The first home health visit: what happens and how to get ready

The first home health visit sets up everything that follows. A registered nurse, or a therapist when therapy is the only care ordered, comes to the house to meet the person, look at their health, their home and their medicines, explain their rights and start the plan of care.^1,2 A little preparation makes that visit go further. This note explains when it happens, what happens during it, and what to have ready.

The short answer

• The first visit comes within 48 hours of the referral or of getting home from the hospital, unless the doctor orders a different start date.¹
• A registered nurse makes it. When therapy is the only service ordered, a therapist can.¹
• Before care starts, the agency gives a written notice of the person’s rights and explains what Medicare pays and what, if anything, the person will owe.^2,3
• The visit includes a review of every medicine the person takes, to catch side effects, interactions, duplicates and doses being missed.¹
• Have the medicines, the discharge papers, the insurance cards and the doctors’ names on the table.

When it happens

Once a doctor or allowed provider orders home health, the agency sets up the first visit. It has to happen within 48 hours of the referral, or within 48 hours of the person getting home from the hospital, unless the doctor orders a specific start date.¹ The same rule applies later if the person goes back into the hospital for 24 hours or more, for anything other than tests: the agency comes again within 48 hours of their return, or on the date the doctor orders.¹

Who comes

A registered nurse makes the first visit. When the only service ordered is therapy, like physical therapy after a knee replacement, a therapist can make it instead.¹ The rest of the team, such as a therapist, a home health aide or a medical social worker, starts coming as the plan calls for them. The home health team, role by role explains who does what.

What happens during the visit

The first visit covers a lot of ground. Expect the nurse or therapist to:

• Go over the person’s rights. Before care starts, the agency has to give a written notice of the person’s rights and responsibilities and its transfer and discharge policies, in a form the person can understand. The person signs to show they got it.²
• Explain the costs. The person has the right to be told, out loud and in writing, what Medicare or another program will pay and what they may owe, before care starts.^2,3
• Look at the person’s health. The assessment covers their physical health, their mood and thinking, how well they move and care for themselves, and what matters to them, including their own goals for care.¹
• Review every medicine. The nurse looks for side effects, reactions, interactions, duplicates, medicines that aren’t working and doses being missed.¹
• Meet the caregivers. The assessment asks who helps the person, and when they’re available and able to help.¹
• Look at the home for safety. The plan of care includes safety measures to protect the person from injury, so expect questions about stairs, rugs, lighting and the bathroom.⁴
• Make an emergency plan. Each patient’s assessment includes an individual plan for a disaster, like a fire, an earthquake or a long power outage.⁵
• Ask about advance directives. The plan of care includes information about any advance directive, like a POLST form or an advance health care directive.⁴

The papers you’ll see

• The written notice of rights and responsibilities, which the person signs²
• The name, business address and phone number of the agency’s administrator, for complaints²
• A privacy notice about OASIS, the standard assessment Medicare requires agencies to collect²
• An Advance Beneficiary Notice, if the agency expects Medicare won’t pay for a service or supply³
• A written copy of the visit schedule, the medication schedule, the treatments, and how to reach the agency’s clinical manager⁴

The next few days

The first visit starts a full assessment that the agency has to finish within 5 days of the start of care.¹ Together with the doctor’s orders, it becomes the plan of care: the services and how often they come, the medicines and treatments, the goals, and what the person and family will be taught.⁴ The doctor or allowed provider signs the plan, and it’s reviewed as often as the person’s condition requires, at least every 60 days.⁴

The person has the right to take part in that planning and to agree to or refuse any part of it.² If something in the plan doesn’t fit the way the household works, say so early.

What to have ready

• Every medicine in its bottle, prescription and over the counter, including vitamins, supplements, inhalers, creams and eye drops
• The hospital or facility discharge papers, and the medication list that came with them
• Medicare, Medicare Advantage or Medi-Cal cards, and any other insurance
• Names and phone numbers for the doctors and the pharmacy
• Any advance directive or POLST form
• Equipment that came home with the person, like a walker or oxygen, and its paperwork
• A notebook for the schedule and for questions
• A family member or caregiver who knows the person’s routine, especially if the person has trouble remembering

Bringing out every bottle matters. The review works best with what’s actually in the house, especially after a hospital stay. Keeping medicines straight after the hospital explains why.

Questions to ask

• Who is our main nurse, and how do we reach the agency at night and on weekends?
• How often will each person on the team come, and on which days?
• Which warning signs should we call about, and who do we call first?
• What are the goals, and how will we know when home health is done?
• What does Medicare cover, and will we owe anything?