Each day, thousands of home-based caregivers are thrust into life-and-death situations with little or no direct supervision. They perform a dizzying array of complicated medical tasks – from cleaning up surgical wounds to administering medications – that once were provided only in hospitals and nursing homes by doctors and nurses. In many cases, caregivers perform services that are specifically prohibited under state law. In a recent national survey, almost half of all caregivers reported performing medical and nursing tasks for people with chronic conditions. Yet, the day-to-day management of these complex medical cases often falls squarely on the shoulders of caregivers who are often undertrained, overworked and overwhelmed. When mistakes occur, complaints to state and county agencies often go unreported or unheeded.