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Long-term care users range in age, and most do not live in nursing homes

Americans who get hands-on help from others so that they can accomplish life's basic daily activities are not necessarily elderly nor do they all live in nursing homes, according to a new research report published by the Agency for Healthcare Research and Quality. The most recent data show that an estimated 9.4 million adults 18 years of age and older are given hands-on assistance to carry out either instrumental activities of daily living (IADLs)—these are chores such as shopping and housework—or for the more basic activities of daily living (ADLs), such as bathing and dressing. Roughly 79 percent of these people live at home or elsewhere in the community rather than in institutions, and almost half are under 65 years of age.

These non-elderly adults who receive long-term care are less disabled than elderly adults, more likely to be mentally impaired, and more likely to live in the community. They also are more likely to receive only informal care, the type provided by family and friends, rather than formal care alone (which is provided by agencies or other paid help) or by a combination of informal and formal care.

The authors also found that between 1984 and 1994, there was a marked increase in ADL disabilities and cognitive impairment among the elderly who received long-term care. The proportion of older long-term care users receiving help with three to six ADLs increased from 35 percent to nearly 43 percent. The proportion of the population cognitively impaired similarly rose from 34 percent to 40 percent. As a result, during this period the intensity of care for the elderly increased. The share of elderly people receiving both informal and formal care grew from 19 percent to 26 percent, and use of institutional care increased from 26 percent to 30 percent.

According to lead author and AHRQ researcher William D. Spector, Ph.D., resource challenges will continue to increase in the future, and it will become increasingly important to tailor services to the disparate needs of the elderly and non-elderly disabled.

Details are in The Characteristics of Long-term Care Users (AHRQ Publication No. 01-0009), which is available from the AHRQ Publications Clearinghouse.

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