Also accompanying this growth in the availability of home care is a rising concern about how to assure that consumers receive high-quality services. Congress addressed home care quality issues in a number of bills introduced during 1987 and 1988. These bills proposed specific quality assurance mechanisms, uniform standards of care, and Federal regulation. Additionally, in 1987, Congress enacted changes to the Medicare program which included a patients' bill of rights and competency testing for home health aides as means of improving the quality of home care funded by that program. Federal home care funding agencies as well as nongovernmental agencies and organizations are also addressing home care quality issues through research efforts, national conferences, and accreditation and certification programs.
Standards are the criteria against which programs assess quality.
The most frequently reported standards for home care providers pertain to worker training, worker certification, licensing, and provider approval. While home health programs tend to have more rigorous training requirements, some supportive care programs also have highly developed standards for training homemakers and personal care aides. Worker certification is required by a number of state programs and is usually tied to training requirements for home health aides or personal care attendants. Very few supportive care programs have worker certification standards. Four-fifths of the study states license home health agencies, and there is little variation in approaches to licensure.