Irwin and Ethel G. were Jewish great-grandparents who lived in a Southern California Jewish retirement community for many years and had previously served there as volunteers for more than 20 years. Irwin, an observant Jew who kept kosher, was hospitalized, diagnosed with terminal cancer and told he had little time to live. His HMO discharged him to a non-Jewish home and would not permit him to use the skilled nursing facility on his Jewish retirement campus, since it was not part of the managed care network. Staff at the Jewish retirement community brought Ethel to see Irwin every day, but Irwin soon died. While California has passed a state return to home law, managed care organizations in Southern California ignore the law and the Health Care Financing Administration says that general federal law preempts the state law and makes the state law unenforceable.

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Rebecca H., an observant Jewish widow in her early 80s with a history of diabetes, had been living in an assisted living facility on a Jewish retirement campus in central Pennsylvania, near several of her children and grandchildren. She fell and required hospitalization. Following her hospital stay, Rebecca needed rehabilitation and her HMO denied access to the Jewish Home. She was discharged to a secular proprietary facility. After an unhappy week far from her friends at the retirement campus, Rebecca transferred to the Jewish Home, relinquishing her right to have the managed care organization pay for her care and "voluntarily" opting out of Medicare coverage. She used up many of her remaining financial assets to pay for her care, for which her children also made payments.

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80-year-old Faina R. lived in Jewish community housing in Florida and was enrolled in a managed care plan. Faina was hospitalized with pneumonia. At the time of her discharge, she asked to be sent to the skilled nursing facility adjacent to her apartment, one maintained by the local Jewish Federation. After enduring a lifetime of anti-Semitism in Russia, Faina felt safe and protected in a Jewish environment. The HMO denied her request on the basis that the nursing home was outside its network, and sent her to an out-of-town secular facility. Once there, Faina's physical and mental condition rapidly deteriorated. She did not trust the new doctors, and they were unfamiliar with her chronic care needs. She believed that she was imprisoned. A Jewish nursing home board member learned about her situation and intervened. Through this special intervention, Faina was able to move to the Jewish home, near family and friends, where she recovered quickly.

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Annie P. was a 95-year-old Orthodox Jew who observed kashrut and who had lived in a Jewish senior campus in Colorado for six years. She broke her hip, and although her senior campus had a skilled nursing facility that was able to provide the therapy that she required, her HMO discharged her to a different facility. The surroundings were unfamiliar to Annie. She did not know the physicians or the facility, and she could not get kosher food. Staff of the Jewish facility volunteered to bring her kosher food in reheatable containers. Neither the insurer nor the contract facility requested or assisted in this endeavor or compensated the Jewish home. Were it not for this facility, her dietary and religious needs would have been lost in the shuffle of insurer convenience and likely documented as "poor appetite." She remained in the HMO's institution, far from her "family" at the Jewish home.

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Ester M., an 85-year-old grandmother in central Florida had emphysema and was a hospice client of a Jewish retirement campus. After hospitalization, she required oxygen 24-hours a day, but was extremely alert. While Ester really wanted a Jewish atmosphere and wanted to remain on her senior campus, her HMO had a contract elsewhere, and she was discharged to a secular home. Ester said she was "heartsick."

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Jonathan and Sara M., in their mid-80s, lived in one of Florida's continuing care retirement communities (CCRC) that included a skilled nursing facility. After Sara was hospitalized with a kidney ailment, her HMO refused to discharge her to the nursing home or the CCRC and instead released her to a home located on the opposite side of the county. The 20 miles presented a hardship to Jonathan, who had difficulty driving, and to Sara who longed to return home. Despite pleas from Jonathan and Sara and the efforts of the CCRC's administrator, the HMO would not allow Sara to recuperate in a familiar setting, close to her husband and friends. Within months, Sara died at the HMO facility, without the benefit of frequent visits from her spouse and friends.