A shortage of home care paraprofessionals in Ohio is causing concern about the quality and continuity of care. Worker turnover is high, ranging from 30-70 percent. Most paraprofessionals share several traits: middle-aged women; single, with dependents; sole breadwinners in their households; wage earners of less than $11,000 per year; part-time workers; and high school graduates or less. Several reasons account for the labor shortage: low wages; lack of benefits, career advancement, recognition, and full-time hours; inadequate training and supervision; burnout; transportation problems; and worker isolation. Trends affecting the home health industry include the following: the increasing elderly population; decreasing availability of family caregivers; escalating health care costs; the AIDS epidemic; and limits to nursing home admissions. Standardized training and certification would increase continuity and quality of care, establish minimum criteria for workers, provide for consistency and uniformity of workers' training and skill levels, and provide credentials. Action is being taken through public policy changes, coordinated funding and policies, state-mandated wage and benefit levels, agency coalitions, work life improvements, and worker-owned agencies. (18 references) (NLA)