In 1983 Medicare’s prospective payment system established billing categories and set costs for inpatient hospital services. In an effort to cut costs, hospitals shortened stays and discharged patients at higher levels of acuity than before. Today the trend continues. In 2004 many frail older adults are being cared for at home—as they were in the early 20th century. The difference now is that family members must operate technologically complex equipment, administer IV drugs, and change complicated dressings