Home Care After Surgery or Hospital Discharge: What Philadelphia Families Should Know

The hospital discharge comes faster than families expect. Your loved one had a hip replacement, a heart procedure, or a fall that required surgery, and within days they’re being sent home — often still needing significant daily help. The hospital discharge planner asks whether you have support at home, and most families say yes because what else can you say? But “support at home” and “I’ll figure it out” are very different things.

Here’s what Philadelphia families should know about home care after surgery or hospital discharge.

Two Types of Post-Discharge Care

After a hospitalization, your loved one may qualify for two separate types of home-based services— and they serve different purposes.

Home health care is the medical piece: a visiting nurse checks the surgical site, manages wound care, monitors vital signs, and ensures the recovery is on track. Physical and occupational therapists help your loved one regain strength and mobility. Home health is ordered by the physician, covered by Medicare, and typically lasts weeks to a few months until recovery goals are met.

Home care (personal care) is the daily living piece: help with bathing (your loved one can’t shower alone after hip surgery), dressing, meal preparation, medication management, and mobility. This is the service that Medicaid funds through CHC— and it can continue long after home health services end.

In our experience at CareChoice, the critical gap families fall into is this: home health runs for fourto six weeks after discharge. It ends. And the family assumes all care is over. But the personal careneeds — the bathing, the dressing, the meals, the mobility support — often persist far longer thanthe medical recovery period. That’s when Medicaid home care takes over.

When to Start the Medicaid Home Care Process

Ideally, before discharge.  If your loved one was already struggling with daily activities before the hospitalization — and the surgery or illness is going to make things worse — start the Medicaid application through COMPASS and contact PCA at (215) 765-9040 while your loved one is still in the hospital. Mention the pending discharge to request expedited processing if possible.

If you didn’t start before discharge, start now. Every week of delay is a week of uncompensatedcaregiving and a week without formal support.

The Family Caregiver After Discharge

Many post-surgical home care situations follow a predictable pattern: a family member takes timeoff work to care for the loved one during recovery. That time off is unpaid, the recovery takeslonger than expected, and the family member faces a financial crisis on top of the caregivingcrisis.

Participant-Directed Services through CHC can solve this. If your loved one qualifies for ongoing Medicaid home care (not just the short-term post-surgical period, but ongoing daily living support), a family member can be hired and paid as the caregiver. The family member who took time off work now has income — not from their employer, but from the Medicaid-funded caregiver role.

What the Hospital Won’t Tell You

Discharge planners at Philadelphia hospitals are focused on immediate medical needs — homehealth referrals, medication lists, follow-up appointments. In our experience, they rarely mentionMedicaid home care programs, Participant-Directed Services, or paid family caregiving. Theseprograms aren’t in the discharge planner’s workflow, even though they’re exactly what mostfamilies need once the medical recovery ends and the daily living challenges persist.

This is the information gap CareChoice fills. We help families connect the dots between thehospital discharge and the long-term home care system — so the transition doesn’t leave yourfamily scrambling.

Contact CareChoice →Philadelphia team

Written by Carolyn Choates, Assistant Marketing Manager | CareChoice