Where Are Long-Term Services Provided?

Long-term services can be provided in institutional settings (such as nursing homes) or in the person's home. Most people who need long-term services live in the community and prefer to receive care in the community. Nearly 85 percent of all people needing this level of care—more than 75 percent of those over age 65 and more than 95 percent of those under age 65—live in the community. However, insurance coverage and other help paying the cost of community-based care is not available to most individuals who need this care, which can cost tens of thousands of dollars annually.

Community-based care includes home- and community-based services (HCBS), personal assistance services, and personal care services. Community-based care can help people maintain their independence, participate in the economy, and avoid institutionalization and hospitalizations. Community-based care is much less expensive than institutional care, costing, on average, about one-fifth as much. However, the costs of community-based care can still be quite a strain on individuals’ finances.

Long-term care facilities such as nursing homes provide care for more than 1.8 million individuals. Most of those people are seniors or individuals with multiple chronic conditions that make it difficult for them to live in the community. For some, institutional care best meets their needs. However, many who now live in institutions could do well in the community—if there were adequate services and supports.