1.4 Why refer frail elders to a MediCaring service delivery system?

The question here is whether frail elderly people could just opt into MediCaring services from time to time and stay in some other payment and delivery system at other times. Two strong reasons argue against this course. First, the MediCaring approach is meant to be comprehensive, to build on a strong and shared individual care plan, and to be supportive of the elderly person (and family) goals at every turn. Having frail elders use whatever services happen to be offered at any point would eliminate the coherence and excellence of the overall plan and would make it very difficult to manage. This would invite the chaos that would ensue if every high school student could just drop into classes of interest, anywhere in the county. There would be no continuity, no overall plan to assure timeliness and adequate coverage, and no management of the system supply and quality. In addition, at least the first years of MediCaring depend upon capturing the savings from more prudent and appropriate use of Medicare-covered services. Calculating those savings is much more plausible for a well-defined population, even though it would always be possible to sign up and later leave the program. The elderly person keeps control.