Senior-Housing-OptionsAging in place is a primary goal for most aging adults. However, without a national long-term care insurance system in the US, most expensive services must be paid out of pocket or provided by unpaid family members.

New Study Explores the Need for Expanded 
Long-Term Care Services to Support Aging-in-Place 
John Hopkins -April 10, 2025 by Lindsey Culli 

A recent study led by Katherine E.M. MillerChase Mulholland Green, Abigail Fassinger, and Jennifer L. Wolff of the Johns Hopkins Bloomberg School of Public Health highlights the urgent need for an expanded infrastructure to support long-term care services (LTSS) and enable successful aging-in-place.

The study, “Long-Term Care Services and Supports Needed for Successful Aging-in-Place: A Critical Review,” published on April 8 in the Annual Review of Public Health, highlights critical gaps in care and services that must be addressed to meet the growing demands of the aging population in the US.

Aging Population and Increasing Demand for Long-Term Services and Support

According to the study, by 2034, the number of US adults aged 65 and older is expected to exceed, for the first time in history, the number of children under the age of 18, leading to an unprecedented demand for long-term services and support (LTSS).

LTSS refers to the range of paid and unpaid services that help people with physical or cognitive impairments live independently at home.

The study emphasizes that without significant improvements in the Long-Term Services and Supports (LTSS) infrastructure, many older adults may struggle to remain independent as they age.

Additionally, the study highlights that current long-term services and supports (LTSS) offerings are often insufficient to meet the needs of aging populations, with pronounced inequities in access to these services based on financial resources, geography, and family structure.

A literature review identified two significant barriers to aging in place: the inadequate availability of affordable services and insufficient trained and qualified health personnel to meet emerging needs.

The review concluded that although there has been a shift from institutional care, such as nursing homes, to home-based care, the infrastructure to support aging-in-place remains fragmented and underfunded.

Causes and Symptoms of Caregiver Burnout

According to the study, the health workforce faces acute recruitment and retention challenges, and specialists in geriatrics—the geriatricians, nurses, and home health aides—face considerable excess demand relative to supply.

Factors such as inadequate pay, challenging work environments, and limited training opportunities can contribute to high turnover rates and poor staff retention.

Technology is increasingly vital in enabling individuals to age in place.

Innovations such as telemedicine, remote patient monitoring, and home-based care frameworks, including those under hospital-at-home initiatives, promise to enhance communication among patients, caregivers, and healthcare professionals.

However, the availability of such technological advances is unbalanced, especially in rural areas, and privacy concerns exist.

This study calls for further research on scalable and affordable tech solutions that can be implemented equitably among diverse populations.

Family caregivers provide most LTSS, with three-quarters of the US’s older adults with functional or cognitive impairments relying on unpaid family members for support.

Mayo Clinic: Caregiver stress: Tips for taking care of yourself

Caregivers make substantial financial, emotional, and physical sacrifices with little training or backing from support systems.

Although over 40 states have implemented programs like paid family leave and the Caregiver Advise, Record, Enable (CARE) Act to improve communication between healthcare providers and caregivers, these policies are not yet widespread or adequately funded.

The study highlights the need for policies to support caregivers and the potential benefits of integrating caregivers more fully into care teams.

Financing Long-Term Care: A Fragmented System

National Library of Medicine: Medicare serves most adults over 65 but covers only post-acute care, as coverage does not extend to long-term maintenance services.

As a result, many families must bear the expenses of long-term care services themselves, causing considerable financial strain.

Without reform to make LTSS more affordable, middle-income families who do not qualify for Medicaid but cannot afford private long-term care insurance are at particular risk of facing financial hardship as they care for aging family members.

The researchers emphasize the importance of conducting further research into innovative care models that can be scaled to meet the growing demand.

Programs like the Program of All-Inclusive Care for the Elderly (PACE) and hospital-at-home initiatives are promising, but to reach more people, they will require policy change and funding support.

As the US population ages, the need for a comprehensive and adequately financed structure to support aging-in-place becomes increasingly urgent.

The Potential Impacts of Cuts to Medicaid

As of November 2024, over 70 million Americans were enrolled in Medicaid,

The study’s findings highlight several challenges that older adults and their caregivers face. They encourage collaboration among multiple stakeholders to achieve a sound financial future for multifaceted long-term care services.

Without significant changes, the current LTSS infrastructure will continue to be overburdened, and workforce shortages will persist, resulting in many older adults not receiving the support they need to enable them to continue to live in their homes.