Document Type


Publication Date

Spring 2009


Published in Journal of Women, Politics & Policy, 2009, p.248-271.

This is an Author's Accepted Manuscript of an article published in Journal Of Women, Politics And Policy, 2009, copyright Taylor & Francis, available online at:

Originally appeared as Chapter 7 in Heidi Hartmann and Sun-hwa Lee, eds. Women and Retirement Security, New York: Russell Sage Foundation.

© 2009 Taylor & Francis

DOI: 10.1080/15544770902901825


Over 20 million people today, including children, working-age disabled, and elderly persons, require some sort of assistance to live safely. Largely because women live longer than men, well into the ages when the probability of needing care increases, 70 percent of elderly people who need long-term care are women. Furthermore, most long-term care is provided by women, mainly as unpaid care in the home, or as low-paid care in institutions and community settings (Stone & Weiner 2001). The United States faces a severe long-term care crisis because of the nation's inability to plan for the changing demographic balance. The crisis in long term care has two problems: a) that we are putting too many resources into institutional care relative to home- and community-based care and relying too heavily on unpaid care in the home to meet the real needs of the aging population, and b) that we do not, and increasingly will not, have enough people to provide for the volume of care that will be needed in the coming decades. This chapter begins with a description of the long-term care system in the United States – what long-term care is, who needs it, in what settings it is provided, and who pays for it. Using the author's analysis of a national survey of caregivers conducted by the National Alliance for Caregiving and the AARP in 2003 along with other sources, this section shows that a substantial portion of the people who need long-term care rely on unpaid care from family and friends, mainly women. When people do receive paid care, almost half – mostly women -- receive it in institutional settings. The discussion demonstrates that women are far more likely to end up in institutions than men, even controlling for age and level of impairment. It then argues that, for a number of reasons, states and the federal government will have to respond to the preferences of consumers for home- and community-based care.




The views expressed in this paper are solely those of the author.