People with vastly different chronic conditions face similar challenges in getting the care and support that they need, including:

• Enormous medical bills that can ultimately lead to bankruptcy for some families;
• Difficulty in keeping a job or even working at all, a challenge that extends to caregivers who must give up work to care for their loved ones;
• A complex and difficult-to-use health care system in which physicians, social agencies, and others do not always work together on behalf of patients.

As traditionally practiced, the American model of medicine excels at treating emergencies such as injuries, heart attacks, and appendicitis. American medicine is less effective at providing care over an extended period of time for one or more chronic conditions. Moreover, American health care is rarely able to carefully tend to the basic needs of patients such as bathing, dressing, preparing meals, or transporting people to and from medical appointments. The health care system is also not equipped to design and alter physical environments to maximize a person's ability to function independently.