The delivery, regulation, and politics of home care: a California case study.

This study examined seven basic types of formal home care service providers in California, licensed and unlicensed, delivered by agencies and by individual providers. The primary differences were based on sources of payment, duration of care, supervision of personnel, and state regulation, rather than on statutory definitions of services offered and clients served. Many key officials and providers advocate regulatory reform by extending licensure to unlicensed agencies and providers. Competing special interest groups have not developed a consensus about regulation, leading to a political stalemate. Research has not determined differences in quality, access, and costs of licensed and unlicensed home care providers.