You cannot practice medicine in the closing years of the millennium and not know what this is about. They want to tell me what the approved days of hospitalization will be for E.T. I tell them the problem, and they tell me the length of stay for which they will pay for the patient’s hospital expenses.

I pick up the telephone and begin, “Hello, nice to hear from you. Yes, E.T. is my patient. It was necessary to hospitalize him last night when his spacecraft crashed near Memorial Hospital. He is an elderly alien, as best we can tell. His vital signs are stable, but we are uncertain if they are normal for his species. He is in the Cardiac Care Unit and is bright red. I called neurology, orthopedic, cardiology and genetics consultants. His mental status caught my attention. He moves objects by his will alone. Ortho is interested because his bones didn’t break in the crash. They simply bent. Genetics heard about the case and came as a courtesy. I am handling his nutrition. He is coming along nicely. That is the case in a nutshell. Pretty exciting for all of us!”

Then, without a pause, I am asked, “Is the patient on a breathing machine? Is the patient in a coma? Is the patient likely to require surgery? I answer “No” to all three questions, but sensing I am losing the debate for length of stay, I quickly add, “E.T. is going to need some time to regain strength, and we need to see if he can take care of himself. He does have a long ride home. Then the answer. “Dr. Costrini, we approve E.T. for a 4-day hospital stay. Try and set up home care with our recently established Intra-Galactic Home Health System. Have a good day.” Crestfallen, I hang up.

The above story is nearly true. Would I make up something like that? The elderly have a real problem these days. The number of Americans over age 65 has increased from one million in 1900 to 37 million today. During that time life-expectancy has increased by 20 years, in part because of life-saving medical care during hospitalizations; however, one-third of hospitalized senior citizens are discharged in worse shape than when they entered, as measured in terms of ability to care for themselves. The patient survives pneumonia, is discharged in five days, but cannot bathe, dress, or walk as independently as before hospitalization. Unless carefully monitored, the patient is at risk for a fall and injury, malnutrition, and additional illness or depression, due to loss of independence.

For most inhabitants of this world, getting along after discharge cannot be taken for granted. The single greatest challenge in medicine is the improvement in care of the elderly as their numbers approach the 50 million mark in the first decades of the new millennium.

With the changes in healthcare financing, there is at this time a very worrisome trend we all must know to protect ourselves and our families. At a time when the average age of the hospitalized patient is increasing, the length of hospital stay is falling. This is harder to believe than my giving Ensure to E.T., but it is true. It is due to the simultaneous occurrence of two events in history: the aging of America and the necessity of controlling health care costs. What to do?

First, identify the risk factors for loss of success as an outpatient due to being an inpatient. These include age, mental status, and pre-existing problems with independent living. If the patient is 80 rather than 70, has had episodes of confusion before hospitalization, or has had difficulty with managing finances, doing housework, or shopping before entering the hospital, it’s more likely that patient will require time to reach the level of independence he/she previously enjoyed.

Second, when you enter the hospital (better yet, when you enter the galaxy served by your hospital), find out about the hospital-associated rehabilitation programs and “transitional care” floors of the hospital. It is not out of this world for our senior citizens to have four days of hospital stay for acute care followed by a two-week care period in an area of the hospital less costly but more dedicated to ensuring the recovery of out-patient independence.

By the way, E.T. phoned home to say, “I am doing well, son. I’ll be in rehab for a while, then I’ll return home in good health…thanks to medical care on Earth.”