An historical perspective on home care policy.

Although home care has received increased policy attention in recent years, the health services literature does not offer a historical perspective. The way home care is viewed and the nature of its support have changed significantly, yet history also suggests continuity. The era of modern medicine has relegated the status of home care to that of a residual set of follow-up services and there has been a lack of consensus about the goals of home care. For about 75 years, the legitimacy of home care has depended upon claims that it would relieve utilization and costs of institutional care, which has served both to maintain its policy salience and to undermine its legitimacy. Profound demographic and fiscal changes have increased the demand for home care, especially among the chronically ill, but various issues remain unresolved.