Elder Care

Elder care policy addresses how the United States supports its rapidly growing older population — through Medicare, Medicaid-funded nursing home care, home and community-based services, and caregiver support programs. The U.S. population is aging significantly: the 65-and-older population is projected to nearly double from 54 million in 2020 to 94 million by 2060, as the large Baby Boom generation moves fully into old age. This demographic shift has profound fiscal and policy implications. Long-term care — the ongoing assistance that older adults and people with disabilities need with daily activities — is the fastest-growing category of health spending. Medicaid is the single largest payer of nursing home care, covering about half of all nursing home costs, because Medicare does not cover long-term custodial care. The average annual cost of a private room in a nursing home exceeds $100,000. Most Americans are unprepared for these costs; there is no universal long-term care insurance system, and private long-term care insurance markets have largely collapsed due to mispriced risk. An estimated 53 million Americans provide unpaid care to a family member — the backbone of the U.S. elder care system — at significant personal and economic cost. Nursing home quality is a persistent concern: understaffing, high turnover, and abuse and neglect scandals prompted new federal staffing standards in 2024 requiring minimum nurse-to-resident ratios. Alzheimer's disease and other dementias are expected to affect 13 million Americans by 2050, creating a mounting care challenge.