You've probably seen it with loved ones. An elderly person checks out of a hospital or nursing home only to be readmitted within a few months.

During the transition, medications weren't taken, doctor appointments weren't made and chronic illnesses weren't cared for. The downward spiral seems unstoppable, the medical bills never-ending. And you're at a loss for what to do.

At least one in five people with Medicare are readmitted to the hospital within one month of discharge.