have access to this kind of home-based primary care.
Gliatto and his staff— seven part-time doctors, three nurse practitioners, two nurses, two social workers and three administrative staffers— serve about 1,000 patients in Manhattan each year.
First, Gliatto stopped in to see Sandra Pettway, 79, who never married or had children and has lived by herself in a two-bedroom Harlem apartment for 30 years.
Pettway has severe spinal problems and back pain, as well as Type 2 diabetes and depression. She has difficulty moving around and rarely leaves her apartment.“ Since the pandemic, it’ s been awfully lonely,” she told me.
When I asked who checks in on her, Pettway mentioned her next-door neighbor. There’ s no one else she sees regularly.
Pettway told the doctor she was increasingly apprehensive about an upcoming spinal surgery. He reassured her that Medicare would cover in-home nursing care, aides and physical therapy services.
“ Someone will be with you, at least for six weeks,” he said. Left unsaid: Afterward, she would be on her own.( The surgery in April went well, Gliatto reported later.)
Several blocks away, Gliatto visited Dickens, who has lived in her one-bedroom Harlem apartment for 31 years. Dickens told me she hasn’ t seen other people regularly since her sister, who used to help her out, had a stroke. Most of the neighbors she knew well have died. Her only other close relative is a niece in the Bronx whom she sees about once a month.
Dickens worked with special-education students for decades in New York City’ s public schools. Now she lives on a small pension and Social Security— too much to qualify for Medicaid.( Medicaid, the program for low-income people, will pay for aides in the home. Medicare, which covers people over age 65, does not.) Like Pettway, she has only a small fixed income, so she can’ t afford in-home help.
Every Friday, God’ s Love We Deliver, an organization that prepares medically tailored meals for sick people, delivers a week’ s worth of frozen breakfasts and dinners that Dickens reheats in the microwave. She almost never goes out. When she has energy, she tries to do a bit of cleaning.
Without the ongoing attention from Gliatto, Dickens doesn’ t know what she’ d do.
The next day, Gliatto visited Marianne Gluck Morrison, 73, a former survey researcher for New York City’ s personnel department, in her cluttered Greenwich Village apartment. Morrison, who doesn’ t have any siblings or children, was widowed in 2010 and has lived alone since.
Morrison said she’ d been feeling dizzy over the past few weeks, and Gliatto gave her a basic neurological exam, asking her to follow his fingers with her eyes and touch her fingers to her nose.
“ I think your problem is with your ear, not your brain,” he told her, describing symptoms of vertigo.
Because she had severe wounds on her feet related to Type 2 diabetes, Morrison had been getting home health care for several weeks through Medicare. But those services— help from aides, nurses and physical therapists— were due to expire in two weeks.
“ I don’ t know what I’ ll do then, probably just spend a lot of time in bed,” Morrison told me. Among her other medical conditions: congestive heart failure, osteoarthritis, an irregular heartbeat, chronic kidney disease and depression.
Morrison hasn’ t left her apartment since November 2023, when she returned home after a hospitalization and several months at a rehabilitation center. Climbing the three steps that lead up into her apartment building is simply too hard.
“ It’ s hard to be by myself so much of the time. It’ s lonely,” she told me.“ I would love to have people see me in the house. But at this point, because of the clutter, I can’ t do it.”
Bruce Leff, director of the Center for Transformative Geriatric Research at the Johns Hopkins School of Medicine, is a leading advocate of home-based medical care.“ It’ s kind of amazing how people find ways to get by,” he said when I asked him about homebound older adults who live alone.“ There’ s a significant degree of frailty and vulnerability, but there is also substantial resilience.”
With the rapid expansion of the aging population in the years ahead, Leff is convinced that more kinds of care will move into the home, everything from rehab services to palliative care to hospital-level services But that will be challenging for homebound older adults who are on their own. Without on-site family caregivers, there may be no one around to help manage this home-based care.
8 SENIOR RESOURCE GUIDE 2025