The growth in home care use has been accompanied by concerns about the quality of the care provided. Many untrained workers care for people in the isolation of the home with little or no supervision. Anecdotal reports or occasional media stories about fraud or abuse of home care recipients have raised fears about safety. Policymakers and regulators want to know if public monies are paying for effective services that result in better health or improved functioning for the consumer. Researchers question whether current quality assessment tools are capable of measuring quality of care.
Consumers ask whether home care workers have been adequately trained for the services they provide.
The extensive literature on quality of home care addresses these issues by examining the roles played by government regulators, researchers, home care workers, and consumers in assuring quality care. This report provides an overview of this literature to summarize the debate and discussion. An understanding of these issues can help educate the consumer, inform the policymaker, and guide future research. Section II describes a quality assurance model upon which regulators and researchers have relied for years to provide a framework for their work. Section III discusses the federal and state regulatory roles, particularly under the Medicare and Medicaid programs.