In survey after survey, Americans say they want to avoid spending time in a nursing home, wishing instead to receive care in assisted living facilities or in their home.

That thinking has changed the way older Americans receive care. The Lewin Group, citing
statistics from the National Nursing Home Survey, says the percent of adults 65 and older receiving care in nursing homes declined from 4.2 percent to 3.6 percent in the two decades from 1985 to 2004.

In the oldest age group, 85 and above, the use rate fell from 21.1 percent to 13.9 percent. The number of people age 85 and above in nursing homes remained stable over the 20 years from 1985 to 2004, but the 85-andolder population nearly doubled overall.

The Lewin Group, in its presentation to the National Press Club, lists several reasons why the number of older adults in nursing homes has declined:

The oldest old are healthier and wealthier. Disability rates among the elderly declined as more elderly stayed out of poverty and received better care. The poverty rate for people 85 and older dropped 28 percent between 1985 and 2005.

Changes in nursing home use patterns. The amount of time people had to stay in nursing home dropped. A focus on post-acute stays and shorter custodial stays meant more people spent less time in nursing homes.

Nursing home alternatives developed. Residential facilities now house 1 million residents with an average age of more than 80, according to Lewin Group, and home-based services became more widely available through state-funded and Medicaid-funded waivers. In addition, families have taken a more active role in caregiving.

More private long term care insurance. More and more LTCI policies allow the elderly to receive care where they want.

State efforts. Many states have tried to reduce the number of Medicaid recipients in nursing homes through home-based services and community-based services.

To view the entire presentation, visit www.lewin.com.