The arguments and model put forward by MacAdam are laudable, but fall short. The proposal would create a home-care system that is a support system for medical care, thus fulfilling only one of the three functions of home care. The emphasis in the model on expanding professional services addresses the demands for increases in intensive postacute care. However, the support of chronic long-term care and of health promotion and disease prevention would not be strengthened and, indeed, would lead to the already visible demise of traditional chronic long-term care as evident throughout recent health reform. It would ensure that a preventive function is not developed.

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