"Lifecare": a viable option for long-term care for the elderly.

In the absence of any coherent US long-term care policy, the "lifecare" or "continuing care" retirement community (CCRC) has emerged as one viable model, providing housing, health care, social supports, and long-term care insurance to about 300,000 elderly Americans. Some CCRCs have also demonstrated the cost-effectiveness of a health care philosophy targeted to the maximum functional independence (MFI) of residents. Broad dissemination of the CCRC model and the philosophy of MFI depend on development of new approaches to the role of government and private health insurance along with a new understanding of, and commitment to, risk management.

Aging in the 21st century: projections, personal preferences, public policies--a consumer view.

The demographic revolutions of the recent past and projections of continuing increases in the number and proportion of elderly in the United States and other advanced nations pose extremely difficult economic, political, and ethical issues. However, there is growing evidence-based on changing public and professional attitudes-that humane solutions are economically feasible. Of special importance is the new emphasis on "productive aging", "successful aging", "preventive gerontology" and related policies and programs which already give promise of postponing the average age of incidence of chronic illness and disability and extending the productive lifespan. Simultaneously there is growing attention to the "right to die" and other indications of a new focus on the quality of life rather than the length. Such developments also offer hope for the feasibility of adequate long-term care benefits for the victims of Alzheimers and other disabling conditions that we do not now know how to prevent. However, adoption of this approach to national health policy remains an option, not a prediction.