HarvardCare at Home 
Wound Care
Skilled Nursing Care
Physical Therapy
Occupational Therapy
Accessing the Care You Need at Home
You know you need help at home. Maybe a wound is not healing. Maybe you are struggling after surgery. Maybe your parent is declining and needs professional medical support. The challenge is that home health care requires a physician order, and knowing how to navigate that process can be the difference between getting care and going without.
This guide walks you through the practical steps of getting your doctor to order home health services, what to say, what to expect, and what to do if your initial request does not succeed.
Understanding Why a Physician Order Is Required
Home health care is a medical service. Like other medical services, it requires a physician to determine it is medically necessary and to create a treatment plan.
What the Physician Order Includes
A home health order specifies that the patient needs home health care, the specific services required such as skilled nursing, physical therapy, or wound care, the diagnosis requiring treatment, the frequency and duration of visits, and any specific treatment instructions.
Who Can Order Home Health
Home health orders can come from your primary care physician, a specialist treating your condition, a surgeon following a procedure, a hospitalist during hospital discharge, and in some cases physician assistants or nurse practitioners depending on state regulations.
Know What Home Health Covers
Understanding available services helps you articulate what you need.
Skilled Nursing
Skilled nursing provides wound care and dressing changes, medication management, IV therapy, catheter and PICC line care, disease monitoring and education, and post-discharge transition care.
Rehabilitation Therapy
Physical therapy for mobility and strength, occupational therapy for daily living skills, and speech therapy for communication and swallowing.
Specialized Services
Home health also covers chronic wound management, diabetic wound care, wound vac therapy, post-surgery rehabilitation, fall prevention therapy, and home safety evaluation.
Our Medicare home health coverage guide explains eligibility and covered services in detail.
Step 1: Identify Your Specific Needs
Before talking to your doctor, clearly identify what you or your loved one needs help with.
Questions to Consider
Think about what medical tasks you cannot safely manage alone. Are there wounds that need professional care? Do you need help managing complex medications? Have you fallen or are you at risk for falls? Is recovery from surgery or illness not progressing as expected? Do you struggle with mobility or daily activities?
Document Your Concerns
Write down specific problems including what you cannot do that you used to do, safety concerns at home, symptoms that are not improving, medications you find confusing, wounds that are not healing, and instances of falls or near-falls.
Specific documentation is more compelling than general statements. Instead of saying you need help, say that your surgical wound has not improved in three weeks, you have fallen twice in the past month, or you cannot manage your new medication regimen safely.
Step 2: Prepare for the Conversation
How you present your needs matters.
Schedule Appropriately
Do not try to discuss home health during a brief follow-up focused on another issue. Request an appointment specifically to discuss your care needs at home. If possible, schedule a longer appointment.
Bring a Family Member
Having a family member at the appointment provides another perspective on your needs. They can describe challenges they have observed, supplement information you might forget, and provide the caregiver’s perspective on what support is needed.
Prepare Your Talking Points
Be ready to explain your specific medical needs, what you cannot do safely at home, what has changed recently, what you have tried that is not working, and your goals for home health care.
Step 3: Have the Conversation
During your appointment, communicate clearly and specifically.
Be Direct
State that you would like to discuss whether home health services would be appropriate. Ask specifically about the services you believe you need. Physicians respond well to direct, specific requests.
Focus on Medical Necessity
Frame your needs in medical terms. Rather than saying you want help at home, explain the skilled medical needs that home health would address. For example, you might say that your wound requires professional dressing changes you cannot perform yourself, you need physical therapy but cannot safely travel to an outpatient clinic, your medication regimen has become complex and you are making errors, or you have fallen multiple times and need fall prevention assessment.
Reference Specific Concerns
Use concrete examples. If you have a wound, describe how it looks and whether it is improving. Mention relevant information like why chronic wounds need professional care or signs of wound infection you may be seeing.
Ask Questions
If your doctor does not immediately agree, ask what alternatives they recommend, what criteria you would need to meet for a home health order, whether they would reconsider if your condition changes, and whether they can refer you to someone who can evaluate your needs.
Step 4: If Your Doctor Agrees
When your physician orders home health, here is what happens next.
Choosing an Agency
You have the right to choose your home health provider. Consider agencies that serve your area, offer the specific services you need, have good quality ratings, and can begin services promptly.
In Los Angeles, home health services are available throughout the area including Beverly Hills, Pasadena, Glendale, Santa Monica, Torrance, Long Beach, and many other communities. Browse our service area pages to find coverage in your location.
The Intake Process
The home health agency contacts you to gather information, verify insurance coverage, and schedule your initial evaluation. Learn about what to expect during your first visit.
Starting Services
Services typically begin within a day or two of the order. A clinician visits your home for a comprehensive assessment and care plan development.
Step 5: If Your Doctor Says No
Sometimes physicians decline home health orders. Understanding why helps you respond.
Common Reasons for Denial
Physicians may say no because they believe you do not meet homebound criteria, they think outpatient services are sufficient, they are unfamiliar with what home health provides, documentation in your record does not support the need, or they believe your condition does not require skilled care.
How to Respond
Clarify the Homebound Criteria
Homebound does not mean bedridden. It means leaving home requires considerable effort. If your doctor thinks you are not homebound, explain the difficulty you experience leaving home.
Explain Why Outpatient Is Not Feasible
Describe specific barriers to outpatient care such as transportation challenges, fall risk during travel, fatigue limiting ability to attend appointments, and wound or medical issues making travel difficult.
Educate About Available Services
Some physicians underestimate what home health offers. Share information about specific services that would address your needs. Reference our services page for a complete overview.
Request a Home Health Evaluation
Ask your physician to order a home health evaluation even if they are unsure. The evaluation itself determines whether services are appropriate.
Seek a Second Opinion
If you genuinely need home health services and your physician disagrees, consider getting a second opinion from another provider.
Special Situations
After Hospitalization
Hospital discharge is the most common entry point for home health. Before leaving the hospital, ask your care team about home health services. Discharge planners and case managers can arrange orders. You do not need a separate appointment with your doctor.
Our article on hospital discharge and recovery at home covers this transition in detail. Also see our guide on how home health bridges the hospital-to-home gap.
For Wound Care
If you have a wound that is not healing, specifically request wound care services. Professional wound care nursing can assess and treat wounds that home management has not resolved. Common situations include diabetic foot ulcers, pressure ulcers at any stage, venous leg ulcers, and surgical wounds with complications.
For Fall Prevention
If you or your parent has fallen, this is strong justification for home health. Falls indicate need for fall prevention therapy, fall risk assessment, and home safety evaluation. Read about how physical therapy reduces fall risk.
For Caregivers Seeking Help
If you are a family caregiver struggling to manage your loved one’s care, express this to the physician. Caregiver training is available through home health. Our guide on caring for elderly parents may help you articulate what you need.
Advocating Effectively
Getting the right care sometimes requires persistence.
Tips for Effective Advocacy
Be specific rather than general about your needs. Document everything including symptoms, challenges, and incidents. Bring written notes to appointments. Involve family members who can support your case. Follow up if you do not get a response. Know your rights as a patient.
Your Right to Home Health
If you meet Medicare home health eligibility criteria, you have a right to receive these services. Physicians may not always be aware of the full scope of home health or the eligibility criteria. Being an informed advocate helps ensure you receive appropriate care.
Take the First Step
If you believe you or a loved one could benefit from home health services, do not wait. Talk to your physician. Be specific about your needs. Be persistent if necessary. The care you need is available. Sometimes accessing it just requires knowing how to ask.
For questions about home health services or help determining whether you might qualify, contact us or visit our FAQ page.
