The role of personal care aides will become vitally crucial in behavioral health for elderly over the next 5 years and it will be interesting to see how well managed care plans cover these services, how coverage and allowable hours change, and specifically what sorts of criteria health plans implement to ensure these aides are adequately trained in assessing, recognizing and managing things like depression and anxiety. Will they, for example, be able to help patients recover from a fear of falling? I say this as my mother-in-law just fell three times over a two week period last month, the last fall knocking her out and landing her at Beverly Hospital in Massachusetts. The hospital mostly focused on stabilizing her, dealing with a broken shoulder, and preparing her for the next level of care. There was some effort made to determining the reason for the fall, but not significant; there was some “testing” to check for cardiac related issues, but her EKG was generally normal. Apparent to me and my family was the clear absence of the physician, or at least the same physician, in the process. There was a swift decision to move mom off her blood pressure medication after she was determined to be orthostatic but discussion about the true reason for the falls was limited. Ultimately, my family suggested that mom was not eating and drinking and that dehydration or scarily low nutrition led to the falls. The hospital concurred, but again, there was no discussion or at least introduction about the cause of not eating or drinking. After 10 days in post acute rehab, mom is now home here with us and beginning to regain strength and learn activities of daily living. “These cases are unfortunately far too common,” says Dr. Michael Yanuck, MD, a friend of mine who I called to discuss mom’s situation. And I suspect preventive treatment including how to manage medications and how to eat and drink properly is ideal but not always practical as America ages and many of our parents are alone, as was the case with my mother-in-law. Just how many social workers and aides will be available to help? Will they be trained and up to speed on the latest techniques? And will they be simply used in post acute transitional support or more long-term?