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. 1994 Fall;16(1):69–89.

Table 1. Suspected Home Care Quality Problems, by Type of Criteria.

Structure Providers with criminal convictions.1
Home health aides deficient in basic knowledge.2
Essential services not available in community.3
Not enough qualified personnel to meet demand.3
Inappropriate match of personnel and client.4
Care too expensive, insufficiently reimbursed.5
Process Case managers not seeking to remedy remediable conditions.4
Rough care.4
Failure to perform or complete tasks adequately.4,6,10
Failure to conform to physician orders.4,7
Worker insensitivity, disrespect, or intimidation of client.6
Inadequate plan of treatment.7
Inadequate coordination of patient services.7
Inadequate clinical care.7
Post-hospital care not received according to guidelines for time of initial visit and intensity of service.8
Outcome Unintentional physical injury of clients.6
Intentional injury or abuse of clients.6
Enabling Theft and financial exploitation.4,6
Worker tardiness, no-shows, or early departures.4,6
Attendants not available at hours needed or long enough.5
User has insufficient control over selection, training, job definition, supervision, and firing of home attendant.5
Clients not confident workers will be available as long as they will be needed.9
2

A 1987 survey by the National League of Nursing of Home Health Aides found 46 percent did not know how to monitor fluids; 45 percent did not know proper diabetic care; 40 percent could not safely assist a stroke victim in walking; 30 percent could not Identify low-salt foods; 30 percent did not know what to do if a patient stopped breathing; and 4 percent could not read a thermometer.

5

Litvak, Zukas, and Heumann, 1987, referring particularly to personal assistance for independent living.

6

American Bar Association, 1986. Data came from testimony of interested parties, including consumers.

7

Leader, 1986, reporting 1985 Health Care Financing Administration surveys in New Jersey and in Region 2 (New York, Puerto Rico, Virgin Islands). Data came from record reviews.

10

In a 1987 survey by the U.S. Office of Inspector General, aides failed to document or perform one-half of all prescribed tasks that were needed to support the duties of skilled nurses or physical therapists. One hundred percent of all personal care duties were performed.