This article describes current problems in the financing and delivery of long-term care, and assesses several proposals for reform. Proposed financing changes are found to differ in their objectives, with some reforms seeking to shift from greater to lesser government support, and others seeking to replace current public efforts with expanded entitlements. Organizational reforms hold promise of more equitable allocation of public expenditures for long-term care, but are not likely to reduce such spending. Thus difficult choices cannot be avoided.

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