New report downplays cost savings of home-based care

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States and nonprofit groups are trying to offer more long-term care services in individuals' homes and communities. While many people welcome the shift, economists warn that better care or lower costs will not necessarily result, according to a Congressional Quarterly report due out today.

The number of Americans aged 85 and older is skyrocketing. It has soared from just over 100,000 in 1990 to 4.2 million in 2000 – and is projected to be 21 million by 2050. About 69% of people turning 65 this year will need long-term care during their lifetimes, and 20% will need it for five years or longer.

Today, families of people with serious chronic illnesses like Alzheimer's and state Medicaid programs -- originally intended to serve poor children -- provide most long-term care. Meanwhile, most elderly people fear ending up in nursing homes, where understaffing, low pay and poor working conditions put residents at risk of devastating malnutrition, bed sores and other life-threatening ailments.

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