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Most Older Adults Are Likely to Need and Use Long-Term Services and Supports Issue Brief

Publication Date

Most Older Adults Are Likely to Need and Use Long-Term Services and Supports

Richard W. Johnson and Melissa M. Favreault
Urban Institute

Judith Dey, William Marton, and Lauren Anderson
Department of Health and Human Services

January 2021

Link to HTML Version (10 PDF pages)

ABSTRACT: Most Americans underestimate the risk of outliving their financial resources in retirement or experience economic hardship stemming from large, unanticipated health and long-term care costs in later life. Based on microsimulation modeling, this brief shows that more than one-half of adults develop serious disabilities after they reach age 65 and use some paid long-term services and supports (LTSS), such as home care or nursing home care. Older adults who earned relatively little over their lifetimes are most likely to develop a need for LTSS and receive paid LTSS, but the risk of needing care and receiving paid services is high throughout the lifetime earnings distribution.

The full report on which this brief is based is "Economic Hardship and Medicaid Enrollment in Later Life: Assessing the Impact of Disability, Health, and Marital Status Shocks," available at The DYNASIM projections were developed by Melissa Favreault, Karen Smith, Paul Johnson, Doug Murray, and Damir Cosic at the Urban Institute, with conceptual and modeling help from William Marton and Brenda Spillman. All errors are our own.

This report was prepared under contract #HHSP233201600024I between HHS's ASPE/BHDAP and the Urban Institute. For additional information about this subject, you can visit the BHDAP home page at or contact the ASPE Project Officers, at HHS/ASPE/BHDAP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C., 20201;,,

DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. This report was completed and submitted on October 2020.