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In Brief: Across the States 2000: Profiles of Long-Term Care Systems, 4th Edition

Across the States 2000: Profiles of Long-Term Care Systems, 4thEdition, features current state-level statistics for long-term care on: Demographics, home and community-based services, nursing facility services, and public expenditures for long-term care services.


  • The population age 65 and over was 34.5 million in 1999, up from 33.9 million in 1996, a 1.7 percent increase.
  • The population age 65 and over is projected to reach 53.3 million by 2020, a 51 percent increase from 2000 estimates.
  • By 2020, projected growth rates of the population age 65 and over reveal a clear shift to states in the West, including Nevada, California, Arizona, Utah, Washington, Colorado, and Alaska. Hawaii shows the largest projected growth in the population age 85 and over (124.2 percent).

Home and Community-Based Services

  • The number of beneficiaries in Medicaid aged and disabled waiver programs continues to expand, with the U.S. total at 355,135 in 1998, an increase of 22.1 percent from 1996. Every state (except Arizona) had one or more Medicaid waiver programs in 1998. (Arizona operates comparable waiver programs under a federal research and demonstration waiver.)
  • During 1998, the U.S. average number of home health visits per beneficiary was 51, an increase from 36 in 1990. However, the average decreased 30 percent from 1997 to 1998, which many experts attributed to changes in reimbursement policy in the Balanced Budget Act (BBA) of 1997.

Nursing Facility Services

  • Although the U.S. population age 65 and over has increased, the nursing facility resident population has remained relatively static. Nationally, the number of nursing facility residents in 1999 was 1,494,662, a one percent increase from 1995.
  • The national nursing facility occupancy rate dropped to 82.7 percent in 1999 from 84.5 percent in 1995.
  • Nationally, Medicaid supported an average of 67.6 percent of nursing facility residents, at least in part, in 1999, which was a decline from 68.6 percent in 1995.

Public Expenditures for Long-Term Care Services

  • Nationally, Medicaid expenditures totaled $179.7 billion in 1999, with about 34 percent of the total allocated to long-term care (LTC) spending; Medicaid LTC expenditures totaled $62.2 billion and have increased steadily since 1996, an average of 6 percent annually.
  • Overall, about 26 percent of Medicaid LTC funds were expended on home and community-based services (HCBS). Medicaid HCBS expenditures totaled $16.2 billion in 1999, an increase of more than 51 percent from 1996.
  • Medicaid expenditures for institutional care totaled $46.1 billion in 1999, a 13 percent increase from 1996.
  • Nationally, Medicare expenditures for LTC totaled $21.7 billion in 1998, with skilled nursing facility (SNF) payments totaling $11.4 billion. The average reimbursement per diem for SNF beds increased to $250 from $187 in 1995.
  • For home health services, Medicare payments decreased 38 percent to $10.4 billion in 1998 from $16.7 billion in 1997, following passage of the BBA.


  1. AARP Public Policy Institute Publication # D17317(1200) (December 2000). To order copies of the chart book, call (202) 434-3860.
  2. References to 1995, 1996, and 1997 expenditure figures are from the previous edition, Across the States 1998: Profiles of Long-Term Care Systems, 3rd Edition, and are used for comparison only.

Written by Steven R. Gregory, AARP Public Policy Institute
December 2000
©2000 AARP
May be copied only for noncommercial purposes and with attribution; permission required for all other purposes.
Public Policy Institute, AARP, 601 E Street, NW, Washington, DC 20049

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