”

	Adults With ADL and IADL Limitations

Researchers at ASPE used data from the Survey of Income and Program Participation (SIPP), conducted by the Bureau of the Census, to estimate that 4,380 working-age (aged 18 to 64) and 5,690 elderly adults need assistance with one or more activities of daily living (ADL) or instrumental activities of daily living (IADL). 12, 1994). 4, 1994). 6, 1993).
Why GAO Did This Study

Pursuant to a congressional request, GAO provided estimates of the current and future numbers of people needing long-term care, focusing on the: (1) characteristics of the population needing long-term care; (2) prevalence of current long-term care needs; (3) factors that may influence future long-term care needs; and (4) diversity of needs among different groups.

What GAO Found

GAO found that: (1) currently, there are over 12 million people with chronic conditions who need assistance with everyday activities; (2) about 5 million of the long-term care population are working-age adults and about 420,000 are children under age 18; (3) nearly 10 million people needing long-term care live at home or in small community residences; (4) family and friends provide most long-term care services without compensation; (5) long-term care needs range from occasional help with household chores to daily help with self-care activities; (6) about 5.1 million people need substantial assistance with basic self-care activities because of severe disabilities and about one-half of these persons are institutionalized; (7) long-term care need could double within the next 25 years as the baby boomers age, but meaningful projections are difficult to make due to uncertainties pertaining to life expectancy, life styles, and health status, the size of the future nonelderly disabled population, and technological and medical advances; (8) the nonelderly disabled population will probably increase as more low-birth-weight babies and young adults survive previously fatal conditions and events; (9) the diversity in ages, disabling conditions, and needs among the long-term care population will require greater flexibility in the design and administration of long-term care programs to match individual needs; and (10) increased government subsidized long-term care will be needed as fewer family members and friends have the resources and time to care for the disabled.