A public hospital based geriatric 'community care system'

18% of aged family and 47% of aged single individuals in the US are at or below the poverty level (Chen, 1971). A large percentage of these impoverished people have physical and/or mental illness leading to significant disability and need for coordinated health care. These are the elderly most in need of a new health system, a system that does not require one to struggle to obtain the necessary social and medical support. Utilization of the present system requires mobility, strength, competitiveness, money, and keen awareness of the splintering of services; just the characteristics opposite to the life situation of most of the ill elderly. What is needed is a health 'system' in each community, which provides both medical and social security in the broadest sense of the terms, and is endowed with capacity to provide many necessary 'at home' social, nursing and medical support services; capacity to institutionalize at general acute hospital, convalescent, and long term facilities, for varying time intervals; options within the community for varying types of ambulatory care; and a simple coordinating and finance mechanism.