Nearly 70 percent of those turning 65 this year will need long-term care (LTC) in their lifetimes; 20 percent will need it for five years or longer. But - unlike most other industrialized nations - the United States has no public or private insurance infrastructure to pay for LTC. Those needing years of care will have to impoverish themselves before Medicaid will pay for it. But state officials say Medicaid - intended as a health-care safety net for poor children - could be bankrupted by rising LTC costs as the baby-boom generation ages, and the number of people over age 85 soars from around 5 million to 21 million by 2050. Meanwhile, understaffing, low pay and poor working conditions at nursing homes put residents at risk of life-threatening malnutrition and bed sores. As an alternative, states and nonprofits are offering more home- and community-delivered care, but LTC experts say the alternatives may not be any safer.

Marcia Clemmitt is a veteran social-policy reporter who joined CQ Researcher after serving as editor in chief of Medicine and Health, a Washington-based industry newsletter, and staff writer for The Scientist. She has also been a high school math and physics teacher. She holds a bachelor's degree in arts and sciences from St. Johns College, Annapolis, and a masters degree in English from Georgetown University.