AARP: More than 5 Million Older Americans Need Services and Support to Remain at Home

A new report from AARP shows older American’s growing need for services and support to remain living in their homes and communities.

The majority of this population receives help exclusively from family caregivers, but others but others pay for services through public programs, out-of-pocket spending, or private insurance.

“The primary source of public funding is Medicaid, but other sources include the Older Americans Act and state funds,” said AARP.  “Residential alternatives that deliver supportive services in a home-like environment also play a role in helping older people avoid more institutional settings.”


In 2009, about 10 million Americans living in the community needed longterm services and supports (LTSS), of whom more than half (5.2 million) were age 65 or older and 1.7 million were aged 85+. Those with LTSS needs comprised some 14 percent of the community-dwelling population age 65+ and 38 percent of those age 85+.

According to the report, almost 72% of older adults with disabilities receive help with basic personal activities or household chores exclusively from family caregivers.  Among these, only 28% receive supplemental assistance from paid services (either out-of-pocket, by private insurance, or through a public program.)

In order to receive funding for home and community based long term service and supports waiver, individuals must be at risk of nursing home placement.


However, this doesn’t mean they’re going to get support for services.  According to the report, eligible individuals are not entitled to receive waiver services and may be placed on a waiting list. As of 2007, some 1.2 million individuals were served in these programs, of whom nearly half (49 percent) were older people or adults with physical disabilities.

“It should be noted, however, that spending for this population comprised just 20 percent of all Medicaid expenditures for HCBS waiver programs, as services for this population are less costly than are those for persons with intellectual disabilities,” said the report.

Medicaid paid $114 billion for LTSS in 2009, about 32 percent of Medicaid expenditures. Only about one-third of Medicaid spending for older people and adults with physical disabilities paid for HCBS; the majority paid for institutional services.  Medicaid benefit for eligible persons and served nearly 814,000 persons in 2007. (The Medicare program also provides home health services to people who are homebound, need help intermittently, and require skilled services.)

View a copy of the report here.