In some instances, more care will be needed than can be provided by a single family member or friends. Additional help from trained health care workers may be especially necessary when the patient's needs require help with complex treatment care such as ostomy care and catheters, wound care following surgery, and complex medication needs. Home health care services are usually used on a relatively short-term basis.

Think of integrating home health services as part of the process of forming a team — which includes family, friends, the health care team, as well as home care staff members from a home health agency or other source.

• Home health care includes providing trained staff to help with tasks such as wound cleaning and dressing changes, checking on the patient's overall condition, etc. Some home health aides also provide limited help with housekeeping and/or personal care.

Note: If you are able to manage the medical care requirements of your loved one without additional regular help, then what you may need is assistance and support in housecleaning and yard chores. Hiring a cleaning agency or a yard service is easier and generally far less costly than health care aides. In some instances, you may be able to locate free sources of assistance for this work, in the form of volunteers from community groups or even area social service agencies.

• Kinds of home health services staff include registered nurses, certified nursing assistants (CNAs), physical therapists, social workers, and other professionals. Review the services available and their costs with potential home health care service providers so you can select the help you need.

• Home health agencies also usually arrange for rental of medical equipment. Ask about costs in advance; it may be less expensive to rent some types of equipment yourself from a separate home care rental agency, especially if the equipment is not expected to be used for a long period of time.

• Work with your hospital staff and/or physician's discharge planners to determine eligibility for coverage of costs of home health care, skilled nursing care and physical therapy. Medicare and Medicaid are sources of limited coverage for these needs, as well as hospice services. Also explore the possibilities of coverage through the Veterans Administration (if your loved one is a veteran) and the Older Americans Act. Medicare: 1-800-MEDICARE. You can find more information about Medicare coverage by calling 1-800-MEDICARE (1-800-633-4227) or online at www.medicare.gov. Look for "Home Health Compare" on the home page

• Medicaid, is a joint state-federal program serving low-income people, is also coordinated by the Centers for Medicare and Medicaid Services (CMS). Medicaid coverage varies from state to state, but usually includes some amount of nursing, aides, equipment and supplies. Get info from your community's welfare office, state department of health, and on Internet at www.cms.hhs.gov/Medicaid.

• The Older Americans Act helps frail and disabled people 60 or older to remain independent. It covers home care aides, escorts, meal delivery, shopping, etc. Contact your local area agency on aging for information and referrals — look under county or city government headings. Or, call the Eldercare Locator hotline run by the U.S. Administration of Aging at 1-800-677-1116. This information is available online at www.eldercare.gov.

• If income levels or other requirements prevent reimbursement from government sources or private long-term care insurance, then these services must be paid out-of-pocket. Insurance coverage usually only pays for services provided by professionals; check with your insurer to learn about your coverage. Many insurers also cover a hospice benefit, but the amount and degree of reimbursement varies considerably. Check with your insurer.

• Seek out your local senior and social services agencies and ask what kinds of help they provide, and for whom. There is great variety nationwide.

Finding a reputable home health agency. Start by seeking a recommendation from your health care team for home care agencies who have cared successfully for cancer patients. Additional information is often available in your local community or from your state department of health. Any agency you hire should be licensed by your state regulatory agency. See the website of the Family Caregiver Alliance, www.caregiver.org, for detailed fact sheets to help you think through various hiring options (agencies or individuals) for your ongoing care needs.

• Make use of a service offered by Medicare online to compare how well a home health agency performed at helping clients on 11 key measurements. Click on "Home Health Compare" at www.medicare.gov.

• Consult the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for help in choosing a home health agency. They can provide useful information about accreditation status of many agencies. (www.jchao.org)

• Veterans Administration (VA) - Disabled vets can receive some home care services from the VA — but these must be provided by VA hospitals. For information call the VA Benefits Office at 1-800-827-1000. Online you can reach the VA at www.vba.va.gov.

• The American Cancer Society has useful information about hiring and working with home health care services; see www.cancer.org or 1-800-ACS-2345. Also, some local ACS chapters can provide local information and support; look in your local phone book for numbers.

• National Association for Home Care - the trade association for home care providers - offers free online resources to help you choose home care help; the website is www.nahc.org/consumer/coninfo.htm — look for the section titled "How to Choose a Home Care Provider." Help is also available by calling 202-547-7424.

Respite Care — for hours, days or weeks — is the gift of time to you, the caregiver, to take care of your own needs, to rest, to rejuvenate yourself. This can be provided either by paid companions or volunteers in the community (such as those who work with hospice programs). Length of time varies with your needs and with what arrangements might be possible.

Nursing Homes and Assisted Living Facilities. Nursing homes are residential full-care facilities for people who require medical care around the clock, but who do not require hospitalization. Most provide medical care 24 hours a day as well as convalescent care for people recovering from surgery and other treatments. For a few cancer patients, especially those who are very old, frail and/or have other health conditions that require care and monitoring, a nursing home may prove to be the only viable solution. Talk with your health care team for advice and ideas on nursing homes available for your loved one.

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