What passes for a system of long-term care in the United States is actually a disconnected chain of independent and uncoordinated platforms for delivering varying levels of care, each with its own definitions, eligibility, and financing parameters. Moreover, each of these platforms is changing over time as senior citizens’ longevity increases, their health care needs evolve, and the range of caregivers expands.
But one constant is that long-term care usually begins with some type of informal care provided by the care recipient’s family, generally on a gratis basis, for as long as the caregivers can hold off transitioning to paid assistance or an institutional care arrangement. Approximately 80 percent of long-term care received by U.S. elders is provided by informal caregivers, usually relatives. It is not hyperbole to note that the other components of the U.S. long-term care “system” – including adult day care centers, assisted living facilities, nursing homes, and continuing care retirement communities – could not function if families of older relatives with physical or mental deficiencies did not provide this free care.