Home-based Care for a New Century; edited by
Daniel M Fox and Carol Raphael. Blackwell
publishers, Oxford UK, in co-operation with the
Milbank Memorial Fund, Malden, USA. 304 pp.,
$59.95 (cloth).
As traditional health and social care structures are
subject to pressures from changing patterns of health
and need, and changing economic climates, it is timely
to re-conceptualize the ways in which services are
delivered, and the goals that they have. This book is
therefore timely in the way that it explores issues sur-
rounding one form of care provision which has been
relatively neglected in policy literature, the provision of
home-based care.
The book is the result of a series of debates and dis-
cussions carried out by the Milbank Memorial Fund,
which is a policy analysis organisation, and the
Visiting Nurse Service (VNS) of New York, a not-for-
pro®t health care organisation. The book begins with
several discursive chapters which outline current and
future policy issues and imperatives. These chapters
include discussions on the general restructuring issues
in home care, the boundaries of home care, how home
care ®ts in with other service initiatives and structures,
such as managed care, and ®nancial and employment
issues. The book then goes on to cover speci®c areas
of services with chapters on services for children,
people with AIDS and people with serious mental
health problems.
The book is USA based, and makes little reference
to service models outside the USA. This makes it di-
cult for readers whose main experience is with other
systems to draw analogies and parallels. This is par-
ticularly the case where histories are taken for granted,
such as the development of Medicare and Medicaid.
Having said this, however, the experience of the USA
with a mix of state and privately funded and provided
care oers many important lessons and challenges to
other systems. There are, for example, a number of
issues and debates that stretch across socio-political en-
vironments. An example is the discussion by Rosalie
Kane about the boundaries of home care, in which she
asks whether these boundaries should be de®ned
simply by type of accommodation, in other words
whether home care should be thought of as something
that only happens in a person's domestic residence, or
whether it is a useful descriptor of care delivered in
other settings, such as nursing home care.
These conceptual and theoretical discussions are
immensely stimulating and crucial to the development
of policy and theory in care delivery generally, and not
just home care. With the emphasis on the quite
detailed analysis of policy, however, these broader
debates are somewhat hidden. In reading the text the
occasional, almost throw-away, phrase touches on
what could become a substantive debate about theor-
etical issues, such as the concepts of home, care, or
professional. The term ``paraprofessional'', for
example, is used frequently and without much discus-
sion, whereas in other books with other aims, the term
itself could form the basis for a major and detailed dis-
cussion.
The covert or implicit nature of the theoretical basis
of this book is at times frustrating, particularly where
readers might want to pursue issues in greater depth.
The emphasis on detailed policy analysis is appropri-
ate, however, if the book's aims and target audience
are mainly interested in the detail of operationalising
policy. As a companion to more abstract texts, then,
this book could form a useful correction for books
which debate concepts but which do not address how
these play out in practice and policy. While it is tempt-
ing, therefore, to see this book as mainly being about
policy, and therefore useful for policy students and
analysts, the way in which it stimulates a range of
other debates about theoretical models of care justi®es
its presence on the book shelves of anyone with an
interest in this area.
Jan Reed
Professor of Health Care for Older People, Centre for
the Care of Older People, Faculty of Health, Social
Work and Education, University of Northumbria at
Newcastle, UK
Social Science & Medicine 48 (1999) 1502±1503