ABSTRACT
Long-term care differs from acute care in content, financing, adequacy, and place in public policy. Although government contributes heavily to financing care for people whose resources are inadequate, almost half of nursing home care is paid for directly by its users, frequently imposing a catastrophic expense. Financial burdens, particularly for the nursing home population, are perhaps more obvious. The service gaps, family burden, and financial risks in long-term care system reflect methods of financing. Financing arrangements and the mix of informal and formal long-term care they support leave some people unserved, impose heavy burdens on relatives and friends, and expose all elderly to the risk of financial catastrophe if they need nursing home care. State efforts to contain costs limit the supply of nursing home beds, create access problems for patients in need of extensive care, and restrict the availability of alternative or supplemental services in the community.
