Skilled Nursing, at Your Kitchen Table

A skilled nurse is the one who notices. The dressing that looks a little different today. The ankles that are puffier than last week. The pill bottle that should be half empty and is still full. Home health nursing brings that trained eye into your home, on a schedule your doctor sets.

If your doctor orders it and you qualify, Original Medicare covers skilled nursing at home at no cost to you.

What skilled nursing looks like at home

Mr. Reyes came home from the hospital with a new heart medicine, a water pill, and instructions he half remembers. His daughter lined the bottles up on the counter and hoped for the best. On the first visit, the nurse sits at the kitchen table with both of them, picks up each bottle, and explains what it is for, when to take it, and what to watch for. She writes a simple schedule in large print and tapes it inside the cabinet door.

Two streets over, Mrs. Okafor has a wound on her leg that is slow to heal. Her nurse measures it, cleans and dresses it, and photographs it for the doctor so the plan can change if it needs to. Mrs. Okafor's son learns how to change the dressing on the days in between, if the family wants that.

These are ordinary visits. Nothing dramatic happens, and that is the point. Small problems get caught while they are still small.

What the nurse does

• Checks on you. Blood pressure, pulse, breathing, weight, blood sugar, pain, and how you are doing day to day.
• Wound care. Surgical incisions, pressure sores, diabetic foot wounds, and leg ulcers. Cleaning, dressing, measuring, and watching for infection.
• Medicines. Goes through every bottle in the house, compares them with what the doctor ordered, sets up a system you can follow, and watches for side effects.
• Injections and IV care. Injections your doctor orders, and care for some IV lines and ports.
• Catheters, ostomies, and tubes. Changes, care, and teaching so you and your family feel confident.
• Teaching. What the numbers mean, when to call the nurse, and when to call 911. The goal is that you understand your own care.
• Reports to your doctor. After visits, and right away if something changes.

What the first visit looks like

The first visit usually happens within 24 hours after your doctor or the hospital sends the order. Expect it to take a while. The nurse reads your discharge papers, checks you from head to toe, goes through your medicines, looks at the home for hazards like a loose rug on the way to the bathroom, and asks what you want to be able to do again. From that, the nurse and your doctor write a plan of care. You get one named coordinator who knows your case. We call before every visit, and we send the same nurse whenever we can. If someone else must come, we call first.

When to call

Call 911 for chest pain, trouble breathing, signs of stroke such as a drooping face or sudden weakness, or bleeding that will not stop. Call your nurse or doctor for a wound that is redder, warmer, or draining more than before, a fever, new swelling, dizziness, a fall, or a medicine question. When in doubt, call. That is what the nurse is for.

What family can do

• Be there for the first visit if you can. You will hear the plan firsthand.
• Keep a notebook. Daily weights, blood pressure, or blood sugar if the doctor asks for them, and questions as you think of them.
• Keep the medicine list current. Bring it to every doctor visit.
• Ask to be taught. Dressing changes, injections, and using a blood pressure cuff are all things families learn.

Cost and who qualifies: with Original Medicare, covered home health is $0 if you qualify, and your doctor decides. See what Medicare covers, who qualifies, and what is not covered.

Our team speaks English, Spanish, Armenian, Russian, and Tagalog. Speak another language? Call (818) 579-4012 and ask whether we have staff who speak it. If we do not have staff who speak your language, we arrange a free interpreter.