Patient advocate: What to know about care at home after the hospital
It’s usually good news when the doctor says you or a loved one can come home from the hospital. Sometimes, though, it’s a mixed blessing.
Hospital discharge sometimes means that further hospital care won’t improve someone’s health condition, and the hospital is eager to get someone else in that bed. People are discharged faster these days, often with significant lingering health issues that have to be seen to.
In the hospital, there’s a staff of nurses, nurse aides, therapists and others to care for you or a loved one. When you get home, though, it’s just you and maybe a spouse or other family member. That’s why the home health industry is booming.
In 2020 (the most recent data available), approximately 3 million patients received home health care services in the U.S., often following a hospitalization or skilled nursing facility stay. They are being cared for by some 12,000 home health agencies, more than 80% of which are for-profit companies.
Home health is something patient advocates know a lot about — and there’s a lot to know. Here are some of the things I’ve learned over my years as an RN and nurse advocate.
Prepare in advance if you can
A best-case scenario is that you know you’ll need some help when you get home. For every day you spend in a hospital, you lose a month of muscle tone and mobility, so depending on how long you’ve been hospitalized, you may need considerable help.
Will you need a walker or wheelchair? Shower chair? A first-floor sleeping arrangement? A bedside commode? These are all things that can be planned for if you know they’re coming. Very often, hospitals have social workers who help patients navigate after-hospital care. Medicare has a thorough discharge planning guide on its website; search Medicare Publication No. 11376 in your browser.
Other things to think about are trip hazards, like small pets and throw rugs, and having some ready-made or frozen meals on hand.
Arrange for help in advance, too
A spouse may be standing by, but they may need help themselves. Adult children, friends or neighbors may be able to pitch in. If there’s no one you can call on for help — and more than 50 million Americans over 50 are aging on their own — it’s time to contact a home health agency. A patient advocate, who is likely familiar with the home health landscape in your area, is a good resource and go-between.
The cardinal rule is: Ask for assistance when you need it to avoid further complications from falls, lack of nourishment or lapses in personal care.
Understand what Medicare covers
Home health care spending grew at an annual rate of more than 10% in 2024, and shows no signs of slowing down. A significant chunk of the spending in 2023 — $148 billion — was by Medicare. But Medicare doesn’t cover everything, so you may have out-of-pocket expenses.
Medicare-covered home health services include skilled nursing care, physical therapy, occupational therapy and speech-language pathology services when ordered by a doctor. Part-time or intermittent home health aide care is covered only if you’re also getting those services at home.
Skilled nursing care can include wound care, injections, nutrition services and monitoring unstable health conditions. Medicare also covers durable medical equipment when prescribed by a doctor, such as beds, walkers, wheelchairs, pumps and oxygen.
Medicare doesn’t pay for 24-hour a day care, meal delivery, homemaker services or personal care services that help with bathing, dressing, grooming, etc.
Questions to ask a home health agency
There are a zillion questions you could ask, but I think these are among the most important:
• How long has this agency been in business, and is it licensed to perform home health care?
• Can you provide references, or can I speak with previous clients?
• Do you accept long-term care insurance, Medicare or Medicaid? If so, do you bill insurance, or do clients pay you and then file for reimbursement?
• How do you recruit and select caregivers, and do you perform background checks?
• Are your caregivers employees or contractors? Are they bonded?
• Can I meet caregiver candidates and select the ones I want?
• What should I do if my caregiver doesn’t show up as scheduled?
• How often is the care plan reviewed?
• How do I communicate concerns and questions to you?
Research has found that patients who recover at home have better outcomes, which is why the hospital-at-home movement is growing. So if you’re going to be recuperating at your place, don’t go it alone.
• Teri (Dreher) Frykenberg, R.N., a registered nurse and board-certified patient advocate, is the founder of www.NurseAdvocateEntrepreneur.com, which trains medical professionals to become successful private patient advocates. She is the author of “How to Be a Healthcare Advocate for Yourself & Your Loved Ones” and her new book, “Advocating Well: Strategies for Finding Strength and Understanding in Health Care,” available at Amazon.com. Contact her at Teri@NurseAdvocateEntrepreneur.com to set up a free phone consultation.