A major deficiency of national health care policy is the lack of a structured and comprehensive system of long-term care. A review of existing federal programs reveals that substantial resources are being expended to care for the elderly. Program structures and requirements, however, are frequently skewed toward institutional care to the exclusion of more appropriate home- and community-based services. A recent federal study highlighted the dimensions of the long-term-care problem and proposed a compelling remedy, but a consensus continues to elude policymakers, and the prospects for fundamental reform are uncertain.