At the signing of the Medicare bill in 1965, president Lyndon B. Johnson remarked that the American tradition of helping those in despair was at the core of the law. He said, “It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.”1 Today, Medicare's potential for mitigating untended morbidity and mortality remains unmet. The prevailing public policy discussion is that Medicare is too costly and the anticipated increase in spending is unsustainable.2 Despite high Medicare expenses, older adults with serious chronic illness are at high risk for mortality, functional limitations, poor quality of life, high out-of-pocket costs, and often report dissatisfaction with their care and barriers to adequate care.3-5 For the most ill and costly beneficiaries, physical illness and mental health problems are frequently compounded by the burden placed on a family caregiver, a “hidden patient” whose physical and emotional needs often remain unnoticed.6