These are predictable challenges. We already know nearly everyone in the United States who will be 85 years old in 25 years. So, where is the serious planning? Recent health reform debates cast the issues of frailty, dependency, multiple chronic conditions, and dying as small side issues in a care system dominated by hospitals and physicians who just need a little more reliability and efficiency. Yet, on any day, more people are in nursing homes than hospitals.5 Already, approximately $203 billion are spent annually on long-term care, and the voluntary support of family is estimated at an additional $450 billion.6 Those sums will multiply as the baby boomers age, as the 2 reports in this issue of the Archives demonstrate.3,4 By 2050, approximately 27 million people will need formal long-term care,7 compared with the current prevalence of 9 million.8 Yet no comprehensive plan for efficient, reliable, medical care and supportive services exists. Other developed countries have policies to support family caregivers, and they have local authorities that monitor and try to meet needs for transportation, in-home aides, and medication delivery. The United States does not; we do not even have deliberate policy to expand the ranks of personnel needed to meet the coming demands, whether front-line home health aides or geriatricians.