Quality of care in licensed and unlicensed home care agencies: a California case study

This descriptive study examines quality of care issues among licensed and unlicensed home care agencies in California. Data were collected from interviews with 56 key informants in state and federal agencies, representatives of provider associations, consumer groups, professional associations, licensed and unlicensed home care providers, referral agencies, and legislators. Primary and secondary data from state and federal sources were collected and analyzed. Many problems were found in the quality of services delivered by both licensed and unlicensed agencies. Most respondents were concerned about the potentially serious quality of care problems for consumers who received care from unlicensed agencies. However, the large number of providers and the diversity in provider types offering home care services make it difficult to monitor the quality of care being delivered in the home. The findings indicate that there are similar problems in the quality of services provided by licensed and unlicensed agencies. Licensure does not assure that the quality of services will be adequate. The development of stronger, more uniform standards for licensed and unlicensed agencies in California may provide greater safeguards against the potential for abuse.