ABSTRACT
This chapter summarizes some of the most important research on long-term care of elderly people. It also uses federal and state administrative data, as well as various surveys focused on long-term services and supports (LTSS), to describe the trends in policy, programmes, the industry and the workforce. It demonstrates how some peculiarly American institutional arrangements have created incentives promoting neither sufficient coverage, high-quality care, nor a sufficient supply of care workers, even as the need for long-term care is expected to double over the next 30 years. The LTSS industry has evolved into a highly profitable, rapidly expanding, and increasingly unregulated industry. As fiscal concerns aligned with consumer a preference, most growth has been in the home- and community-based services sector. Employment and industry establishments more than doubled between 2001 and 2015, while revenue increased by 160 per cent. The US long-term care system falls short of providing adequate care for most who need it.
