The Internal Revenue Service has been cited as indicating that average Americans work about 3 months of each year to earn enough money to pay their income taxes. Most of us also spend considerable time searching for allowable deductions to make the tax bite as painless as possible and generally end up doing at least a little complaining about how the government spends our hard-earned tax dollars. While Medicare and Medicaid are frequently faulted for their cost, inefficiencies, and reimbursement policies, they prove extremely beneficial in serving the populations for which they were originally designed. Just as the Social Security system was not intended to be a retirement policy for all individuals, Medicare and Medicaid were not planned as a national health insurance system. The following is my perspective on some of the ways in which these programs meet critical health care needs, permitting elderly individuals to remain in their and to live with a greater level of dignity than would otherwise be possible. THE INEVITABILITY OF THE AGING PROCESS In most contemporary American families, elderly parents harbor a fear of and seemingly pass that fear on to their children, exhorting them never to put them in a (or whatever those places might be called), whatever the reasons. Responsibility for management of the financial, business, and personal affairs of partially or fully disabled elderly relatives, especially parents, seems to fall most often to the oldest surviving female child. She usually makes most of the major decisions with regard to payment of bills, insurance, preparation of estate documents, medical care, and living arrangements. She frequently assumes overall responsibility for the delivery of most of the actual nonhos-pital health care received by the disabled person and often provides that care in her own home. My mother had only two children, both male, both now in their 60s, both living hundreds of miles from her in Massachusetts, and both ill equipped to perform as successful caregivers. We also shared my mother's skepticism about the dreaded nursing homes and their counterpart assisted living facilities. We would do most anything to avoid placing our mother in a nursing home but, on balance, were aware of the inevitable. My mother, a fiercely independent and intelligent woman, had enjoyed a relatively uneventful medical history through her 83rd year, with the notable exception of sustaining three transient ischemic attacks in 1982. Her physicians recommended a bilateral carotid endarterectomy, as both carotid arteries were 90% blocked. After doing her own research, she declined the procedure, a decision based mostly on her age, overall risk of the operation, and unwillingness to undergo surgery. Her doctors prescribed Couma-din as an anticoagulant. Although management of this medication required biweekly trips to the physician's office to have blood drawn, she was ambulatory and easily capable of walking. At the time, she lived in a one-bedroom, low-income, federally and state-subsidized apartment building in Fall River, Massachusetts. Her primary means of financial support was through Social Security. At some point in about the spring of 2002, my mother, now age 91, began having difficulty remembering near-term occurrences. She also began to repeat her recollections of daily events excessively, began having extensive difficulties using the telephone, expressed fear about handling money (which she had hidden in various places throughout her apartment), and began wandering the corridors of her apartment building in the early morning hours, unsure of where she was going. Her ability to distinguish between day and night was also compromised on occasion, and she would frequently take her many medications at inappropriate times or not at all or would take multiple days' medication. INTERIM SOLUTIONS As a result of concerns expressed by neighbors and close friends, along with several falls requiring initial hospital stays and subsequent short stays in local for rehabilitation, she applied for and received supplemental security income (SSI) and Medicaid (a. …