This chapter describes the situation of long-term care in the United States (US), including demographic developments and projections of the need for long-term care, public and private insurance schemes, facilities and care givers. The aged population is growing steadily, especially the over-85 cohort. The overall system has developed in a rather piecemeal and incomplete fashion. Although the US does not have a formal public long-term care insurance system, the majority of formal long-term care expenditures are publicly funded, primarily by Medicaid. Nonetheless, the burden on households for both formal and informal care is quite high, especially for middle-income households that do not qualify for Medicaid. The system faces numerous structural issues. The private long-term care insurance system is small and stagnating. The supply of health care workers is inadequate due to low wages and difficult working conditions, and results in many deficiencies in care delivery.