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The Syyacsay-3IDgs7irgd-414frly are usually in their late 70s and <br /> older. When institutionalized they often have advanced and frequently <br /> painful infirmities of old age requiring a comprehensive program or <br /> care or supervision generally beyond the capabilities of their family <br /> or of availablelcommunity-based services. They often show chronic <br /> confusion or disorientation. or behavioral disorders. Because of the <br /> financial status of the majority of the severly impaired. they are <br /> preponderantly medically indigent and must generally look for <br /> institutions that accept Medicaid clients. In institutions as well as <br /> the home. they r1 equire a range of human services. <br /> The diversity of care needs experienced by those with varying <br /> degrees of physical impairment points to the need for a continuum of <br /> care services for older persons. This need was one of several explored <br /> by the work group. <br /> Between 1950 and 19750 94 to 95 percent of the aged have resided <br /> in non-institutional settings. Although the percentage of senior <br /> citizens residing with their adult children has been declining (from 21 <br /> percent in 1950 to 12 percent in 1970). data indicate that this is <br /> attributable to an increase in the numbers of non-dependent aged <br /> choosing independent living arrangements rather than a decline in the <br /> willingness of families to provide care for their older members. Since <br /> 1970, only 5 to 6 percent of the aging population have been residents <br /> in institutions. ' Most of the institutionalized senior citizens are in <br /> nursing homes. and various types of homes for the aged; a declining <br /> number are in mental hospitals.(4) <br /> Even severely handicapped older persons are. for the most part. <br /> cared for in noniinstitutional settings. usually by family members or <br /> friends. A comparison of rates of institutionalization with rates of <br /> handicapping conditions reveals that most of the handicapped aged are <br /> not receiving institutional care. Nationally. twenty-one of every <br /> 1,000 adults between sixty-five and seventy-four are in institutions. <br /> and 83 per 1.0001are more or lass handicapped. Ninety-two of every <br /> 1,000 aged over seventy-four are institutionalized. but 162 per 1.000 <br /> are handicapped. These comparisons are striking, despite the fact that <br /> not all residents of long-term care institutions are handicapped. (4) <br /> Despite the !small proportion of elderly utilizing institutional <br /> long-term care facilities. the number and size of these facilities has <br /> increased dramatically over the past 15 years. By 1978. there were <br /> 18.722 long-term ;care facilities in the United States and the number of <br /> beds grew from 51j0.000 in 1963 to 1.349.000 in 1978. (About 10 percent <br /> of those beds were used by patients younger than 65.) Total costs for <br /> these facilities Also increased rapidly - more than $22 billion in <br /> public and private funds were spent in 1981. Federal and state <br /> Medicaid paymentslare predicted to increase from about $8 billion in <br /> 1980 to as much as $31 billion in 1990 under present conditions. (5) <br /> North Carolina currently spends more than 45 percent of its Medicaid <br /> budget for institutional long-term care. (6) <br /> 4 <br /> 3 <br />