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Many elderly and disabled Americans may face extended hospital stays or long term care in nursing homes. But, many could be receiving high quality care that keeps them healthier, longer in their own homes.

Alice Bonner, of Northeastern University, and Robert J. Master, of the Commonwealth Care Alliance, look at how the long-term care landscape is changing — and what the future may hold.

Alice Bonner, PhD, RN, is an associate professor of nursing at Northeastern University. Previously, she served as director of the division of nursing homes at the Centers for Medicare and Medicaid Services.

What does home mean to you?

It may be a house in the suburbs or a high-rise apartment in the city. A trailer in the country or some type of shelter or group home. At the end of life, or for those with severe disabilities, it often means a nursing home.

Roughly 12 million Americans with functional impairments today rely on “long-term services and supports” (LTSS). LTSS refers to assistance for people who need help performing routine daily activities: getting dressed, taking a bath, eating, going to the bathroom. Most people receiving LTSS are elderly, but 44 percent are under 65.

Long-term services and supports are costly. On average, nursing homes cost about $70,000 a year per person, although cost varies considerably from state to state. Assisted living facilities generally cost about half that. However, the vast majority of people receive LTSS delivered by unpaid caregivers in the community. Estimates are that unpaid caregiving may represent up to $200 billion in health care costs that are not captured in Medicare, Medicaid and private spending projections.