Trends in Disability, Community Living, and Caregiving: Analysis of Data from the National Long-Term Care Survey

Over the 20 years covered by the National Long-Term Care Survey (NLTCS), disability rates among older Americans have declined substantially. If 1984 agespecific rates had remained unchanged, 1.3 million more persons age 65 or older would have experienced a disability in 2004. If rates of institutional use among older persons with disabilities had remained constant, three-quarters of a million more older people would have been in institutions, and federal and state Medicaid spending on nursing homes would have been $24 billion higher.

The ways in which community-dwelling older people with disabilities managed their conditions also changed significantly between 1984 and 2004. Many more persons with less severe disabilities managed with assistive devices. Among those receiving human assistance, the vast majority were helped by family caregivers, who are increasingly taking full responsibility for providing care. Since 1994, the proportion of family care supplemented by formal (paid) care declined from 39% to 28%, and since 1999, the hours of paid care decreased significantly.

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