Given the multiple health problems faced by many older Americans, and the range of health care
settings and professionals who serve their needs, it is notsurprising that many experience serious
discontinuities in care. This article examines research conducted on previous approaches to
addressing discontinuities, such as case management to enable frail elderly to remain in home
and community settings. The article identifies limits in such approaches, in particular their focus
on solving problems at the individual rather than at the organizational and system levels. It
proposes that the application of theories of interorganizational relations, in particular resource
dependency and transaction costs theories, may better address the structural factors that
determine the persistence of discontinuities in the experiences of the elderly.
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