Records the conclusions and recommendations of a study group commissioned to explore the use of home-based care as a strategy for coping with the growing number of individuals in need of long-term care. Addressed to policy-makers the report responds to striking demographic and epidemiological changes that have created an urgent need to expand the availability of cost-effective chronic care. These changes include the growing population of elderly persons and the devastating impact of HIV/AIDS on social networks and health services. With these problems in mind the report aims to help policy-makers in both industrialized and developing countries understand the options available for providing long-term care in the home or family setting. Throughout the report examples from different countries and lists of key questions are used to help policy-makers think through problems and solutions and learn from the experiences of others. Issues discussed range from the importance of avoiding over-medicalization of long-term care through the need to recognize that caregivers also need support to the great danger that home care may be used to justify abdication of public or government responsibility. The report has six concise sections. The first explains the growing need for long-term care and introduces some of the factors that need to be considered when developing policies and programmes. The implications of home-based care for caregivers as well as for the chronically ill are also briefly discussed. Target groups and scope are considered in section two which lists some of the most common elements of home-based long-term care. The third and most extensive section sets out fundamental principles of long-term care services applicable to different health and social systems. Topics covered include responsibilities at the national district and community level the

importance of ensuring that caregivers who are most often women are not overwhelmed and the specific needs faced by countries at different stages of economic development. A section on financing identifies five basic approaches and offers advice on cost-containment and priority setting including a list of the most common measures used to limit costs. The remaining sections outline needs in terms of material and human resources. A summary of conclusions stresses the important finding that primary health care systems in developing countries can form the basis for sustainable cost-effective long-term care. Developing countries are further advised not to adopt the strategies that have evolved in industrialized countries which often segregate age groups and provide separate health and social services for acute and long-term care.