Consumer-Directed Services At Home: A New Model For Persons With Disabilities

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Abstract
The care needs of the “frail” elderly represent a large part of the chronic care system and are met through a variety of means, including the services of family members. Consequently, projected growth in the elderly population, combined with increasing demands on their shrinking families, seems to imply both demand- and supply-side pressures on the chronic care system. Yet recent downward trends in old-age disability suggest to some that care needs might not grow. I review evidence relevant to these demand- and supply-side factors, with particular attention to the distinction between trends and compositional change, the factors’ respective contributions to declining disability, and their prospects for continuation in the future. I conclude that population change is more likely to be foe than friend of the chronic care system for several decades.