Home care management in chronic illness and the self-care movement: an analysis of ideologies and economic processes influencing policy decisions.

Over the past few decades there has been an increasing trend toward self-care and home health care, and one would suspect that these trends will continue into the next century. This article addresses the policy issues that have arisen from a program of research with families caring for a child with a chronic illness in the home and with women who have diabetes mellitus. The argument is developed that, although the home care and self-care movements can be seen as directed toward providing more humanistic care and promoting the independence of the client, the economic and sociopolitical factors that influence their development should not be overlooked. Furthermore, the "cost of caring" must be reckoned with in both human and economic terms. Cost-effective care, in the long run, will mean care that takes into account the social context of health and illness.