A 102-year-old man I know is likely to be sent home from rehab today. This 102-year-old man lives in another state. Until three weeks ago, he was driving, playing tennis, and living in his own home. Over the last few months, he developed leg swelling and then shortness of breath, likely the result of some heart failure and some disturbances in the heart’s rhythm, which put him in the hospital for about a week. The hospital adjusted his medicines and got him much better, but he was still left pretty weak, so he went to rehab for two weeks –– he was unsteady on his feet with limited endurance, and he had to relearn how to get out of a chair and climb stairs – and he now walks with a walker but is able to take care of himself again. All good.
But. He lives alone in a house with a staircase to the second floor where the bedrooms and shower are. That’s a pretty big jump to go from rehab, surrounded by people and walking with a walker, to being at home with a big staircase and other obstacles.
Rehab wanted to send him home next Tuesday, but of course his Medicare Advantage insurance denied coverage, and then refused an appeal, so he’s likely going home today.
He’s a proud guy who doesn’t want anything from anyone. The good news is that he has a close and supportive family, who are organizing a hospital bed for the first floor. One of his children will stay with him for the first week or so, so he will have good support at home.
That said, he’s probably leaving on a Friday. It’s not clear if home health will get there today or tomorrow, and fairly certain that physical therapy won’t arrive until next week. He will not have had a home safety evaluation, to test how safe he is in his actual home environment, until after he gets home, and there hasn’t been enough time to carefully prepare his home for his return, although his children are scurrying about to make his house as safe and comfortable as possible.
This 102-year-old man’s situation is pretty common among elderly people, who eventually weaken with age. People do okay until they don’t. More often than not that weakness turns into a small or large crisis which leads to a hospital stay, and then they and we try to organize what comes next, which is often some version of scurrying about, patching together services that are covered by insurance, with additional resources from people themselves and their families, every situation being a little different, each in its own way, to paraphrase Leo Tolstoy. Many choices are dictated by insurance companies, unless families step in and pay for extra, and sometimes needed, services.
Now let’s take a moment to imagine a different scenario. Imagine we had an actual health care system, instead of a health care marketplace that exists to sell services and maximize profit. In such a system, imagine that every community of 10,000 people might have a primary care center which had primary care doctors and nurses, physical and occupational therapists, mental and behavioral health professionals, home health nurses and nursing assistants and home health aides and community health workers all working together to take care of everyone in that community.
If such a system was in place, no one would worry about what day this 102-year-old man comes home, because there would be a team of people, in the community, ready to receive and help support my him at home. The home safety evaluation would have been conducted a day or two before discharge, by bringing the 102-year-old home for a few hours, testing to see how he did on the stairs, and making sure the house had a hospital bed and a shower stool and the guardrails and grab bars needed to make a house safe for a becoming-a-little-frailer 102-year-old. And no insurance company would be calling the shots.
The great thing about health care in the US in 2026 is that we have lots of knowledge and technologies to help becoming-frailer 102-year-olds be safe and live proud and independent lives, longer, at home.
But we don’t have a health care system that takes care of everyone and makes best use of our knowledge and ability. Instead we have a market focused on profit. And health insurers, focused on their bottom line.
That’s crazy.
P.S. Looks like the 102-year-old-man’s discharge just got held up by a complication. There is a new round of appeals in the works. His family may just pay out of pocket for a few extra days if those appeals are denied again. Which makes this process sound more like criminal activity than normal aging. Or a game of Whack-a-Mole. Can’t we do better for people who make it to 102?
Michael Fine will be reading short stories this Thursday, June 18th at 5 pm at Hotel Viking, One Bellevue Avenue, Newport RI, as part of the Hotel Viking’s cultural programming series.
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