Long-Term Care Challenges Ahead for North Carolina: 2010 and Beyond

Abstract

G iven the minimal attention paid by the news media to long-term care issues in the recent deliberations about national health care reform, one would think that these are problems of relatively small importance to the nation’s future health services needs. But the reality is that both federal and state governments spend substantial sums of money each year to provide long-term care to persons (particularly the elderly) with disabilities, and the number of persons needing these services is expected to grow substantially over the coming decades. Estimates are that the number of older people with disabilities will nearly double over the next 20 years. National public sector expenditures for long-term care in 2007 were approximately $150 billion, and these expenditures are expected to increase to about $295 billion by 2030.1 It is estimated that one in five North Carolinians over the age of 65 will be admitted to a nursing home for some period of time.2 In this issue of the North Carolina Medical Journal, Mary Anne P. Salmon and Gary M. Nelson make clear the extent to which the need and demand for long-term care services in several categories are likely to increase dramatically in coming decades. Jose Gonzalez also describes the increasing burden of chronic disease and disability which are major contributing factors in these increasing demands for long-term care services. Public financing of long-term care services is a critical component of this level of care. Although families of individuals needing care while living at home are providing a great volume of these services at a substantial cost to themselves, they could potentially be leaving many critical needs unmet. Estimates as high as 85% indicate that older adults requiring disability-related assistance rely on unpaid care from family members at home.2 Yet no other part of the health care system in this country is as dependent on public financing as long-term care. As Joshua Weiner at RTI notes in his 2009 testimony to the US Senate Committee on Finance, “In 2008...77% of nursing home residents had their care covered by either Medicare or Medicaid.”3