I appreciate the comments of Dr. Somers and Mr. Sloan and agree that life care communities offer many advantages. Unfortunately, Dr. Somers may have misinterpreted my central point. It was not to relate one elderly woman's typical "touching story" but rather to demonstrate how these communities can have a negative impact, primarily because residents must repeatedly relive life's terminal events and chronic disabilities. As both writers correctly point out, the closeness of such experiences can also lead to more support from the group and allow some residents to cope more effectively, but, in my experience, it is certainly not the rule.

Like Dr. Somers, I doubt that there is an optimal answer for dealing with the declining years. In our society, the days of the extended family, living in close proximity and caring for its own, while almost over, continue to exist, especially in some rural populations and urban ethnic neighborhoods. It offers the advantage of intergenerational coping and support and avoids the concentration of so many of life's negative events into a small social unit. In a sense, it "dilutes" chronic disability, long-term care, and aging across generations.

In the search for better solutions, the efforts of the Institute of Medicine and other groups deserve our support. For the immediate future, life care communities will continue to offer a viable alternative for those who can afford them. My plea is that we make the elderly who select them aware of both their obvious advantages and their more subtle disadvantages and that more organized support be provided to assist life care community residents in coping with what befalls them.