Care of the Chronically Ill at Home: An Unresolved Dilemma in Health Policy for the United States

Abstract

The problems of caring for patients with disabling illnesses who neither get well nor die are not new. Such patients have always required assistance at home from family, benevolent volunteers, or paid caregivers. Despite two centuries of experimentation, however, no agreement exists concerning the balance between the public and private resources to be allocated through state funding, private insurance, and family contributions for the daily and routine care at home for chronically ill persons of all ages. This article examines these issues and the unavoidable tensions between fiscal reality and legitimate need. It also uses historical and policy analyses to explain why home care has never become the cornerstone for caring for the chronically ill.

Medicare Home Health Payment Reform May Jeopardize Access For Clinically Complex And Socially Vulnerable Patients

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Childhood epilepsy in a tropical child psychiatric unit: Challenges of providing care in a resource-constrained environment

“…[17] Provision of home care, in chronic illnesses, has been observed to be daunting even in developed countries where several cushioning facilities are available. [14,18] Apprehension, discrimination, and communal isolation driven by alarming traditional beliefs and myths about epilepsy could be adduced for the preclusion of home care to caregivers or immediate family members. For the majority of these caregivers, there is a need for initiation and implementation of family-centered programs that assist in the provision of care to the child and support for the families.…”

Living in the Community With Dementia: Who Receives Paid Care?

“…To date, there is no clear consensus or healthcare policy that addresses the long-term care needs of those with functional and cognitive impairment. 29,30 Expansion of programs that provide direct payment to family members for caregiving roles is needed to further support family caregivers as they provide the lion's share of care in the community. Yet, new ways of making paid caregiving more accessible are required if an individual's preferences to remain living in the community are to be met.…”