Current long-term care policy and practices are built on the premise that family is and should be the primary party responsible for impaired older persons. This article presents evidence that this premise and the resulting policies and practices are (a) built on myth; (b) fueled by gender, income, and ethnic inequalities; and (c) largely responsible for the creation of a service system that has inadequate capacity to meet current and future needs. An alternate paradigm, which places primary responsibility for long-term care needs on the individual, is proposed here and implications for newpolicy direction are outlined. The projected benefits of this shift in paradigm will be the development of a more viable and more equitable long-term care system that has the capacity to provide high quality care to meet the expanding need.
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