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Health Aff (Millwood). 2010 Jan-Feb;29(1):11-21. doi: 10.1377/hlthaff.2009.0535.

Long-term care: who gets it, who provides it, who pays, and how much?

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  • 1Institute for Health and Aging at the University of, California, San Francisco, California, USA.

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  • Health Aff (Millwood). 2010 Mar-Apr;29(3):567.


Long-term care in the United States is needed by 10.9 million community residents, half of them nonelderly, and 1.8 million nursing home residents, predominantly elderly. Ninety-two percent of community residents receive unpaid help, while 13 percent receive paid help. Paid community-based long-term care services are primarily funded by Medicaid or Medicare, while nursing home stays are primarily paid for by Medicaid plus out-of-pocket copayments. Per person expenditures are five times as high, and national expenditures three times as high, for nursing home residents compared to community residents. This suggests that a redistribution of spending across care settings might produce substantial savings or permit service expansions.

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