Leutz and his colleagues offer the most practice-oriented and realistic assessment of how chronically ill elders are being served at the community level. They analyze options and opportunities open to policy makers and practitioners relative to long-term care in the community environment where so many elders want to be. In the process, the authors evaluate the range of needs, the importance of gender and cultural differences, and the effectiveness of Medicare and Medicaid as entitlement strategies.

Community care constitutes a major gap in the nation's health-care system. The authors show that there are many persuasive reasons to build, staff, manage, and pay for high quality community-care systems. Such programs are demonstrated to be affordable and to meet better the needs of a large percentage of elders who require long-term care. The authors set forth goals for community-care systems and criteria for assessment. This timely analysis, coupled with practical, socially compelling recommendations, responds effectively to the realities of an aging population and the great public policy and related fiscal concerns.