Things to think about. Where a person with cancer lives while receiving care will depend on a number of factors. For most people, home is a logical and satisfactory choice. However, for some others, a different setting may be a better choice. If you are a caregiver considering decisions like this, here are some issues to consider:

• Does your loved one want to be cared for at home, or would a different setting be preferred?

• How willing and able are the patient's caregivers (you and others who will help) to provide care at home? Is it feasible to organize a network of people who can assist if necessary?

• Does the family understand that caregiving in the home, especially for a very ill person, can have a somewhat disruptive impact on family life? Are they willing to cope with this impact and accommodate to special needs?

• What is home life like? Does the family get along reasonably well? How have you coped with past difficulties as a family?

• Are there special family problems that could have an impact on caregiving, such as a family member who abuses alcohol or drugs?

• If the cancer patient is cared for at home, are there people available to provide care as often as necessary during the day and in the evening?

• If caregiving is needed around the clock, are resources available to help with hiring home health care staff to provide relief and support to family members?

• What social services in the community are available to support caregiving in the home? Ask your hospital's oncology social worker for information. You may also find additional resources in your local telephone book's "Yellow Pages" under "Social Services."

Choosing Home. For many people with cancer, remaining at home throughout the course of treatment is the best, preferred option. Being home means, for many people, being close to loved ones, and taking comfort in a familiar and comfortable world.

How many or how few changes to the home will be needed depends on a number of factors, the paramount of which is how disabled your loved one is. Some people in cancer treatment need virtually no physical changes to their environment. Others who are experiencing more difficulty may need special accommodations made.

These changes may be relatively simple, such as turning a downstairs room into a bedroom, or more extensive changes like making a half-bath into a full bath with special safety accommodations and arranging for wheelchair access throughout the house. Other changes made frequently include creating ramps for stairs, adding slip-proof floor coverings, and changing the way doors swing to accommodate a person in a wheelchair or using walker.

To determine how to make your home suitable for caring for a loved one, the first step is to assess the individual's condition, and discuss likely future needs with your health care team. Once you understand what changes are likely to be needed, you can make those that are relatively simple yourself, such as installing grab bars in bathroom tubs and showers, installing a shower chair, and attaching a flexible hose to the shower head so the patient can shower conveniently while sitting. If your home has stairs, make sure a sturdy railing is installed.

If your loved one has some mobility problems, such as difficulty in walking, you may want to consider renting (as opposed to buying) appropriate equipment, such as a walker, from a home health supply store; many communities have these. If this service is unavailable in your community, talk with your hospital's oncology social worker for assistance in obtaining what you need.

For other, more complex needs, consult a home remodeler for assistance. In many communities, some remodelers specialize in remodeling for home care. For assistance and information, check the website of the National Association of Home Builders (NAHB) Remodelers™ Council at www.nahb.org (click on "Resources" and then "For Consumers"). You'll find a state-by-state list of councils that can refer you to remodelers in your area. Your local health care team, especially the oncology social work staff, may also be able to provide recommendations.

The patient's bedroom. If modifications to the patient's bedroom are necessary or likely to become necessary in the future, a comfortable downstairs room might prove most convenience for both the patient and the caregiver. If a wheelchair is likely to be needed, place the bed in a way that allows for several feet of clearance around the bed, so the transfer from bed to chair can be accomplished easily. Conveniences like an over-the-bed table will make tasks like eating, reading and writing in bed easier (these can be rented from home health agency suppliers). Special pillows designed for sitting up in bed can be helpful. A night stand with a comfortable reading light is also important, as is chairs that can be brought close to the bedside, for visitors as well as caregiving. For most people, a hospital bed is not needed, unless it is likely that the patient will eventually be in bed most of the time. In that instance, a hospital bed can make caregiving much easier, since it can be raised or lowered.

Communications. If a person is bedridden or spends a significant amount of the day in bed, it may be a good idea to arrange for a means for her or him to summon help from people in other parts of the house. There are a variety of options available, including pagers, remote control speaker phones and other devices. In general, almost all patients will want a telephone at bedside for their use, as well. For people who spend a time alone in the house, an emergency response system, one that dials a predetermined number for outside help, may be helpful and comforting.

Safety matters. If there are mobility issues, it is important to take time to do everything you can in the home to keep it safe for the patient. Some safety tips include:

• Make sure stairs have handrails — ideally on both sides.
• Place nightlights in dark hallways and rooms, including bathrooms.
• Install grab bars and non-slip mats in the bathrooms.
• Don't permit anyone to smoke in bed.
• Install a smoke detector.
• If the patient is using oxygen, don't allow any smoking in the room.

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