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Home care for the frail elderly is in a state of crisis. While demand is rapidly increasing, the home-care industry is beset by organizational problems that undermine its ability to respond effectively. We have identified and analyzed four sets of problems. First, home-care services exist in a turbulent fiscal and political environment that undermines organizational stability. Second, service effectiveness depends on close interpersonal relations between worker and client, which cannot be readily attained with a nonprofessional work force. Third, because the service is delivered outside the organizational boundaries, there are serious issues of quality control. Finally, the home-care organizations rely on an unskilled labor force characterized by high turnover and staffing instability.
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Schmid et al. (1993) studied this question.
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