An issue brief released by the Urban Institute analyzed the organization’s Well-Being and Basic Needs Survey data from December 2025 and found that nearly 1 in 4 (24.0 percent) older adults with disabilities reported there was a time in the past 12 months when they did not get personal assistance they needed. This share includes 7.7 percent who reported that there was a time they needed help from another person with personal care (e.g., eating, dressing, bathing, managing medications, or getting around inside their home) due to a health condition or disability but did not get it. It also includes 22.9 percent who needed help with routine household tasks (e.g., cleaning, managing money, preparing meals, or shopping) but did not get it.

Approximately one-third (33.1 percent) of older adults who had difficulty with daily activities reported unmet personal assistance needs, compared with 6.9 percent of those with other functional limitations.

Other findings include:

• Overall, 11.3 percent of adults ages 60 and older (including those with and without disabilities) reported unmet needs for personal assistance in the past 12 months. Rates of unmet need were higher among groups that are more likely to have a disability and limited resources.
  • Older adults were more likely than their peers to report unmet needs for personal assistance if they had family incomes below 200 percent of the federal poverty level (FPL) (20.9 percent), were Black (14.5 percent), or were in fair or poor health (28.6 percent).
  • These disparities in unmet personal assistance needs persisted when the sample was limited to older adults with disabilities.
• Among adults ages 65 and older enrolled in Medicare, those who also participated in Medicaid (known as dual enrollees) faced the greatest level of unmet need for personal assistance.
  • One in four (24.8 percent) Medicare beneficiaries with dual coverage reported unmet needs, compared with 1 in 10 (9.9 percent) of those with Medicare only.
  • These differences largely reflect the greater level of need for personal assistance among adults with dual coverage, who were more than twice as likely as those with Medicare only to report difficulty with daily activities.
• Adults ages 60 and older who reported unmet personal assistance needs also had significant difficulty meeting other basic needs, such as food, housing, and health care.
  • Nearly 4 in 10 (39.3 percent) older adults with unmet personal assistance needs reported experiencing food insecurity in the past 12 months.
  • Older adults with unmet personal assistance needs were much more likely than their peers to have problems paying family medical bills (29.5 percent) and to forgo needed health care because of the cost (44.4 percent).
  • About 1 in 10 (9.6 percent) older adults with unmet personal assistance needs reported problems paying the rent or mortgage in the past 12 months, 14.5 percent had problems paying heating and electricity bills, and 5.1 percent had one of these utilities shut off.
• About 18 percent of adults ages 60 and older reported that they regularly provide help or take care of an adult relative or friend who needs assistance due to aging, disability, or illness.
  • These findings suggest that federal and state policy decisions concerning access to paid personal assistance services may affect older adults both as service beneficiaries and as caregivers.

More information is available in the issue brief here.