What is home care? What can we expect from home care after surgery and during other treatments?

70. What is home care? What can we expect
from home care after surgery and during
other treatments?

Home care is a broad term used to describe many types
of medical and/or personal care services provided in a
person’s home. Multiple terms used for different types
of care are often confusing, so be specific about your
wants and needs when you discuss home care options.

Medical home care often requires a doctor’s order and
usually involves skilled nursing needs such as open
wound care, checks of vital signs, or infusion care.


Skilled nursing need = A need for services or care that 
can be performed only by a licensed nurse, such
as treating a wound, teaching the administration
of new medications, or assessing clinical status at
home. Often a requirement for home care by insurers.


A home health aide (sometimes also referred to as a personal
care attendant) is a person who is qualified to provide
“personal care,” such as assisting someone with
bathing, dressing, and getting around. They most often
work for a home healthcare agency and may also assist
with light housework. A home health aide is not usually
covered by insurance unless it is ordered in conjunction
with a skilled nursing need. A home attendant (or homemaker
care) is a person who can assist with shopping,
house cleaning, doing laundry, cooking, and accompanying
a person to appointments, and whose services are
usually not covered by most insurance policies.


Home health aide = A qualified person able to assist a patient
with bathing, dressing, getting around in his or her own home,
and doing other homemaking tasks (also, Personal care
attendant).


A common misperception among patients and family
is that they will automatically have insurance-covered
home care provided after their discharge from an inpatient
hospital admission, particularly after surgery.

Most insurance companies cover only skilled nursing
needs, usually requiring a registered nurse, a physical
therapist, an occupational therapist, or someone with
other medical expertise. In addition to covering
these skilled medical needs, policies sometimes cover
a limited number of home health aide hours (most
often fewer than 20 hours a week, if at all).

Patients and family may feel cheated if they were
expecting more professional assistance to be covered by
insurance. This is an upsetting situation that can be
avoided with advance preparation. Contact the insurance
carrier for your loved one and ask about home
care coverage and what, exactly, is needed for coverage
(for example, physician certification of a skilled nursing
need). Furthermore, it is important for patients
and family members to understand the limits of home
care and begin to make arrangements early for caring
for the patient at home. This may entail family members
helping the recuperating patient after discharge
with cooking, cleaning and other needs, and/or providing
other types of assistance, such as transportation
to follow-up doctor visits. Family members may also
need to learn to do wound dressing changes, take care
of drains, or manage other medical home equipment
or needs.

If home care is ordered by the doctor and covered by a
patient’s insurance, the discharge planning staff member
(often a social worker or nurse case manager) will
discuss the type of care the patient will receive and
when the initial home visit will take place. Sometimes
the home care agency will contact you directly to
establish the details after the formal referral has been
made by the discharge planning staff. Often a first visit
from an intake registered nurse will take place one day
to several days after discharge. The nurse will assess
the patient’s needs and the home environment to
determine the type of care, the frequency of visits, and
any equipment/supply needs that may be required. Be
sure to accurately describe your loved one’s diagnosis,
surgery, or other treatment side effects as well as any
other concerns or questions you have about managing
at home.

Before your loved one leaves the hospital, be sure to get
the names and numbers of the discharge planner (or
whomever you should contact at the hospital if you have
problems with the home care that is ordered), the name
of the home care agency, and whom you should contact
in case of a medical emergency (even after business
hours). This information should be located on discharge
papers you receive the day of discharge from the hospital.

Patients and family sometimes leave the hospital without
these crucial contact numbers, which can cause added
stress if they have a question later. If this information is
not given to you, or if you misplace it, ask for it and keep
it handy so that you can refer to it when needed.

In addition to medical home care and family or friend
caregivers, you might also want to investigate community
agencies that provide various services to a person’s
home, such as Meals on Wheels (where low-cost, prepared
meals are delivered directly to your home); senior
centers; private nonprofit organizations that serve
senior citizens or disabled individuals; volunteer agencies;
and churches, synagogues, and other religious
centers. Furthermore, there are long-term care policies,
and supplemental insurance coverage may be available
to purchase even after the cancer diagnosis. Contact
your state’s insurance department for a list of companies
that sell long-term care insurance or check with
your current medical insurance provider for purchasing
additional coverage.

If you feel that you and your loved one cannot manage
safely or easily at home, discuss other options with
your family and discharge planner. These can include
private pay home care, nursing home placement, or
assisted living options. New LifeStyles
is a good resource for investigating the
types of home care, facility placement, and other alternative
living arrangements (such as “assisted living”).