Mr. Starnes, 49, lives in Dayspring Village, a former motel that is licensed by the State of Florida as an assisted living center for people with mental illness. When he gets his medications, he is stable.

"Without them," he said, "I get aggravated at myself, I have terrible pain in my gut, I feel as if I am freezing one moment and burning up the next moment. I go haywire, and I want to hurt myself."

Mix-ups in the first weeks of the Medicare drug benefit have vexed many beneficiaries and pharmacists. Dr. Steven S. Sharfstein, president of the American Psychiatric Association, said the transition from Medicaid to Medicare had had a particularly severe impact on low-income patients with serious, persistent mental illnesses.

"Relapse, rehospitalization and disruption of essential treatment are some of the consequences," Dr. Sharfstein said.

Dr. Jacqueline M. Feldman, a professor of psychiatry at the University of Alabama at Birmingham, said that two of her patients with schizophrenia had gone to a hospital emergency room because they could not get their medications. Dr. Feldman, who is also the director of a community mental health center, said "relapse is becoming more frequent" among her low-income Medicare patients.

Emma L. Hayes, director of emergency services at Ten Broeck Hospital, a psychiatric center in Jacksonville, said, "We have seen some increase in admissions, and anticipate a lot more," as people wrestle with the new drug benefit.

Medicare's free-standing prescription drug plans are not responsible for the costs of hospital care or doctors' services. "They have no business incentive to worry about those costs," said Dr. Joseph J. Parks, medical director of the Missouri Department of Mental Health, who reported that many of his Medicare patients had been unable to get medicines or had experienced delays.

At least 24 states have taken emergency action to pay for prescription drugs if people cannot obtain them by using the new Medicare drug benefit. Florida is not among those states.

In an interview, Alan M. Levine, secretary of the Florida Agency for Health Care Administration, said: "We've set up a phone line and an e-mail address for pharmacists. We try to solve these problems on a case-by-case basis. We have stepped in to get drug plans to pay for prescriptions, so people don't leave the pharmacy without their medications."

Federal officials said they were moving aggressively to fix problems with the drug benefit. About 250 federal employees have been enlisted as caseworkers to help individual patients. The government has told insurers to provide a temporary supply - typically 30 days - of any prescription that a person was previously taking. And Medicare has sent data files to insurers, supposedly listing all low-income people entitled to extra help with premiums and co-payments.

But in many cases, pharmacists say, they still cannot get the information needed to submit claims, to verify eligibility or to calculate the correct co-payments for low-income people. And often, they say, they must wait for hours when they try to reach insurers by telephone.

S. Kimberly Belshé, secretary of the California Health and Human Services Agency, said the actions taken by the federal government "have not been sufficient to address the problems that California residents continue to experience."

At Dayspring Village, in the northeast corner of Florida near Jacksonville, the 80 residents depend heavily on medications. They line up for their medicines three times a day. Members of the staff, standing at a counter, dispense the pills through a window that looks like the ticket booth at a movie theater.

Most of the residents are on Medicare, because they have disabilities, and Medicaid, because they have low incomes. Before Jan. 1, the state's Medicaid program covered their drugs at no charge. Since then, the residents have been covered by a private insurance company under contract to Medicare.

For the first time, residents of Dayspring Village found this month that they were being charged co-payments for their drugs, typically $3 for each prescription. The residents take an average of eight or nine drugs, so the co-payments can take a large share of their cash allowance, which is $54 a month.

Even after the insurer agreed to relax "prior authorization" requirements for a month, it was charging high co-payments for some drugs - $52 apiece for Abilify, an anti-psychotic medicine, and Depakote, a mood stabilizer used in treating bipolar disorder.

The patients take antipsychotic drugs for schizophrenia; more drugs to treat side effects of those drugs, like tremors and insomnia; and still other drugs to treat chronic conditions like diabetes and high blood pressure.

"If I didn't have any of those medications, I would probably be institutionalized for the rest of my life," said Deborah Ann Katz, a 36-year-old Medicare beneficiary at Dayspring. "I'd be hallucinating, hearing voices."

Michael D. Ranne, president of the Jacksonville chapter of the National Alliance on Mental Illness, said the use of powerful psychiatric medications "virtually emptied out state mental hospitals" in the 1970's and early 80's. Ms. Katz said she had been "in and out of hospitals" since she was 13.

Sponsors of the 2003 Medicare law wanted to drive down costs by creating a competitive market for drug insurance. They focused on older Americans, not the disabled. They assumed that beneficiaries would sort through various drug plans to find the one that best met their needs. But that assumption appears unrealistic for people at Dayspring Village.

Heidi L. Fretheim, a case manager for Dayspring residents, said: "If I take them shopping at Wal-Mart, the experience is overwhelming for them. They get nervous. They think the clerks are plotting against them, or out to hurt them."

Residents of Dayspring Village see worms in their food. Some neglect personal hygiene because they hear voices in the shower. When nurses draw blood, some patients want the laboratory to return it so the blood can be put back in their veins.

Under the 2003 Medicare law, low-income people entitled to both Medicare and Medicaid are exempted from all co-payments if they live in a nursing home. But the exemption does not apply to people in assisted living centers like Dayspring Village.

Douglas D. Adkins, executive director of Dayspring Village, said: "Some of the pharmacists have been saying, 'No pills unless we get a co-payment.' Well, how are these people going to get the money for a co-payment? They don't have it."

Eunice Medina, a policy analyst at the Florida Department of Elder Affairs, said the state was trying to "find a solution" for people in assisted living centers.

"We are all aware that the next couple of months will be difficult for these clients, and that the possibility of a transition to a nursing home is their only option if prescriptions are not covered in assisted living facilities," Ms. Medina said in a memorandum to local social service agencies.

Luis E. Collazo, administrator of Palm Breeze, an assisted living center for the mentally ill in Hialeah, Fla., said many of his residents were forgoing their medications on account of the new co-payments.

"Because of their mental illness," Mr. Collazo said, "they don't have the insight to realize the consequences of not taking their medications. Without their medicines, they will definitely go into the hospital."

However, after driving into Manhattan from our home in the suburbs and arriving at the restaurant, we encountered an unwelcome surprise. There was no elevator, ramp or kitchen access, and the restaurant's staff looked at us dumbfounded and confused.

We always come prepared with two different sized ramps of our own, which in most cases do the trick. However, the stairs leading down to the dining room are so steep and numerous that a ramp placed over them would have resembled a ski jump. After a few clumsy attempts to negotiate the situation, the headwaiter very politely informed us that the restaurant was not, in fact, wheelchair-accessible at all, but that the staff would be happy to carry my husband in his wheelchair down the steep flight of steps.

Not only was this plan physically impossible (my husband is a solidly built 200-pound, six-foot man - with the wheelchair, the total load would be 500 pounds), it was also dangerous. Moreover, it was demeaning. Being carried down stairs in full view of the entire dining room would have humiliated my husband, for whom normality is of paramount importance. I know very few people who would willingly accept being put in that position. After all, people flock to Manhattan's fashionable, pricey restaurants and endure enormous bills and long table waits to feel glamorous and be treated like royalty, not to lose their dignity in public. Sadly, my husband and I had no choice but to leave, insisting that our friends stay to enjoy their dinner.

After more than a decade of dealing with this, it is clear to me that many establishments and their staffs do not fully grasp what it means to be wheelchair-accessible. Some places that claim to be fully accessible are not outfitted correctly or completely for the disabled, and many more do not properly train their staff members to respectfully assist those with disabilities. My husband and I are far from being "wheelchair militants" - we are not overly fussy people and are happy to accept help when needed. But we do not particularly enjoy being misled or encountering ignorance, indifference or unnecessary awkwardness.

In another - somewhat comic - example, Tom and I were doing our last-minute Christmas shopping at a big toy store. We parked our car at the handicapped spot in the front, but discovered upon our return that another shopper had parked too close to us, covering the blue lines that are intended for wheelchair ramps. I ran inside and quickly talked to the salespeople, who were apparently so overwhelmed by the Christmas rush that they could not help us out. One of the newer salesgirls was appointed to make the announcement, but was reluctant to mount the podium in front of all the shoppers.

At my wit's end, I grabbed the microphone from the girl, got on the podium and started shouting: "Attention shoppers. Will the owners of the car with the following license plate kindly move their vehicle? You are blocking a handicapped spot." The faulty parker, a sweet older woman, was horrified at her faux pas, apologized profusely and explained she never realized what those blue lines meant.

She's not alone. The failure to consider the needs of disabled people often simply reflects a lack of awareness. I can't tell you how many times a restaurant hostess has asked Tom if he will be getting out of his wheelchair to sit at the table. Why do they ask this? Do they really think he would be rolling around in a $7,000 contraption if he could walk into the restaurant?

Of course, as both the wife of a quadriplegic and a 20-year veteran of the hospitality industry, I am particularly sensitive to the daily challenges the disabled face. But the truth is that there needs to be better enforcement of and adherence to wheelchair access, and only establishments that truly meet those requirements should be permitted to say that they do. People in the hospitality industry, and in other businesses with public spaces, have to be better trained to deal with disabled customers. And everyone should be better educated about the needs of people with disabilities. Otherwise, expect fewer polite requests and just maybe a little more militancy.