differences that exist in home and residential care and between older and younger individuals with disabilities; the differences are important and must be considered within their own contexts. Ultimately, however, the committee believes that the similarities among these services and populations are great enough to allow for a unified approach in addressing all the needs identified in the study. In fact, the committee believes such an approach will contribute significantly to efforts to eliminate much of the fragmentation and duplication that are the hallmarks of the current LTC system.
The committee identified six major areas to be examined in the larger study, and these are explained below. The discussion also notes, in general terms, the types of information and data sources that might be used to address these questions.
What key features define home care services and the consumers receiving them? What key features define residential care settings and the residents living there? To what extent do home care consumers and residents in residential care settings differ from or resemble each other?
A clear understanding of the issues and individuals being studied is plainly necessary. What are the key demographic features of the population who need or desire such care? These could include age, sex, socioeconomic status, household structure, clinical and developmentally appropriate functional characteristics, including level of cognitive impairment and mental health status, and extent of isolation or community integration). What is the range of services needed or desired by that population? In what settings are those services provided? Who are the major providers (agencies and/or individuals) of such care? Who are the major purchasers of such care and how much does it cost? How do any of the above vary by state? What, if any, trends, can be identified?
Although it is the sense of the committee that consumers of home care and residents of residential care settings face many of the same issues in terms of quality, committee members also felt that it was important to approach each population separately and then examine the overlap between the two. For example, under what conditions might those living in residential care settings actually receive services from home care providers? Under what conditions might a residential care setting better be considered a “home” in the sense of a private apartment, a “home” in the sense of a rooming house, or an institution? Are there differences between the two groups that are significant enough to warrant the use of different quality assurance and improvement approaches?