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Senator John McCain is determined to implement changes to the U.S. health care system by making it more efficient and more responsive to consumers. Like the 50 state governors who on average see one fifth or more of their budgets taken up by Medicaid (their largest single expense), he has asserted that there is a crisis coming in the form of long-term care. Like the National Governors Association, he believes that moving from institutional care to home and community-based care is a large part of the answer. However, he favors bundling of health care services, and cash and counseling models which would give money to those in need, allowing them to hire their home care services directly. In respect to these ideas, he differs from his Democratic opponent. This is also true with respect to Senator McCain's belief that any changes in the health care system should be done through the private insurance market instead of expanding public insurance programs such as Medicare.

For more than thirty years, forward-looking gerontologists and entrepreneurs have realized the potential market for private-pay home care services and have proposed creative approaches to meeting the projected demand. Innovative ventures ranging from "life care at home" to "virtual retirement communities" have been launched throughout the country in an attempt to meet a growing need while responding to an unprecedented business opportunity. While these ventures reflect intriguing ideas, the story of an unconventional private-pay home care company in Greater Boston suggests that innovation and creativity are most needed to transform the fundamentals of private-pay service delivery: responsiveness, reliability, customer service, and sales.

When confronted with their own or their loved one's cognitive decline, many people attribute it to "normal aging." Home care providers, due to their regular interaction with their clients, may be the first to identify dementia. As such, home care providers can play an important role by encouraging those involved to address the problem and develop a plan of care to help them to successfully navigate the challenges they face. Alzheimer's disease is one of the most common causes of dementia. This article identifies the warning signs of Alzheimer's disease and provides advice to home care providers on intervention and how to care for patients who are cognitively impaired.

Our nation's battle with the bulge has contributed to the current co-epidemics of obesity and metabolic syndrome. The US Surgeon General's office reports that these disease risks may soon cause as much disease and death as cigarette smoking (HHS, 2001). In the United States, one in four adults has metabolic syndrome, which includes about 15 million persons with type 2 diabetes (Ford, 2002). About 50 percent of the estimated 47 million individuals with metabolic syndrome also have insulin resistance, which is a major factor in type 2 diabetes (Ford, 2002; Blackburn, 2001). Overweight and obese adults have a 50 to 100 percent increased risk for premature death compared to those of normal weight (HHS, 2001). The co-epidemics of obesity and metabolic syndrome are costly, as well, having an estimated price tag in 2000 of over $117 billion (HHS, 2001). This article will define the co-epidemics of obesity and metabolic syndrome and describe recommended prevention and management procedures to be adopted in home care.

Who is involved in the decisions to discharge patients from home care and how much lead-in time for planning is observed? How does the process of discharging patients from home care differ by reason for discharge? These questions are addressed in this study of 383 Medicare-funded patients discharged from home care agencies in central Ohio.

This article reviews the current literature regarding public awareness of home care and describes a pilot descriptive study that addresses public awareness of home care.

To what extent are patient outcomes associated with the amount of home care resources used by patients over episodes of Medicare home care? How can we use the Outcome and Assessment Information Set (OASIS) to improve planning and practical knowledge about the relationship between resource use and patient outcomes? This article addresses the questions and provides readers with some insightful answers.

This article identifies some of the vulnerable links in the discharge referral process and discusses areas where home care providers might intervene to improve the process.

OASIS data will provide a host of information to the Health Care Financing Administration. Agencies should look beyond HCFA's reasons for collecting the data and capitalize on the opportunity to use OASIS to improve their own services and better understand their patients' needs.

Several trends will accelerate changes in the industry initiated by Medicare's change in payment methodology, including explosive growth fueled by changing demographics, patient preferences, and technological advances; altered customer buying incentives created by managed care organization-provider partnerships; and accelerated consolidation. Home care agencies should "take inventory" of current practices and systems to determine capability gaps for competing in the new environment.

The Balanced Budget Act of 1997 included legislation that profoundly affected many residents of the community served by Visiting Health Professionals, Inc. of North Carolina. This legislation not only eliminated coverage for the nursing visit for venipuncture, but also ended coverage for all home health aide visits to these patients for personal care.

OASIS and ORYX are on their way for home care, and those agencies that are not up to speed on using them may not make it through the next year. Above all, before implementing OASIS data collection, agencies need to understand outcomes. This understanding may mean the difference between merely surviving and actually thriving in home care.

A lot can happen when a psychiatric home care program hooks up with patients' families, practitioners, and the community to ensure quality care. According to a recent study, one home care agency's experience demonstrates that psychiatric home care is not only cost effective, but also a clinical success.

The elderly comprise a growing percentage of the population. Home care providers find it increasingly important to monitor rates of hospital readmissions and prevent unnecessary readmissions from occurring. This effort requires a conscious, well-thought-out effort on the part of today's providers.

Congestive heart failure is the most common hospital discharge diagnosis in the United States. Increasing hospital readmission rates for this patient population translate into spiraling health care costs. One agency decided to measure the outcomes of patients enrolled in a specialized cardiac home care program that focuses on teaching and monitoring this patient population using cardiac-trained nurses. The findings suggest that patients enrolled in a cardiac specialty program may have improved outcomes, which translates into significant cost savings for payors.

Health care budgets are being slashed at the same time that the aging of the baby boomers will increase the need for in-home care delivery in the next few decades. New regulations will likely be introduced in conjunction with this caseload influx; to prepare to meet such demands, providers need to anticipate a program of national standards and upgrade the skills of their staff accordingly.

Countries all over the world are facing an increasing demand for home care services. Home Care in Europe: A Country-Specific Guide to Its Organization and Financing assesses European countries' home care in terms of funding, staffing, and organization and covers both home nursing and home helps and how the two work together to provide home care in Europe.

The home care industry has proposed a unified plan for prospective payment. Providers, however, are still unclear about what factors are involved and what will change for them under this plan. This article answers some of the most common questions.

Older Americans, who often live in isolation, encounter barriers to accessing health care and frequently lack basic knowledge about disease prevention. With a growing elderly population, providers will need to focus on prevention education and health promotion strategies.

Providing rural home care demands a knowledge of and sensitivity to rural culture. An understanding of the five A's of rural home care--affordability, availability, accessibility, acceptability, and administratability--will help providers to orient their staff to the intricacies of rural home care delivery.

Horizontal networks offer providers challenges as well as options. To help providers explore the idea of joining a network, a national study presents the experiences of successful and unsuccessful home care networks.

Those who predict the future see managed care as a major element in reformed health care delivery. And one tool that managed care uses increasingly is outcomes measurement. Home care has just begun to develop its role in outcomes measurement by completing a uniform minimum data set to gather and compare data. The data set as yet does not include outcomes; it is the first step toward that goal.

The Belgian health care system blends national health insurance with private service providers. This small nation's home care system is clearly and simply organized, providing an example that other countries may wish to follow.

Agencies looking to compete in tomorrow's care provider market need to consider not only cost per visit, but overall cost per patient. This study uses parts of the Medicare cost report to compare cost per patient in 17 agencies in Connecticut and Massachusetts.

A 1993 Louis Harris and Associates poll shows that not only do clients prefer home care, but they are more satisfied when they have a say in their care, including who performs the care, when they receive it, and how they receive it. The next step is for policymakers to understand and act on this information.