Choosing an in-home caregiver

Leaving the hospital after surgery, treatment for an infection or other major health issues does not mean that care is no longer necessary.

Many patients need ongoing attention in the form of wound care, catheter maintenance, IV medication administration or physical therapy.

Their loved ones may also need support with daily household chores for the patient and themselves.

An in-home caregiver can be a lifeline at such times. But how do you find one and what can they do?

UCI Health geriatrician Dr. Sonia Sehgal, director of the UCI Health SeniorHealth Center, shares the guidance she gives to her patients and their loved ones who may need this level of care.

Why have an in-home caregiver?

Such assistance may seem optional, but without in-home caregiving services, patients face increased risks for:

• Medication issues and errors
• Wound issues
• Infection
• Rehospitalization

"To avoid rehospitalization and other negative health consequences that can result from delays in care, I always encourage my patients and their families to advocate for timely initiation of home health services,” Sehgal says.

Though such care may not be covered by insurance, Sehgal stresses the importance of having a caregiver who can assist with bathing, dressing, toileting and other basics of daily living.

This type of care is called custodial or personal care.

“There are agencies that vet nonskilled caregivers,” she notes. “They can perform background checks and skills training.”

The agency is also responsible for filling any gaps if a caregiver is unable to attend a shift.

Getting the process started

Sehgal recommends inquiring about in-home caregiving services as soon as possible, well before the patient is discharged from the hospital. If needed, such services are usually ordered by a physician.

“The care provided by home health workers is usually for a defined period of time,” Sehgal notes. “This type of care is often covered by a health plan.”

The Centers for Medicare & Medicaid Services have set a standard of no more than 48 hours between hospital discharge and receiving in-home care services.

“But occasionally delays do occur,” Sehgal says. “Those can be related to time of discharge, insurance issues and missing orders.”

Before leaving the hospital

Sehgal recommends starting preparations for in-home healthcare as soon as a patient’s need for it has been determined to get ahead of any barriers or issues early. For a smooth transition home, she suggests:

• Working with hospital case managers and social workers to identify a home health services provider that is covered by the patient’s health plan.
• Knowing clearly what the home health team is expected to do: wound care, catheter care, medication administration, physical therapy, etc.
• Identifying any physical barriers that would prevent a home health caregiver from entering the patient’s home and removing them before discharge, if possible.
• Getting the physician’s order for home healthcare and the caregiver company’s contact information in writing before discharge.

“Ideally, the home health company will set up an appointment time for their staff to meet the patient at home on the day of discharge or the day after,” Sehgal says.

She also suggests calling the home healthcare company ahead of the patient's release to confirm that they have a record of the patient and that any needed medications or equipment are on hand.