The Quality of Home and Community-Based Services

Abstract

The quality of long-term home health services is particularly difficult to study because of (a) the multidimensionality and chronicity of patients' needs, (b) the complexity of and the number of social and health-related services provided, (c) the isolation of care in individual homes, and (d) the lack of norms and standards on which to base judgments. A study was undertaken of the quality of care received by two client groups receiving home- and community-based services, in which some of these difficulties were addressed. An expert committee of home health practitioners wrote criteria for process and outcomes of care based on local norms of practice. Applying these criteria to the care received by the study groups, the committee found a high degree of quality of care. Specific problems identified in the care were a lack of appropriate case management and poor chart documentation. In most cases, if good care was received, the client experienced good outcomes.

Rural Case Management

“…The study also indicated the need for better data upon which to base policy decisions about problems such as lack of community resources for long term care; fragmentation and duplication of services; lack of support for the family caregiving system; and coordination between institutional and community-based acute and long term health services. Case management was studied in an evaluation of the quality of care in Kentucky's Home and Cornmunitybased waiver (Beaulieu, 1991). That study documented that activities not strictly defined as case management, such as aid supervisory visits, were being interpreted by agencies as "case management.…”