Home Care During Chemotherapy in Massachusetts: Which Days to Buy

Do not buy every day. Chemotherapy runs in cycles and the hard days arrive on a schedule, usually starting a day or two after the infusion and lasting three to five days. Most families should buy three or four days per cycle rather than thirty, and spend the money on the right days instead of spreading it thin.

Home health aide care is $45 an hour, one to eight hours a day, with no minimum contract. Four hours on four days of a cycle is $720, which is a very different number from a month of daily coverage.

Which days are actually the hard ones?

Infusion day itself often feels deceptively fine, because steroids are frequently given alongside the treatment. The drop usually comes the next day or the one after, and that is the stretch worth covering.

Track the first cycle before committing to a schedule. Write down how each day felt, day by day, and you will have a map of the second cycle and every one after it, because the pattern tends to repeat. Then book those days in advance for the rest of the course rather than scrambling each time.

What does an aide do on a bad day?

• Small food, often, and different food than last month. Taste changes during treatment, sometimes to a metallic flavor, and the thing somebody loved in cycle one is intolerable by cycle three. An aide who shops and cooks adapts; a freezer full of meals planned in advance does not.
• Fluids. Dehydration is what sends people back to the hospital between cycles, and it starts with somebody too tired to get up for a glass of water.
• Bathing and dressing on days when standing in a shower is genuinely beyond someone.
• The laundry, the dishes and the house, so that the person's whole energy budget is not spent on maintenance.
• Being in the house. Not medical supervision, just somebody there, which matters most on the days when getting to the bathroom is a project.

What should I ask about infection precautions?

This is the most important question on this page, and most families never ask it. Chemotherapy lowers white blood cell counts, with the lowest point typically falling a week or two after an infusion. During that window an ordinary cold is not ordinary.

So ask any agency you call: what happens when the scheduled aide wakes up with a sore throat? An agency whose answer is that she comes anyway, or that nobody comes at all, is the wrong agency for an oncology patient. You need somebody who will say plainly that she stays home and here is who comes instead.

Also ask the oncology nurse what handling precautions apply at home in the first days after an infusion. There are some, they vary by drug, and the aide needs to be told what they are rather than guessing.

Can the aide give the anti nausea medication?

No. Our aides are trained, background checked and insured but they are not nurses and cannot administer medication. They can be present while a client takes their own, help if something goes wrong, and call for help.

That limitation bites hardest with nausea medication, which works far better taken on schedule than taken once somebody is already sick. If the person cannot reliably manage their own doses on a bad day, you need nursing rather than an aide, and we will tell you that on the phone instead of selling you the wrong thing.

Does it get harder as treatment goes on?

Usually, yes, and this is the part nobody is warned about. Fatigue tends to accumulate across cycles rather than resetting, so cycle four is often harder than cycle one even though the dose has not changed. Families who declined help in month one frequently call in month three.

Plan for that shape. Start with the minimum on the known bad days, and assume the schedule will need to grow rather than hoping it will not.

What about neuropathy?

Some regimens cause numbness in the feet and hands. Numb feet are a fall risk on stairs and in the shower, and numb fingers turn buttons, jars and pill bottles into problems. If this starts, say so when you book, because it changes what the aide needs to watch and whether the bathroom needs grab bars.

Who drives to the infusions?

Ask the cancer center first. Many have patient navigators, volunteer driver programs or arrangements with transportation services, and the American Cancer Society road to recovery style programs exist in parts of the state. Your town's Council on Aging may also run medical rides. Those are free or low cost and you should exhaust them before paying anybody.

Where they fall down is a standing schedule of fifteen to thirty weekday trips, a wheelchair, or a ride home from a procedure that needed sedation. We cover recurring treatment runs on rides to daily radiation treatment.

Is there anything that pays for the aide hours?

Check four. A long term care policy may reimburse you, after an elimination period you fund yourself, which we explain on making a long term care policy actually pay. Veterans and surviving spouses should ask about Aid and Attendance. Your local Aging Services Access Point runs an income based state home care program. And ask the cancer center's social worker about hardship and grant funds, because many disease specific foundations have them and they are chronically underused.

Medicare does not pay for an aide in the house on an ongoing basis. Day to day help is custodial care and has never been a Medicare benefit.

How do we book around a treatment calendar?

Give us the infusion dates for the whole course and we will put the recurring days in once rather than making you call every three weeks. If a cycle gets delayed because counts were low, which happens often, we move the block rather than charging you for days nobody needed.

Care Remedy serves eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. Call 781-957-8076 with the treatment schedule and which days of the last cycle were worst.

This is general information about care at home and not medical advice. Treatment side effects, infection precautions, activity limits and medication schedules vary by regimen and should come from the treating oncology team.