Long-Term Care: Demography, Dollars, and Dissatisfaction Drive Reform

GAO discussed problems with current long-term care programs, and principles to guide reform efforts. GAO noted that: (1) demand for long-term care for chronically disabled persons is increasing among all age groups, not just the elderly, and is expected to continue to increase; (2) 1993 federal and state Medicaid expenditures for long-term care totalled $42 billion, and Medicaid expenditures for nursing homes are increasing; (3) about 70 percent of money spent on long-term care goes to institutional care; (4) long-term care programs are generally designed to meet acute health care needs, even though less intensive services might be appropriate, and are not generally tailored to meet individuals' needs; (5) institutional care is the only option available for many persons, since Medicaid limits benefits for home- and community-based care; (6) the service delivery system is complicated and compounds the difficulties disabled persons face; and (7) efforts to reform the long-term care system should focus on tailoring services to individual needs and on increasing funding flexibility.