Abuse and Neglect of Clients in Agency-Based and Consumer-Directed Home Care‪.‬

********** Social workers in health care settings increasingly are concerned with the long-term management of chronic illness and with community-based care (Volland, 1996; Volland, Berkman, Stein, & Vaghy, 1999). As access to acute care settings becomes more constrained and hospital stays shorten, more sick and chronically impaired people require services at home (Proctor, Morrow-Howell, Li, & Dore, 2000). Home care ranges from home health services provided by highly trained professionals (including social workers) to supportive services delivered by nonprofessionals with little or no training (Benjamin, 1993; Egan & Kadushin, 1998). Amid the turmoil created by expansion in managed care and legislation designed to restrain growth in home care spending, new and perhaps less-costly models of supportive home care have emerged that rely on recipients for many of the service decisions previously made by professional case managers and providers (Batavia, DeJong, & McKnew, 1991; Simon-Rusinowitz & Hofland, 1993). These consumer-directed models of home care not only challenge traditional agency-based models, but also raise concerns that in the absence of monitoring by agency professionals, recipients are more vulnerable to abuse and neglect by home care workers. The research reported here addresses these concerns by comparing client reports of abuse and neglect by workers in agency-based and consumer-directed home care models.