Person-Centered Long-Term Care The number of older adults in the world in need of long-term care is expected to reach 277 million by 2050. 1 In 2014, approximately nine million people in the US received long-term care services from adult daycare programs, home health agencies, hospice organizations, nursing homes, and senior living communities. 2 As of July 2014, there were 15,600 long-term care residences that were home to 1.4 million people. 3 The number of people needing long-term care will continue to grow as the aging population increases and people live longer with more chronic conditions and cognitive and functional limitations. From 2000 to 2050, the number of people in need of long-term care is projected to more than double from 13 to 27 million. 4 Person-Centered Long-Term Care Long-term care organizations are moving away from a traditional model of care to what is referred to as person-centered or person-directed care. Thomas Kitwood, a psychologist from the United Kingdom, spearheaded this movement approximately 20 years ago. 5 The traditional long-term

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Support for Those Living with Dementia and Their Caregivers In 2015, an estimated 46.8 million people in the world were living with dementia. 1 That number is expected to nearly double every 20 years, and by 2050 is projected to reach 131.5 million. 2 Forty-nine percent of the new dementia cases are seen in Asia, 25 percent in Europe, 18 percent in the Americas, and 8 percent in Africa. 3 In 2015 the global costs of dementia were estimated to be US$818 billion, which represents a 35.4 percent increase since 2010. 4 In the US, the annual cost of dementia care is estimated at US$159 to US$215 billion 5 and is projected to grow to US$1.1 trillion by 2050. 6 Most dementia care costs can be attributed to long-term care and not medical care. Institutional and informal home care is responsible for 75 to 84 percent of the total costs of dementia. 7 Caregiving Dementia is one of the leading causes of disability and dependency for older adults worldwide. 8,9 Approximately one half of those in need of caregiving have dementia. 10 In the next decade, the US will need 1.3 million more paid caregivers. 11 The approaching need, combined with

The inspiration for this book is derived from our commitment to the belief that sharing best practice is an essential tool to guide societies and health systems to make the adaptations needed to support the growing aging population. The case studies and interviews portray initiatives, programs, and health system innovations that can contribute to making the adaptations successful and greatly contribute to the well-being of older adults. One of the greatest stories of the 20th century was that we doubled the life expectancy of adults. Now we need to make sure we have all the supports in place to assure not just a long life but a high quality of that long life. 1 (Terry Fulmer, president of the John A. Hartford Foundation)

Long-Term Care Financing An estimated 12 million people in the United States currently need longterm care. 1 In the United States, long-term care is often referred to as long-term services and supports (LTSS), which include healthcare and assistance with activities of daily living (ADLs). 2 Some common services and supports include caregiver assistance, nursing home care, adult daycare, home health and personal assistance, and transportation. By 2050, the number of those needing long-term care is projected to more than double to 27 million 3 (Fig. 3.1). Nearly 70 percent of those 65 and older will need some form of long-term care in their lifetime, 4 and 20 percent will need it for five or more years. 5 The annual cost of long-term care today is approximately US$725 billion. 6 As the population continues to age, healthcare costs could potentially reach unsustainable levels. Medicaid estimates that their spending on LTSS will increase six percent annually through 2021. 7 When the baby boom generation 8 begins to reach age 85 in 2030, the spending growth for LTSS will be further accelerated and will represent three percent of the GDP. 9 The percentage of GDP of public long-term care expenditures of the OECD countries is projected to grow from 0.8 in 2010 to 1.6 in 2060. For the BRIICS countries (Brazil,