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What Is the Lifetime Risk of Needing and Receiving Long-Term Services and Supports?

Publication Date

This brief provides new evidence on the lifetime risk that older adults will need LTSS and receive paid services and supports. Using longitudinal household survey data from 1995 to 2014 from the Health and Retirement Study, we estimated the likelihood that adults ever development disabilities after age 65 and receive paid care, including paid home care, residential care (such as assisted living), nursing home care, and Medicaid-financed nursing home care, and the duration of need and care spells. Our results show that 70% of adults who survive to age 65 develop severe LTSS needs before they die and 48% receive some paid care over their lifetime. Many older people with severe LTSS needs rely exclusively on family and unpaid caregivers, and most paid care episodes are relatively short. Only 24% of older adults receive more than 2 years of paid LTSS care, and only 15% spend more than 2 years in a nursing home. However, the lifetime risk of receiving paid care is not evenly distributed across the population. Lengthy spells of severe LTSS needs and paid care are much more common among older adults with few financial resources than their wealthier counterparts.

This report was prepared under contract #HHSP23320100025W1 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Urban Institute. For additional information about this subject, you can visit the DALTCP home page at or contact the ASPE Project Officers, John Drabek and Pamela Doty, at HHS/ASPE/DALTCP, 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 April 2017.