Home-Based Care for a New Century

With expansion, the home-care market is becoming more diverse and more competitive. For-profit agencies are multiplying. Nursing homes and hospital systems are moving beyond their institutional walls to provide an array of home- and community-based services. Managed care organizations are enrolling record numbers of individuals and families. They and other third-party payers are aggressively shopping among home-care providers, seeking better value for money. The articles that comprise this book, commissioned by the Milbank Memorial Fund and the Visiting Nurse Service of New York, address these issues.

Daniel M. Fox is president of the Milbank Memorial Fund. His most recent book, Power and Illness: The Failure of American Health Policy (1993), was reissued in paperback in 1995.

Carol Raphael is president and chief executive officer of the Visiting Nurse Service of New York, the largest voluntary home health organization in the United States. Prior to joining the Visiting Nurse Service of New York, she was director of operations management at the Mount Sinai Medical Center in New York City. Before that, she worked at the New York City Human Resources Administration for ten years, ending in the position of executive deputy commissioner of the Income and Medical Assistance Administration.

Contributors

vii

(2)

Foreword

ix

(2)

Samuel L. Milbank

Carl H. Pforzheimer III

Acknowledgments

xi

Introduction

1

(4)

Daniel M. Fox

Carol Raphael

1 The Restructuring of Home Care

5

(18)

Carroll L. Estes

Elizabeth A. Binney

2 Boundaries of Home Care: Can a Home-Care Approach Transform LTC Institutions

23

(24)

Rosalie A. Kane

3 Home-Care Politics in the 1990s

47

(24)

A.E. Benjamin

4 Integration of Home--and Community-Based Services: Issues for the 1990s

71

(28)

Robyn I. Stone

5 Home Health Services in a Managed-Care System: Policy Recommendations from a Program of Research

99

(22)

Merwyn R. Greenlick

Kathleen K. Brody

6 Home-Care Dollars and Sense: A Prescription for Policy

121

(14)

William G. Weissert

7 Financing Long-term Care

135

(20)

Robert B. Friedland

8 Labor Market Issues in Home Care

155

(30)

Penny Hollander Feldman

9 Housing Policy and Home-Based Care

185

(34)

Sandra J. Newman

10 Care at Home for Children with Chronic Illness: Program and Policy Implications

219

(26)

James M. Perrin

Ute Thyen

Sheila Bloom

11 AIDS and Home Care: Lessons for Policy and Practice

245

(24)

David A. Gould

12 Home Care for Persons with Serious Mental Illnesses

269

(24)

Allan V. Horwitz

Susan Reinhard

Index

293

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Home-Based Care for a New Century

Summary

Author Biography

Table of Contents

Supplemental Materials