The problems of caring for patients with disabling illnesses who neither get
well nor die are not new. Such patients have always required assistance at home
from family, benevolent volunteers, or paid caregivers. Despite two centuries of
experimentation, however, no agreement exists concerning the balance between
the public and private resources to be allocated through state funding, private
insurance, and family contributions for the daily and routine care at home for
chronically ill persons of all ages. This article examines these issues and the
unavoidable tensions between fiscal reality and legitimate need. It also uses
historical and policy analyses to explain why home care has never become the
cornerstone for caring for the chronically ill.