Growth and change in the funding and provision of home care for the elderly.

Home care has been promoted as an alternative to acute and long-term care in hospitals and nursing homes in the interests of controlling the high and rising costs of institutional care. This has resulted in legislative and regulatory changes to public programs, of which the elderly are the main beneficiaries. Consequently, there has been major growth and change in the home care industry with Medicare being the largest third-party payor and primary income source for many home care agencies. The industry is now coming under closer scrutiny as a result of the increasing public expenditures, and concerns regarding public accountability and the cost-effectiveness of care delivered by this fragmented and relatively unregulated sector have been expressed. There is now increasing evidence that industry expectations of future growth may not be met from publicly funded home care programs for the elderly as currently conceived, regulated, and reimbursed. Changes are likely to result in an expanded role for the physician in home health care planning and supervision.