Many people identify long-term care with nursing homes, the predominant provider of long-term care in the United States is the family. The elderly express strong preferences for remaining in their own homes as long as possible and for being cared for by relatives. Only about 21 percent of the disabled elderly were in nursing homes in 1985. The rest were in the community, mostly in their own homes. Those with more severe disabilities were more likely to be in institutions, but even among the severely disabled considerably less than half were in nursing homes.
Nearly 90 percent of the disabled old people who were not in nursing homes received assistance from relatives and friends, sometimes supplemented by paid services. The majority of unpaid caregivers are women relatives of the disabled, usually wives, daughters, or daughters in-law.
Families devote enormous time and energy to the care of elderly relatives, often at considerable emotional and physical cost. One study estimates that more than 27 million unpaid days of informal care are provided each week. Other studies suggest the large emotional and physical strain on families caring for elderly relatives.
The strong role of the family in long-term care runs counter to the myth that American families, who supposedly took care of their aging relatives at home "in the good old days," are now "dumping" them in nursing homes. In fact, in the past, few families cared for an elderly parent because relatively few people lived long enough to experience a prolonged period of disability. Because of increased lotngevity, the odds of being called upon to provide parent care are much higher now than in the past.
Although nursing homes serve less than a quarter of the disabled elderly, they dominate long-term care financing. In 1985 there were 19,100 nursing homes with 1.6.......
