If the family feels they are unable to care for the patient at home or that the patient will need some sort of assistance at home, a social worker or discharge planner can be notified.
This person can assist in finding alternate placement for the patient or arranging for home health visits. The social worker can also act, if needed, as a resource person when the patient needs help with financial difficulties.
Upon discharge, home care can be arranged for anywhere in the country. The patient has a right to choose a home care agency based on services offered. Some insurance companies have contracts with specific home care agencies, thus may dictate which agency is used.
Home Health agencies typically offer the following services: skilled nursing, physical therapy, occupational therapy, speech therapy, personal care services and a social worker.
Home health skilled nursing may include: assessing the patient for signs of inflammation or infection, instructing on medication regimen, assessing pain control, assessing wounds, changing dressings, and removing staples.
A home health physical therapist may continue with the exercise program that has been established in the hospital, making sure that patients are doing their exercises correctly.
A home health occupational therapist will assess the home for safety issues after discharge, preventing future accidents that could reinjure the patient. The occupational therapist may also continue with strength training and can better assess the patient?s functional mobility and evaluate his/her ability to perform activities of daily living.
Personal Care workers such as Home Health Aides help patients get in and out of the tub or shower, assist with dressing, perform simple dressing changes, and often help with daily exercise programs.
The Social Worker is available to help with insurance issues, to find alternate payment sources, and to help the patient with coping skills or counseling.