Rethinking the organization of children's programs: lessons from the elderly.

The U.S. system of care for children is a collection of activities and funding mechanisms that create a complex, fragmented patchwork of services and programs. In contrast, the elderly enjoy universal entitlement to national health insurance through Medicare, a uniform level of income security, and an organized system of community-based services. The provisions of the Older Americans Act (OAA) are compared with the current program of maternal and child health services. Basic features of the national policy--and the core program and administrative infrastructure of the OAA--may serve as a model to meet the special challenges of child and family services. The tools for building the coordinated, comprehensive service system that was devised for the elderly are also available to improve the lives of children. Federal legislation is needed to create the special protections that are basic to the organization and delivery of services and to the assurance of a permanent national policy focus for children and families.