Expansion and merger of home care agencies: optimizing existing resources through organizational redesign

This article analyzes the extent to which expansion and the merger of existing home care agencies is an effective strategy for improving in-home services for persons who require long-term care. Information obtained from nine comprehensive home care providers suggests that movement to a new service structure is impeded by (1) limitations and fragmentation of existing funding sources; (2) the traditional separation between agencies that deliver medical care and those that provide health-supportive "social" services; and (3) staff's concern about the impact that organizational changes may have on established roles, functions, relationships, and work conditions. The analysis and supporting evidence show, however, that care providers are more effective and efficient following expansion or merger. After reorganization, agencies appear to be more successful in reaching greater numbers of potential clients, in providing appropriate, well-coordinated services, and in making more effective use of existing resources. Unfortunately, inadequate funding has so constrained the development of in-home services, that expansion or merger of existing providers is, at best, an interim solution. Reorganization of the service system, under existing limitations, will achieve only marginal improvements in services and in the population "at risk." Home care will emerge as a viable resource only when there is a significant expansion in funding, service benefits, and the numbers of persons eligible for a funded program of in-home assistance.