Case management is desperately needed for elders with multiple comorbid conditions and impaired function. In many cases, elderly patients are discharged from the hospital way too early, with inadequate resources at home to meet their complex needs (oftentimes under the care of a frail spouse). They then end up in the ER for one or two visits, then back in the hospital again (within a few days of the original hospital discharge). (Just had a case like this in the ER last night.) The costs to Medicare for this sort of mismanagement are enormous.