Online Books > Helping People Cope: A Guide For Families Facing Cancer

Home-Health Care

Home-health care is appropriate when people with cancer do not need round-the-clock supervision in a hospital or nursing home but still need care that could easily be provided by a family member. Home-health care is possible following hospital discharge or even if you have never been admitted to a hospital. Health-care professionals can come to your home to provide you with such services as skilled nursing care, physical therapy, speech therapy, occupational therapy, social-work services, and nutrition counseling. Home-health aides are available to assist you with personal care two or three times a week for one or two hours per visit. There are many advantages to home care, including remaining in your own comfortable, familiar environment, being able to continue with normal routines rather than having to adapt to someone else's routine, and generally being more in control of your life.

1. Physical therapy, to teach you and your family safe ways to move from the bed to a chair, to show you how to use a walker, and to plan an exercise program to restore your strength and ability to do everyday activities.

2. Speech therapy, to help with communication problems, usually following surgery for an oral cancer (a laryngectomy, for example).

3. Skilled nursing, to help you and your family with nursing procedures or to teach you how to do them yourself, how to recognize medical problems that should be reported to your doctor, how to dress surgical wounds or care for bed sores, to administer chemotherapy, and, in general, to help you solve problems you or your family may be having with your care.

4. Occupational therapy, to help improve or restore your ability to do such things as dress yourself or perform household chores or other activities of daily living so you can live as independently as possible.

5. Social work visits for short-term counseling to help you and your family with problems caused by your illness, or to assist with financial problems or with nursing-home placement, if that should become necessary.

6. Home-delivered meals provided through a referral to a community agency.

7. Home-health-aide services, provided under the supervision of a nurse or therapist, to help with personal care and simple medical treatments.

• Most communities have home-health agencies. Your physician, nurse, or social worker will know about the different home-health agencies in your community, as well as your needs. If you choose a home-care agency on your own, write or call the National Association for Home Care, 519 "C" Street N.E., Stanton Park, Washington, D.C. 20002 (1-202-547-7424), and ask for a copy of the pamphlet "How To Select a Home Care Agency." It is available for $1.25. Also available through the Pennsylvania Association of Home Health Agencies (1-717-233-3363)is the pamphlet, "A Look at Home Health Care." These booklets will be useful in helping you make the right choice. It is available for $.95.

• Payment for home-health care may be covered by Medicare, Medical Assistance, private insurance, or other payment sources, if the care you need is skilled (given by people with special training), intermittent (just for limited periods of time), and if you are confined to your home. Home-health agencies must follow guidelines established by Medicare and Medical Assistance when deciding what types of care will be covered and for what period of time. Insurance guidelines vary, so the home-health-care agency will check with your insurance company to see which services are covered.

• Other sources of payment for home services are the Veterans Administration, Champus, a program covering families of deceased veterans, and your local Area Agency on Aging. A hospital or home-health-agency social worker can direct you to these sources.

• If you want home-health care and your doctor has not suggested it, discuss it with him or her. Home-health care must be prescribed by your doctor.

• If you are receiving home-health care and want the services of a home-health aide, discuss your needs with the nurse, rehabilitation therapist, or social worker at your home-health- care agency. Medicare and Medical Assistance usually pay for these services, while private insurance companies and other private sources usually do not.

• Remember that Medicare will pay for occupational therapy, social work, and home-health- aide services only if you are receiving skilled nursing care, physical therapy, or speech therapy.

• Services provided by a home-health-care agency are intermittent (for limited periods of time). If you need home care for long periods of time, see PRIVATE-DUTY NURSING SERVICES.

• Sometimes you may continue to need home health care after Medicare, Medical Assistance, private insurance, or other payment sources stop paying for these services. Ask if the home-health agency you are considering would continue to provide care for a sliding-scale fee (based on your income) if you need it after insurance payments stop.

• If you are dissatisfied with the services you are receiving or the persons providing these services, contact the home-health agency and ask to speak with the director of patient services or the person who supervises those coming into your home.

• Home care is not right for everyone. Sometimes the type of care you need cannot be provided in the home.

• Helping someone take a bath or cook a meal is not considered "skilled nursing." If your only need is help with bathing or other personal care services, you may benefit from the services of a homemaker. Homemaker services are available from the Area Agency on Aging in your community or county. A homemaker might be assigned to assist you with a bath or other personal care services during one or two visits per week, for one to two hours each visit. Services are available to persons who are at least sixty years old who meet the eligibility requirements. If you need these services, contact the office in your community or county. A caseworker from this office will visit you in your home to assess your needs and determine if you are eligible. These services are available free or for a small fee. There may be a waiting list for services, especially in large metropolitan areas.

  If you are under sixty or not eligible through your Area Agency on Aging, homemaker services are available privately. (See the next section, PRIVATE-DUTY NURSING SERVICES. This section also lists ideas on how to arrange for help if you are unable to pay for services privately.)

• You may sometimes feel lonely and isolated from others, especially if your illness requires you to remain homebound, even on a short-term basis. This can be particularly true for persons whose family members or friends are working or are unavailable to them for other reasons. If this is the case, discuss this with your nurse or social worker. Some communities or churches sponsor friendly visitor programs where a volunteer may visit and provide companionship and conversation.

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