Residential Care of Persons with Alzheimer's Disease (Dementia)
Jonathan M. Evans M.D.
Mayo Clinic
Former Medical Director, The Cottages of Rochester

Introduction
Our society is aging. The social and economic consequences of this have yet to be fully appreciated, however, the increasing demands this places upon our health care system have already been felt for some time. The population of Americans 65 years of age and older currently numbers almost 35 million and represents 13% of the total US population. This number is projected to grow by 40% in the next 30 years, and the number of persons who are 85 years of age and older will grow 80% over the same time period. As we age, the likelihood that we will need assistance in performing basic activities of daily living such as bathing, dressing and feeding ourselves increases exponentially.

Currently, there are almost 2 million Americans living in nearly 20,000 nursing homes at an annual cost of $53 billion. By 2030, 5 million Americans are expected to require nursing home care at a cost of $700 billion or more each year. Nevertheless, despite this enormous need for care, nursing homes in general do not enjoy a very positive image in our society. Perhaps it is because they represent frailty, dependence, old age and impending death. But even among seniors, a recent survey indicated that a substantial number of older Americans (aged 65 and over), most of whom have seen firsthand the inside of a nursing home, "would rather die than live in a nursing home." The need for care is not going away, but the desire for alternatives to nursing home care is growing at least as rapidly as that need.