Effective coordination of medical and supportive services

For at least the past quarter century, tension between "medical/allied health" and "social" models of care have characterized much of the home-care policy debate. There has also emerged a growing body of research and boundary-bending care models based on a holistic view of care recipients and caregiving. Such models coordinate between medical care and expanded supportive community services (SCS) that range from assistance with lifestyle modification, self-care, and informal care to adult-day services and home-health care. This article presents a new rationale for these models based on disablement theory and recent accounts of fairness in health policy. This approach is contrasted with the efficiency and efficacy policy perspectives that have received the most attention. The implications of an equal-opportunity approach to home-care policy for performance indicators are explored. Six basic models of coordination and current evidence on their impacts are described from this new perspective. Using qualitative data from two recent projects, five dimensions of care recipient and caregiver experiences that may be relevant to performance measurement are described. Suggestions for further service innovations and research are offered.