Caring for the Disabled Elderly: Who Will Pay?

Because people are living longer, the question of how to pay for long- term nursing home and home care for the disabled elderly has become increasingly urgent. The cost of care can be far beyond the resources of the average family and at present is not normally covered by either private insurance or medicare. Elderly people must rely on their own or their family's income and assets to pay for care or, when these are depleted, turn to welfare.

This study analyzes the major options for reforming the way long- term care is financed. It first explores the potential market for private long-term care insurance and other private sector initiatives. Then it turns to the advantages and disadvantages of various public sector programs. The study recommends both a greatly expanded role for the private sector in financing long-term care and a new public insurance program.

Alice M. Rivlin and Joshua M. Wiener are senior fellows in the Brookings Economic Studies program. Raymond J. Hanley and Denise A. Spence are senior research analysts in that program. David L. Kennell and John F. Sheils, of ICF Incorporated, were equal partners with the authors in developing the Brookings-ICF Long-Term Care Financing Model and provided invaluable help in formulating and analyzing the simulated options. The authors wish to thank Sheila E. Murray, who assisted in the analysis and the preparation of the manuscript; Diana L. Coupard, Deborah A. Ehrenworth, and Ronald R. Hopkinson, who provided research assistance; Robert W. Davis II, Joseph P. Fennell, Ellen J. Hope, Carole H. Newman, Peter Robertshaw, and Piraphong Suppipat, who supplied computer programming assistance; Caroline Lalire, Jeanette Morrison, and Brenda B. Szittya, who edited the manuscript; Victor M. Alfaro, Carl L. Liederman,

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