Consider the case of Haakon Bangsberg of LaCrosse, Wisconsin. Last year, this 81-year-old man suffered a stroke which left him partially paralyzed. While in the hospital, he worried about how his disability was going to affect his life. He worried about being sent to a nursing home. Fortunately, Mr. Bangsberg did not have to face institutionalization. An in-home program was devised that involved finding a house-keeper for Mr. Bangsberg and his wife, arranging physical therapy at a local hospital, and locating an appropriate day-care program at a senior citizens recreational center. All of these services were arranged by a single organization that reaches beyond the traditional role of home health-care agencies.

Even though home health-care agencies have been around for long-term federal and state funds for long-term care have been largely restricted to nursing-home care with little or no support for in-home programs. It has been shown again and again that somewhere between 20 and 40 percent of institution-alized persons could benefit from less expensive in-home programs.

Few people realize the range of home-care services already available to the bublic. Just consider a partial list of professional services already provided by home health agencies: home kidney dialysis, medical social services, skilled nursing care, enterostomal therapy, and intravenous therapy, not to mention inhalation, physical and occupational therapy.

Lest we be plagued by the scandals afflicting the nursing-home industry, a set of principles or guidelines is urgently needed for the home health-care industry. State and federal government must set definityve standards directed toward the quality of patient care, improving proving patient-care services, attracting and training qualified personnel for home health care and continuing the favorable public image already held by home health-care agencies such as visiting nurse associations.

Home health care, however, is such a dynamic field that the following guidelines should not be etched in stone. Rather, they might be considered as target areas that need citizen as well as professional input to be modified an molded in each community:

Home health-care agencies should adopt and enforce standards for the quality of care and services provided by their professional and administrative staffs.

Home health-care agencies should assume administrative responsibility for coordinating non-institutional care for those patients with degenerative and chronic illnesses residing within a service area.

Home health-care agencies should vie for formal linkages with long-term care institutions, day-care centers, nutrition programs and volunteer and outreach programs.

Home health-care agencies should actively engage in social marketing in order to attract referrals from hospitals, long-term care institutions and private physicians.

Home health-care agencies should actively compete with one another to improve services to patient populations, not restricted to any one economic, ethnic or social group.

Home health-care agencies should reject any aura of commercialism or taint of political patronage.

Associations of home health agencies should demonstrate the cost effectiveness and quality of home health care at the city, county, state and federal levels of government.

Under state licensure laws each home health-care agency should be required to disclose the outcome of its services.

Home health-care agencies should undergo an annual audit of all services rendered with full disclosure of all costs.

Home health-care agencies should establish linkages with professional and administrative training programs in order to attract well-trained personnel as well as to provide life-long learning opportunities for all professional and administrative staff mumbers.