The adequacy of the Older Americans Act home care mandate: a front line view from three programs

Title III-B of the Older Americans Act authorizes closed-ended formula grants for state and area home care program contractors. To what extent, however, does this legislation enable localities to address the complex needs of the functionally impaired aged? This study inquired into staff perceptions (N = 91) of the adequacy of service in 3 urban-based, OAA home care projects. Program adequacy was empirically gauged by mean net difference scores derived from two scales designed to tap worker perceptions of program capacity and program responsibility in dealing with a series of 8 potential client needs. Results revealed significant program inadequacies in both small and large scale agency settings in the client domains of temporary (p = .02), permanent (p less than .001), emergency (p less than .001), emotional (p less than .001), and medical (p less than .001) need. These deficiencies were apparent at the points of service application, delivery and termination. Workers acknowledged greater success in addressing the practical, daily needs of elderly clients. Findings lead to a set of policy guidelines for shaping more responsive home care program legislation in the future.