ABSTRACT
Living longer, and living longer with disability, older adults are the fastest growing
population in the United States (Hobbs & Damon, 1996). Despite unprecedented
longevity and survivability, their access to public and private health care has become
increasingly restricted, in part, because of dramatic changes in health care costs. The
combination of greater need and fewer resources has ushered in the use of a broader
spectrum of health care environments, including subacute and long-term care, adult day
care, and, increasingly, home health care. Ongoing economic changes in health care
finance have resulted in the reclamation of the home environment as the locus of choice
for long-term care provision (Bogner, 1999) and has spawned a new health care industry,
represented by home health agencies.
