I always have choices… sometimes it’s only a choice of attitude.

— Judith Knowlton

Most breast cancer patients do not require home health care. However, knowing what is available may be helpful. You may have a need for home health care services after your breast surgery or during your chemotherapy treatment for a variety of reasons. Or you may require home health care if your disease has progressed.

What is home health care?
Cancer patients often feel more comfortable and secure being cared for at home. Many patients want to stay at home so that they will not be separated from family, friends, and familiar surroundings.

Home health care is professional healthcare that is provided to you in your home. It is normally recommended by a physician, medical social worker or hospital discharge planner. Home care often involves a team approach that includes doctors, nurses, social workers, physical therapists, family members and others.

Home care can be both rewarding and demanding for patients and caregivers. It can change relationships and require families to cope with all aspects of patient care. To help prepare for these changes, patients and caregivers are encouraged to ask questions and get as much information as possible from the home care agency and healthcare team.

To obtain home health care, you must be under the care of a doctor who will prescribe and manage a treatment plan; you must have a need for skilled healthcare services; and you must be a home-bound patient or have approval by a private insurance company.

Services you may be able to receive from a home health care provider include:

• nursing care,
• occupational and physical therapy,
• medical social work,
• personal care,
• wound care/dressing changes,
• medicines,
• pain management,
• blood/urine collection for laboratory procedures,
• running errands and preparing meals, and
• special medical equipment and supplies.

How should I choose a home care agency?
With so many home care organizations and services available, it is sometimes difficult to decide which to use. It is important that you carefully choose a home care agency that meets your needs. Many communities have several providers to choose from. You can talk with your doctor, nurse, hospital discharge planner or medical social worker about the home care agencies in your area. Also, your local health department may know of home care services.

If you are looking for a Medicare-certified agency, call the Medicare Hotline at 800.638.6833. You can also contact the National Association for Home Care (NAHC), which lists phone numbers for state agencies that have directories of home care and hospice agencies. NAHC also has a free publication, “How to Choose a Home Care Provider,” which provides excellent information on many aspects of home health care.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other organizations have information on accredited home care agencies. See the Resources at the end of this section for more information.

Who pays for home health care?
These services can be paid for directly by the patient and family or through various public or private sources. Some agencies receive help through community grants. Others may receive funding from local and state governments to assist patients in paying for their care if they cannot do so themselves. If you do not have private health insurance or do not qualify for home health care benefits, you may want to speak with a medical social worker at your hospital who can help you find other ways to pay for home care.

Home health care services may be covered partially by Medicare, Medicaid, private health insurance, Veterans Administration benefits, HMOs or workers’ compensation. Many home health care agencies are able to arrange for special financial counseling and payment arrangements, if necessary.

Should I think about getting long-term care insurance?
Many insurance companies now offer long-term care insurance to pay for care in a nursing home or in the patient’s home. Long-term care can be very expensive. Bringing an aide into your home just three times a week (two or three hours per visit) to help with dressing, bathing, preparing meals, and similar household chores, can cost $1,000 a month, or $12,000/year. That doesn’t include the cost of skilled help, such as physical therapists.
Long-term care insurance policies aren’t cheap either. Here’s an example. In 1999, a policy offering a $100/day long-term care benefit for four years, with a 20-day deductible, cost:

• a 50-year-old about $409 per year,
• a 65-year-old about $1,002 per year,
• a 79-year-old about $4,166 per year.

Policy prices are based on the patient’s age, the size of the benefit, the length of time benefits will be paid and other factors. Some policies have limitations for pre-existing conditions and benefits will not be paid for six months after the policy begins.

If you are interested in long-term care insurance, be sure to compare policies before you buy. See the Resources at the end of this section for organizations that give guidance about long-term care insurance.
What if I need home health care but cannot afford to pay for it?

There is a range of services available in the community to help meet long-term care needs. Care given by family members or friends can be supplemented by friendly visitor programs, home-delivered meal programs such as Meals on Wheels, chore services, adult daycare centers, and respite services for caregivers who need a break from daily responsibilities. Your local area Agency on Aging can help you locate the services you need. Call the Eldercare Locator at 800.677.1116 to identify your local office.

Portions of this section were adapted from, A Guide to Long-Term Care Insurance from the Health Insurance Association of America (http://www.hiaa.org) and Home Care for Cancer Patients from the National Cancer Institute, 800.4.CANCER or http://www.cancer.gov.

RESOURCES

Organizations

Accreditation Commission for Home Care, Inc.
919.872.8609 (Raleigh)
Provides information about accredited home care organizations in North Carolina.

American Association of Retired Persons (AARP)
202.434.3470 or 800.424.3410
http://www.aarp.org
In North Carolina:
919.755.9757 or 877.434.7598 (TTY) (Raleigh)
http://www.aarp.org/statepages/nc.html
Comprehensive information about caregiving, insurance options, Medicare and other topics (also available in Spanish). Free publications for people over age 50 and their caregivers.

American Cancer Society (ACS)
800.ACS.2345 or 866.228.4327 (TTY)
http://www.cancer.org
Provides information and services for all forms of cancer, diagnosis, treatment and many other topics. Has a free booklet about home care.

Association for Home and Hospice Care of North Carolina
919.848.3450 or 800.999.2357 (in North Carolina)
http://www.homeandhospicecare.org
Has locations and services of hospices and home care in North Carolina and information about hospice and home care.

Health Insurance Association of America
202.824.1600
http://www.hiaa.org
The HIAA offers “A Guide to Long-Term Care Insurance” on their web site.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
630.792.5000
http://www.jcaho.org
Has information on accredited home care and hospice agencies in the United States.

Medicare Hotline
800.MEDICARE (633.4227) or 877.486.2048 (TTY/TDD)
http://www.medicare.gov
Answers questions about Medicare benefits and coverage for home care. Some publications available in Spanish, large print, audio and Braille. Web site also available in Spanish and Chinese.

National Association for Home Care
202.547.7424
http://www.nahc.org/consumer/coninfo.html
Has information about how to choose a home care provider, what home care involves, hospice care and rights of patients.

North Carolina Department of Insurance
Health Insurance Counseling Program (Raleigh, NC)
919.733.2032 or 800.JIM-LONG (546.5664)
http://www.ncdoi.com
Contact for help in learning about and choosing a long-term care insurance plan.

North Carolina Division of Aging (Raleigh, NC)
919.733.3983
http://www.dhhs.state.nc.us/aging/home.html
Contact if you have questions or concerns about choosing a health care organization. Has information on home care and hospice, health, long-term care and other services in North Carolina.