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In Reply: We agree with Dr Forst and colleagues in the need for adequate protections for home care workers—those who often perform heroic work in difficult circumstances. Space constraints limited our discussion of this important topic. As Forst et al state, and as we have witnessed repeatedly, home care workers face innumerable challenges. In addition to workplace standards, home care workers need adequate training, reimbursement, and opportunities for promotion and career advancement. It is also important to remember that the home environment, unlike other workplaces, is less amenable to standardization; therefore, some rules for worker protection might need to be suitably modified and comparisons with other workplaces placed in context.

Jeremy Boal, MD
Departments of Medicine and Geriatrics and Adult Development
Mount Sinai School of Medicine
New York, NY

Peter A. Boling, MD
Department of Medicine
Virginia Commonwealth University
Richmond

Sharon A. Levine, MD
Department of Medicine
Boston University School of Medicine
Boston, Mass

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:3070.

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Linda Forst, Leslie Nickels, and Joseph Zanoni
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