Abstract
Diverging trends will affect the use of home-delivered, paid, disability-related services over the next 30 years. Age-adjusted rates of disability appear to be declining, but the sheer numbers of elders in future cohorts imply that use of all types of long-term support services (LTSS) will increase markedly. Trends in ability to pay, home ownership, and long-term care insurance coverage will combine with consumer preferences for care at home thereby shifting an increasing proportion of LTSS to home settings. Most important for home-delivered care is the unflagging commitment of spouses and other family members to provide informal support complementary to home-delivered, paid services, which continues despite demographic and labor market challenges. Working against these trends in resources for LTSS at home are the increasing cost of services and the reluctance of government to pay adequately for LTSS, whether for lower income elders or as universal coverage for needed supportive services at home.