Licensure and regulations may be mechanisms to control for or assure the quality of care. However, families may perceive that external regulation and oversight represents an intrusion into their personal affairs and an infringement of rights in particular circumstances. Abuse and neglect may still occur, as oversight and monitoring are costly in human and financial terms. Professional licensure is another means to assure quality in its limitation of performance of skills. While home care agencies are obligated to professionally assess, instruct, assign and monitor family member care, states are mute on the dispensing of medications. Abuse and neglect may occur and these may be under reported due to personal and professional consequences. (See Elder Mistreatment for further explanaatiion.)

With projected increases in chronic disease from our increased longevity, health care costs escalating, and federal dollars and programs dwindling, rationing care may be highlighted.

    Tension is increasing among the government's roles in regulation and quality assurance, and fund allocation, private agencies' philosophies and programs, and individual rights and autonomy.

    Conflicts are rising between policies protecting the well being of vulnerable persons and maximizing individual autonomy versus persons' rights to take risks, social versus medical care, cost effective versus community-based services.

    Conflicts emerge between the social and medical models of care and cost containment versus community-based services.

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