Trends in Disability, Community Living, and Caregiving: Analysis of Data from the National Long-Term Care Survey

According to the National Long-Term Care Survey (NLTCS), disability rates among older Americans have declined substantially over the 20 years studied:

If 1984 rates had remained unchanged, 1.3 million more persons age 65 or older would have experienced a disability in 2004.

If rates of institutional use among older persons with disabilities had stayed constant, three-quarters of a million more older people would have been in institutions, and federal and state Medicaid spending on nursing homes would have been $24 billion higher.

The ways in which older people with disabilities managed their conditions also changed significantly between 1984 and 2004. Many more persons with less severe disabilities managed to live with assistive devices. Among those receiving human assistance, the vast majority were helped by family caregivers, who are increasingly taking full responsibility for providing care. Since 1994, the proportion of family care supplemented by formal (paid) care declined from 39% to 28%, and since 1999, the hours of paid care decreased significantly.

The detailed analyses of the NLTCS data in two new research reports provide insight into the factors driving these changes.