Expanding the home care concept: blurring distinctions among home care, institutional care, and other long-term-care services.

Distinctions between home care and residentially based care are blurring because of two trends: home care providers are offering services, including personal assistance, outside of the private, self-contained family home or apartment; and a market-driven movement is underway to develop group residential settings where long-term-care (LTC) consumers with substantial disability receive personal care and nursing in their own, fully equipped, apartments where they largely control the schedule. For the customers, such boundary blurring can lead to experiences of greater power and normality in their everyday lives. State regulations will help determine the extent to which new, "residentially" oriented models of LTC are feasible. Home care providers are challenged to develop flexible and creative paradigms for service that are built on a recognition that older adults with disabilities have the right to choose risks.