The history of long-term home health care (HHC) for aging persons in the United States is one of alternating successes and of dashed hopes for persons wishing to remain in their own homes during their last years. Personal issues and public policy issues are woven into a maze of challenges faced by individuals and families wrestling with the difficult choice of elder health care options. Some of the elements of choosing home health care options are presented, and a suggestion of fundamental reform that puts Medicare and Medicaid on the table is suggested as a means to develop a new framework for social work services in home health care.
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