ABSTRACT
The type of program or type of non-professional service an older person receives is the result of a multitude of factors. The most important are probably the physical health status of the individual with respect to illness acuity and their financial status in terms of ability to pay out of pocket for services and entitlement to means-tested programs. In many programs, including the home attendant program in New York City, there is great variety with respect to the extent of involvement of nurses and social workers in training, supervision and monitoring of care. It is essential to consider whether elderly clients should be differentiated by their need for skilled care versus unskilled care, with respect to the delivery of non-professional services. There is considerable debate about the general effectiveness of formal community-based care programs in reducing the use of hospitals and nursing homes by the elderly.
