Expanded home-based care for the impaired elderly: solution or pipe dream?

Benefits assumed by those calling for massive expansion of home health care to include preventive, health-supportive services for the dependent aged--reduced institutionalization, reduced stress among family caregivers, and enhanced life-satisfaction for the dependent elderly--have been the objects of inadequate research and reflection. Advocates are unable to specify exactly what kind of person could benefit or who would seek to use such services. The little evidence that exists suggests that these benefits may be realized only partially and/or only among select segments of the population affected. A significantly reduced rate of institutionalization appears especially questionable. Only for a relatively small group, those mildly impaired persons without close kin (who now sometimes end up in lower level nursing homes or domiciliary care homes due to absence of this resource), does expansion of long-term maintenance services appear at this point to hold such potential. Local experiments with expanded home-based programs suggest that there may be a number of factors which could limit demand for such services. Carefully designed research to address these issues is needed.