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Care of the Chronically Ill at Home: An Unresolved Dilemma in Health Policy for the United States

Karen Buhler-Wilkerson
The Milbank Quarterly
Vol. 85, No. 4 (Dec., 2007), pp. 611-639
Published by: Wiley on behalf of Milbank Memorial Fund
Stable URL: http://www.jstor.org/stable/25098177
Page Count: 29
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Care of the Chronically Ill at Home: An Unresolved Dilemma in Health Policy for the United States
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Abstract

The problems of caring for patients with disabling illnesses who neither get well nor die are not new. Such patients have always required assistance at home from family, benevolent volunteers, or paid caregivers. Despite two centuries of experimentation, however, no agreement exists concerning the balance between the public and private resources to be allocated through state funding, private insurance, and family contributions for the daily and routine care at home for chronically ill persons of all ages. This article examines these issues and the unavoidable tensions between fiscal reality and legitimate need. It also uses historical and policy analyses to explain why home care has never become the cornerstone for caring for the chronically ill.

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