Consider the case of Mrs. Hamilton. An 81-year-old widow, she lives alone in her own home. She has no grandchildren. She raised a son and two daughters who were the joy of her life until all three were killed in a bizarre bus accident four years ago. After recovering from a stroke, Mrs. Hamilton was diagnosed as having uncontrolled hypertension. In October 1978, she was assigned a home health aide for two hours twice a week.
The nurse would come, monitor Mrs. Hamilton’s blood pressure, and talk with her. Sometimes the nurse would stop at the A&P or the pharmacy to save her patient a trip. Mrs. Hamilton looked forward to these visits. Then one day she was informed that her Medicare allotment of home health care was exhausted; under the law, she was not permitted to receive more than one hundred visits unless she first submitted to a period of hospitalization or a stay in a nursing home. Both patient and doctor protested this hospitalization requirement: Mrs. Hamilton was not in need of institutional care. And the very thought of a nursing home frightened her. “Why should I have togotoa nursing home? I already have a home,” she said. Her father, a German immigrant, had always regarded the Altenhaus or “oldfolks’ home” as the place where society put the discards of life, the hopelessly infirm, the maladjusted, the insane. If that ever was the case, it is no longer, but try to convince Mrs. Hamilton of that.
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