I agree with you that the world of home care is changing rapidly but the thing that keeps bothering me is the types of patients that are being brought onto home care services. People with transient diagnosises that are usually one time and not recurrent such as UTI, pneumonia w/o other comorbities, are provided with services, same as end stage diagnosises because they fit the "homebound" status. However, people that can really use our services, new diabetics, new CHF, new COPD, wounds that patient may not be able to care for themselves are denied services because they are not homebound at time of diagnosis. By denying the patients that are truly in need of education and support aren't we just taxing an already overtaxed system? I recently wrote a paper for one of my classes that that stated "We send the dying to their grave with all of the knowledge about their disease and no time to use it while giving those that can use the knowledge no time." If the purpose of home care is to be pro-active and preventitive and to prevent rehospitilization, we as a system are not focusing our energies in the right places. I believe this is why the home care system is failing so quickly, right message, wrong audience.