This paper provides an overview of the evolution of the system of services developed to take care of the needs of the rapidly increasing older adult population in the United States. It also covers the current policy issues being discussed at all levels of government based on the fact that according to the United States Census, the elderly population by 2030 will reach 70 million people which amount to a doubling of persons 65 and older since 2000. This has implications not only in terms of governmental policy decision, but the impact on families, the workforce and upon communities in which older adults reside, in addition to growing health care demands, the need for better long term care options is increasing.