Home care services are made up of skilled nursing, physical therapy, occupational therapy, social work and home health aides.
Skilled nursing services include instruction in medication regime, assessment of pain control, assessment of wound healing, wound packing and dressing changes to assist in wound healing, staple removal, if indicated, and diet instruction. The nurse will contact the doctor with changes that need to be reported and reinforce the necessity and importance of the follow up appointment with the doctor.
The physical therapist will continue with the exercise program and gait training plan that has been established in the hospital. The physical therapist will also contact the doctor if any problems occur that necessitate such action.
The occupational therapist will assess the patient's functional mobility and evaluate the activities of daily living.
The social worker acts, if needed, as a resource person in financial areas. If the family feels they are unable to care for the patient at home, the social worker can also assist in finding alternate placement for the patient.
A home health aide can arrange to assist the patient with personal care. The physical therapist, occupational therapist and home health aide will normally visit a patient three times a week unless the insurance company makes other arrangements. The insurance company is notified prior to the patient's discharge from the hospital as to what home care services and equipment are needed. Approval for both is given at that time and orders are placed with the designated companies.
Upon discharge from Hopkins Bayview, home care can be arranged for anywhere in the country. The patient has a right to choose a home care agency based on insurance criteria.
