This article focuses on the “efficiency” or cost-effectiveness of home care. Because home care encompasses a range of services targeted to many populations, it is necessary to take cognizance of case mix and clarify its goals to assess effectiveness. Goals for home care can be thought of as meeting and/or compensating for client dependency needs or making a difference in the client’s clinical trajectory. The latter implies comparing actual to expected outcomes, where outcomes can cover a wide range of domains addressing quality of care and quality of life. Inferring the effect of treatment (i.e., home care) on various outcomes will likely rely heavily on epidemiological techniques that, in turn, rely on sophisticated statistical techniques. Problems measuring the costs of care include how to handle the costs of informal care and deciding whose costs should be of primary concern. Better data about the costs, and experimentation with different forms of caregiving, need to be pursued.
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