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The strong role of the family in long-term care runs counter to the myth that American families, who supposedly took care of their aging relatives at home “in the good old days,” are now “dumping” them in nursing homes. In fact, in the past, few families cared for an elderly parent because relatively few people lived long enough to experience a prolonged period of disability. Because of increased lotngevity, the odds of being called upon to provide parent care are much higher now than in the past.
Although nursing homes serve less than a quarter of the disabled elderly, they dominate long-term care financing. In 1985 there were 19,100 nursing homes with 1.6 million beds, more beds than in acute care hospitals. In 1987 dollars, average annual expenditures for nursing home care for the elderly in 1986-90 are estimated to be $33 billion. Estimated expenditures for paid home care are much smaller–only about $8.6 billion in 1986-90–although nearly twice as many people will be served.