Long term care—how to provide, pay for, and monitor it—is a pressing social and policy issue and will be for the foreseeable future.  Comprising predominantly less skilled assistance with ordinary activities like bathing, getting around, and meal preparation, long term care provides required supportive services for a vulnerable segment of the population who have functional problems and typically substantial medical needs as well.  Informal care provided by family and friends is the mainstay of long term care, but spending on formal, paid services continues to rise. 

Nursing homes remain an important part of the long term care system, accounting for $100 billion in spending by Medicaid alone in 2006.  Increasingly, however, nursing homes care is being provided to the sickest and most frail, with a growing proportion of both publicly and privately paid care provided at home or in community-based residential care settings.  Despite improvements in the disability rate in the older population in recent years, increases in longevity, the aging of Baby Boomers, and recent trends in obesity and other health problems among the younger population assure that long term care and associated health care issues will remain high on the policy agenda. 

Long term care research conducted at The Urban Institute has addressed and is addressing pressing issues in long term care, including trends in disability and long term care; the implications of delivery system innovations for quality of care and costs; managing public long term care costs in the face of increasing strains on Medicaid programs; private financing options for this largely uninsured risk to retirement security; and understanding how long term care relates to other parts of the health care system and health spending.  Conducted by UI researchers alone or with colleagues at other institutions, specific research projects have employed a wide range of qualitative and quantitative methods and data to examine:

• Trends in disability and implications for future long term care demand and costs;
• Strategies for identifying and evaluating potential interventions to promote continued declines in disability;
• Lifetime risk of disability and long term care;
• The relationship between long term care needs and other health care spending;
• Long term care and other spending for persons dually eligible for Medicaid and Medicare;
• Transitions between long term care settings;
• Trends and innovations in long term care settings;
• Innovations in Medicaid benefits for long term care recipients;
• Public and personal financing of long term care;
• Private long term care insurance and alternative financing strategies;
• Trends in formal and informal long term care;
• Implications of informal caregiving for caregivers, care recipients, and use of publicly and privately paid services.