March 17, 2026

Home Health Highs and Lows

Your loved one has a surgery or gets out of the hospital after being treated for a condition that is ongoing or has weakened them and sometimes they meet criteria for a stay in an Acute Rehab Facility where they receive nursing care, PT, OT, and sometimes Speech Therapy often with a private room reserved just for them and therapy for several hours a day in their room and in a state of the art gym down the hall. These places (at least the ones that Mom has recuperated in, 3 different facilities so far) are wonderful for ongoing care after they are stable for discharge from the main hospital. We couldn’t be more thankful that these places exist to help rehabilitate our loved ones before they head home.

Side notes: be aware that these Acute Rehabs count as days in an inpatient hospital for the Medicare day count limits, there are Skilled Nursing Facilities (regular nursing homes, some of which are better than others, do sometimes provide rehab but are billed differently and do not always provide the same number of hours of rehab especially on weekends), and PT and OT while inpatient in a main hospital typically only happens for evaluation purposes to choose the level of care for discharge (if you’re hoping for rehab for your loved ones when they start recovering- it’s a great hope- but it’s really not likely to happen regularly. They come to assess when they have to and that’s about all they have the staff for).

Then if you are fortunate and your family member needs home health because they cannot get out on their own to appointments, you get help coming to your home. Don’t get too excited. The help at home can be and frequently is great, but it is very limited and they won’t be there for long. Very rarely is a nursing assistant included in this (someone to help bathe and dress your loved one and do light chores like laundry or bringing a meal to them). What the nurse’s assistants do is a very short list and they do not stay long if you even get them at all. Dad had one to stand nearby while he showered after his quadruple bypass surgery several years ago. We were offered one this time after Mom’s knee surgery but not following her previous procedures and hospitalizations. You almost always (if not always) get a nurse assigned especially one to come check that all of the meds are in order and to do the intake into home health, but they typically examine the patient very little and, in our experience, provide education and talk with you but do very little hands-on care. Once Mom needed something badly that can be done on an outpatient basis and the nurse was still there at the time and I was coming home from work. The magnet from the agency says “Call us First” regarding help with issues and the nurse declined to provide the needed care and I as an untrained family member came home from working all day to handling a delicate and awkward situation with my own Mom myself because that home health RN doesn’t do that. Hmmm, ok. You did not even examine my mom that day but I suppose you collected all of your pay for showing up and being on the Olympic Standing There team. But this is what insurance pays for in home healthcare.

We have had mostly great OT and PT home health staff members and Mom has needed PT the most so she qualifies for PT to stay longer while the nurse and the OT sign off earlier in treatment. Home healthcare stays for about a month, maybe two, but they do not come every day. Maybe the first week you could possibly get one person coming each day if the nurse is once weekly and PT and OT are cleared by insurance to come twice a week each. But they are there for about an hour to an hour and a half per day. This is not what it sounds like, care if your loved one needs someone to be with them at home, that’s not provided. It’s a check in here and there briefly and some therapy that you did not have to drive your family member to.

I am grateful that they come to the home, but it is daunting as my parents continue to age and as I am committed to keeping them in their home with their family, that insurance does not pay for help to come into the home and provide supportive care. All of that is out of pocket. It sounds like Medicaid can provide a limited amount while the state takes all resources to pay for it if the person qualifies. It also sounds like there are some community resources one can sign up for if qualified, but agency care in the home is expensive and not covered by insurance unless your loved ones thought far enough ahead to pay into long-term care insurance (before they developed any pre-existing conditions) and even that really doesn’t cover much. Even going to an assisted living facility will cost quite a bit long-term (though I admit I have not looked into that because it is not an option we are considering at this time).

So the family, usually the daughters, are left to figure it out when there isn’t really a long term plan. And for so many there is not enough income to plan well in advance. And to be honest even when there is it is a difficult choice to prepare for the unknown (who knows how much care a person will need?) versus using one’s income to enjoy a quality life while one is able to enjoy it.

Home health is usually great when they are there. They are very knowledgeable and, especially the therapists, seem to put in a lot of energy and effort to providing great care. Today the PT found an infection in part of Mom’s incision while I was at work and alerted the surgeon’s office before my day ended. SO helpful that I did not have to do that today. But now the office hasn’t done anything and will call back in the morning while I am working again.

OT and nursing have signed off and PT is the only one approved to stay for now but she only got approval to come once weekly for the last month. Mom struggles to push herself through the pain to do the exercises. When we get her approved for outpatient they will work with her more often in a week’s time but we will have to drop everything during the day and drive her because she no longer qualifies to get more than once a week to the house.

I need to look into whether we could have started outpatient while home health was still coming once weekly. I doubt the service can overlap in any way….no matter how much it would make sense for the patient.