Patient Background
Personal and Social History
Mrs. Meenakshi Jha was a 68-year-old retired school librarian living in Patna, Bihar. She had been managing long-standing osteoarthritis affecting both knees and the right hip for several years. Her daily life had been structured around predictable routines — morning walks that gradually shortened, a carefully managed household, and an active role in her local community.
As a widowed woman, she lived with her daughter Ananya and son-in-law Rohit, who formed her primary and secondary caregiving network. Her background as a librarian meant she was intellectually engaged, communicative, and capable of understanding and following medical instructions — factors that would later prove valuable during her rehabilitation.
For several years, her osteoarthritis had been managed with prescribed medicines, activity modification, and occasional physiotherapy sessions. However, during the year preceding hospitalization, a gradual but noticeable decline in her walking ability became apparent. She began avoiding stairs, stopped going to the nearby market independently, and progressively needed physical support while rising from a chair. These changes did not happen overnight — they reflected the insidious, progressive nature of degenerative joint disease that is well-documented in common musculoskeletal problems faced by elderly people in India.
Osteoarthritis progression in the elderly is often slow and intermittent, with periods of relative stability punctuated by acute worsening. Recognizing the pattern of gradual functional decline — rather than waiting for a single crisis — is important for timely intervention. Families often adapt to each new level of limitation without realizing the cumulative impact on the patient’s independence, nutrition, muscle strength, and psychological well-being.
During the three months before hospitalization, her right knee pain worsened significantly. She developed increasing difficulty bearing weight on the right leg. One morning, she experienced severe pain while attempting to get out of bed and was unable to walk safely. This acute exacerbation prompted her daughter to take her to the hospital for urgent assessment — a decision that aligned with guidance on early warning signs in elderly patients that require immediate medical attention.
Clinical Diagnosis
Primary Diagnosis
Affecting both knees (right greater than left) and the right hip joint
Associated Medical Conditions
Notable exclusions: She did not have diabetes, chronic kidney disease, or significant heart disease — which simplified her medical management and reduced the complexity of her home care plan.
Radiological Findings
X-rays performed during hospitalization showed advanced degenerative changes in both knees, with significantly greater involvement of the right knee. These findings were consistent with the clinical presentation of progressive, long-standing osteoarthritis.
Radiological assessment was necessary to confirm that the mobility limitation was due to degenerative joint disease rather than other conditions such as fracture, infection, or inflammatory arthritis. The severity of radiographic changes, combined with the clinical picture, helped the orthopedic team discuss treatment options — including the possibility of future joint replacement — with the family in an informed manner.
Initial Home Assessment — Vital Parameters
| Parameter | Value Recorded |
|---|---|
| Blood Pressure | 138/82 mmHg |
| Heart Rate | 78 beats/min |
| Respiratory Rate | 17 breaths/min |
| Temperature | 98.2°F |
| Oxygen Saturation | 98% on room air |
| Pain at Rest | 3/10 |
| Pain During Walking | 7/10 |
There was no fever, acute breathlessness, or chest pain at the time of assessment.
Hospital Treatment
Mrs. Jha remained in hospital for 6 days. The hospitalization served multiple purposes: pain control, comprehensive orthopedic assessment, detailed mobility evaluation, and the formulation of a structured treatment plan. This period allowed the clinical team to stabilize her acute symptoms while also assessing the full extent of her functional limitations.
Interventions During Hospital Stay
The orthopedic team discussed long-term treatment options, including the possibility of joint replacement if symptoms remained severe despite conservative management. At that stage, the family preferred a structured rehabilitation program before making a decision about further surgery. This is a clinically sound approach — conservative rehabilitation serves both as a treatment in itself and as a functional assessment period that helps the patient and family make a more informed decision about surgical options. It also allows the patient to enter surgery in better physical condition if it eventually becomes necessary.
At the time of discharge, Mrs. Jha remained weak and had difficulty walking independently. The hospital team recognized that early outpatient physiotherapy visits would be difficult for her given her pain and mobility limitations. This is a common challenge for elderly patients in Patna, where frequent hospital trips can be physically taxing and logistically demanding for families. The treating team recommended home-based rehabilitation — a decision supported by evidence showing that home-based physiotherapy can be as effective as clinic-based sessions for appropriate patients, while being significantly more convenient and reducing the risk of travel-related complications.
Why Home Healthcare Was Needed
The decision to arrange home healthcare was not merely a convenience measure — it was a clinically appropriate choice based on multiple factors specific to Mrs. Jha’s condition, her home environment, and the goals of her rehabilitation.
Travel Was a Safety Risk
With pain at 7/10 during walking and a guarded gait pattern, traveling to a physiotherapy clinic multiple times per week would have posed a fall risk, increased pain, and potentially undermined her willingness to participate in rehabilitation.
Rehabilitation Needed to Happen in the Real Environment
Osteoarthritis rehabilitation is most effective when exercises and mobility training are practiced in the actual environment where the patient lives. Transferring from a hospital bed to a home bed, navigating home corridors, and using the home bathroom are different from hospital-based activities. Creating a senior-friendly home environment and training within it produces more functionally relevant outcomes.
Multi-Disciplinary Care Was Required
Mrs. Jha’s needs extended beyond physiotherapy. She required medication monitoring, daily activity support, nutritional guidance, fall prevention, and periodic medical review. A coordinated home healthcare service could provide this integrated approach more effectively than separate clinic appointments.
Family Capability and Confidence
While her daughter and son-in-law were willing caregivers, they lacked the clinical skills to safely assist with transfers, monitor for complications, or structure a rehabilitation program. Professional home healthcare bridged this gap while actively involving the family in the care process — an approach supported by literature on understanding the caregiver role in elderly care.
Post-Discharge Vulnerability Period
The period immediately after hospital discharge is a well-documented high-risk phase for elderly patients. Post-hospital discharge care for senior citizens requires structured monitoring to detect early deterioration, prevent complications, and ensure medication continuity. Home nursing provided this safety net during the critical early weeks.
Home Care Plan by AtHomeCare
The home care plan was designed around Mrs. Jha’s specific clinical needs, functional limitations, and rehabilitation goals. Each service component addressed a distinct aspect of her recovery, working together as an integrated system rather than isolated interventions.
Home Nursing
Clinical monitoring and medical support
Despite the absence of acute medical instability, Mrs. Jha required regular clinical monitoring because she was on multiple medications (including pain management and anti-hypertensive drugs), had risk factors for complications (age, obesity, reduced mobility), and was in the vulnerable post-discharge period. The home nurse served as the clinical safety net — identifying early warning signs before they became emergencies. This role is particularly important in specialized nursing services in Patna where hospital access may involve delays.
The home nurse monitored the following parameters systematically:
Important instruction to family: The family was advised not to increase pain medicines independently when pain worsened. Self-adjustment of analgesic doses — particularly in elderly patients on anti-hypertensive medication — carries risks of drug interactions, side effects, and masking of new symptoms that may require medical evaluation. This aligns with established principles of medication safety in elderly home care.
Patient Attendant
Daily activity support and safety supervision
Mrs. Jha required physical assistance with multiple activities of daily living — bathing, dressing, toileting, and walking. Her daughter and son-in-law had work responsibilities and could not provide this level of hands-on support throughout the day. A trained patient attendant ensured consistent, safe assistance while also encouraging Mrs. Jha to maintain as much independence as possible — a critical distinction from simply “doing everything for her.”
Key principle applied: The attendant was specifically instructed to encourage independence rather than performing every task for Mrs. Jha. For example, she was encouraged to perform grooming and upper-body dressing herself whenever safe. This approach prevents the well-documented problem of excess disability — where patients lose function not because of their disease but because of over-assistance by caregivers.
Physiotherapy at Home
Central rehabilitation component
In severe osteoarthritis, the primary problem is not just pain — it is the cascade of functional consequences that follows: reduced movement leads to muscle weakness, which leads to reduced joint support, which leads to more pain and further activity avoidance. This vicious cycle can only be interrupted through structured, progressively graded exercise. Physiotherapy addresses this cycle directly by improving strength, mobility, balance, and functional confidence simultaneously. Home-based physiotherapy allowed Mrs. Jha to receive this intervention without the barriers of travel, waiting rooms, and unfamiliar environments.
Initial Rehabilitation Goals
Therapy Components
Exercise intensity was gradually increased according to her symptoms and functional response — not according to a fixed timetable.
Doctor Home Visit
Periodic medical review and treatment adjustment
A doctor reviewed Mrs. Jha periodically to assess:
The possibility of future orthopedic intervention — including joint replacement — was kept open throughout the rehabilitation period. Conservative management did not mean surgical options were excluded; it meant they were deferred while Mrs. Jha’s functional potential was explored. If her symptoms remained limiting despite maximal non-surgical rehabilitation, the family and orthopedic team would revisit the surgical discussion from a more informed position.
Medical Equipment Support
Mobility aids and safety equipment
Appropriate equipment was arranged to support safe mobility and reduce fall risk. The home environment was also modified to eliminate hazards — an approach detailed in guidance on comprehensive fall prevention for elderly patients.
Equipment Used
Primary mobility aid for indoor walking; height adjusted by physiotherapist for optimal posture and weight distribution
Reduced the knee flexion required during toileting, making transfers safer and less painful
Allowed seated bathing, eliminating the need to stand on a wet, slippery surface
Installed near the toilet and shower area for additional support during transfers
Reduced slip risk on wet bathroom floors — a critical intervention given that bathrooms are the most common site of falls in elderly patients
For regular home monitoring of her controlled hypertension, ensuring medication effectiveness
Replaced low, unstable furniture to make sit-to-stand transfers easier and safer. Armrests provided leverage for rising. The height was selected to minimize the knee flexion angle required.
Equipment note: A wheelchair was kept available for longer-distance outings but was deliberately not used as the primary method of mobility inside the home. Using a wheelchair for all indoor movement would have accelerated muscle deconditioning and reduced the opportunity for functional walking practice. This principle — of using the least restrictive mobility aid — is central to orthopedic patient walker transfer protocols.
Daily Care Plan
The daily routine was structured around Mrs. Jha’s pattern of morning stiffness, energy levels throughout the day, and the need for consistent rehabilitation without overexertion. The plan was not rigid — it was adjusted based on her pain, fatigue, and progress.
Morning Routine
The day started slowly because Mrs. Jha had significant morning stiffness lasting approximately 30–40 minutes — a classic feature of osteoarthritis that distinguishes it from inflammatory arthritis where stiffness typically lasts longer.
- The attendant helped her sit at the bedside before attempting to stand — allowing time for initial stiffness to ease
- After prescribed medication and breakfast, gentle mobility exercises were performed
- The physiotherapist initially focused on knee movements, ankle movements, quadriceps activation, hip exercises, and safe standing
- A short supervised walk inside the house followed the exercise session
Afternoon — Functional Activities
The afternoon focused on functional activities — practicing the movements that are directly relevant to daily life rather than abstract exercises.
- Walking from bedroom to living room — building real-world walking endurance
- Sit-to-stand transfer practice — reinforcing the most frequently performed and most challenging movement
- Safe bathroom transfers — practicing the specific transfer sequence for her bathroom setup
- Short periods of standing — gradually increasing tolerance
- Light household activities — integrating movement into purposeful tasks
Important: Rest periods were included between activities. The family was specifically advised to avoid keeping Mrs. Jha in bed for prolonged periods unless she was tired or unwell — as prolonged bed rest would worsen her muscle weakness and joint stiffness.
Evening — Consolidation
- A second short walking session was performed
- The attendant supervised movement and ensured frequently used items were within easy reach
- The family checked whether knee swelling or pain had increased after the day’s activities
Night — Safety Preparation
Night-time is a particularly vulnerable period for elderly patients with mobility limitations. Nighttime dangers for elderly patients include unattended bathroom visits, poor lighting, disorientation, and the absence of immediate help if a fall occurs.
- Prescribed medicines were given as directed
- Bathroom access was kept clear of obstacles
- Walking pathways were kept free of loose objects
- Night lighting was maintained
- Walker placement was checked for accessibility
Strict instruction: Unnecessary night-time walking without assistance was avoided during the early recovery period. Night-time falls in elderly patients carry a significantly higher risk of serious injury, hospitalization, and prolonged immobility.
Recovery Timeline
Recovery from severe osteoarthritis exacerbation through conservative rehabilitation is not linear. Progress occurs in increments, with some days being better than others. The following timeline documents the key milestones observed in Mrs. Jha’s 12-week home rehabilitation journey.
Establishing Baseline and Building Trust
- •Walking limited to approximately 25–30 metres with walker and supervision
- •Required moderate assistance for transfers from low chairs
- •Bed mobility was mostly independent
- •Unable to climb stairs safely
- •Outdoor walking not recommended
- •Pain during walking: 7/10
Early Measurable Improvement
- •Indoor walking increased from ~25–30 metres to approximately 100 metres
- •Sit-to-stand transfers became easier
- •Required less physical assistance during toileting
- •Pain during routine movement reduced from ~7/10 to 5/10
- •More confident using her walker
Progressive Loading Tolerated Well
- •Walking approximately 150–180 metres indoors and around immediate home area
- •More active participation in bathing and dressing
- •Physiotherapist introduced more challenging balance and strengthening exercises
Significant Reduction in Assistance Needs
- •Walking approximately 200–250 metres with walker
- •Standing from standard-height chair with minimal assistance
- •Most upper-body dressing performed independently
- •Completed short household tasks
- •Bathroom transfers managed with supervision rather than physical assistance
- •Movement-related pain: 3–4/10 during routine activity
Long-Term Goals Substantially Achieved
- Indoor mobility largely independent with walker
- Walking approximately 300 metres with rest breaks
- Bathing required only occasional supervision
- Dressing mostly independent
- Could prepare a simple meal while seated for part of the task
- No major falls during the entire rehabilitation period
- Confidence in walking had improved significantly
Important note: She continued to have osteoarthritis-related pain and stiffness. The orthopedic team continued to monitor her condition and discussed that further treatment, including possible joint replacement, could still be considered if symptoms later became limiting again. The goal of rehabilitation was better function and quality of life — not a cure for osteoarthritis itself.
Clinical Evidence — Functional Progression
The following tables document the measurable changes observed during Mrs. Jha’s rehabilitation. All values are derived from clinical assessments performed by the home healthcare team.
Walking Distance Progression
| Time Point | Walking Distance | Aid Required | Supervision |
|---|---|---|---|
| At Discharge | 25–30 metres | Walker | Required |
| Week 6 | ~100 metres | Walker | Required |
| Week 8 | 150–180 metres | Walker | Required |
| Week 10 | 200–250 metres | Walker | Required |
| Week 12 | ~300 metres | Walker | Largely independent |
Pain Level Progression (During Walking)
Pain at rest remained consistently low (3/10) throughout the rehabilitation period. The significant change was in movement-related pain, which reduced as strength, confidence, and joint support improved.
Functional Status Comparison — Discharge vs Week 12
| Functional Parameter | At Discharge | At Week 12 |
|---|---|---|
| Walking Distance | 25–30 metres | ~300 metres with rest breaks |
| Walking Aid | Walker (with supervision) | Walker (largely independent) |
| Sit-to-Stand (Low Chair) | Moderate assistance | Minimal assistance |
| Sit-to-Stand (Standard Chair) | Not assessed independently | Minimal assistance |
| Bathing | Required assistance | Occasional supervision only |
| Upper-Body Dressing | Required assistance | Mostly independent |
| Bathroom Transfers | Physical assistance required | Supervision only |
| Stair Climbing | Unable safely | Not yet attempted independently |
| Simple Meal Preparation | Unable | Partial (seated for part of task) |
| Fall Incidents | Previous near-fall episodes documented | No major falls during 12-week period |
| Confidence in Walking | Low; fear of falling present | Significantly improved |
| Morning Stiffness | 30–40 minutes | Continued but better managed |
Activities of Daily Living — Baseline Assessment
| Activity | Level of Independence |
|---|---|
| Bathing | Required Assistance |
| Dressing (Lower Body) | Required Assistance |
| Toileting (Low Toilet) | Required Assistance |
| Long-Distance Walking | Required Assistance |
| Shopping | Required Assistance |
| Prolonged Cooking | Required Assistance |
| Carrying Household Items | Required Assistance |
| Stairs | Required Assistance |
| Medication Organization | Required Assistance (initial period) |
| Communication | Relatively Independent |
| Decision-Making | Relatively Independent |
| Eating | Relatively Independent |
| Grooming | Relatively Independent |
| Feeding | Relatively Independent |
| Mobile Phone Use | Relatively Independent |
| Basic Upper-Body Activities | Relatively Independent |
Risks Being Monitored
Throughout the rehabilitation period, the care team maintained systematic vigilance for a range of potential complications. The distinction between expected rehabilitation challenges and warning signs requiring urgent medical attention was clearly communicated to the family — a principle that is central to early warning sign recognition in elderly home care.
- •Falls and near-fall events
- •Increasing joint swelling
- •Sudden severe pain increase
- •Reduced ability to bear weight
- •Medication side effects
- •Reduced physical activity and muscle weakness
- •Constipation
- •Skin problems from prolonged sitting
- •Loss of functional independence
- •New symptoms suggesting another medical problem
- •Sudden inability to walk
- •Significant trauma after a fall
- •Chest pain
- •Severe breathlessness
- •New neurological symptoms (weakness, numbness, speech changes)
- •Unexplained fever with hot, swollen joint
- •Any other acute change from baseline
Mrs. Jha had multiple concurrent fall risk factors: pain, reduced leg strength, slow transfers, fear of movement, difficulty turning, and a history of near-fall episodes. In elderly patients, a single fall can trigger a cascade of decline — fracture, hospitalization, immobility, muscle deconditioning, loss of confidence, further inactivity, and progressive dependence. The emphasis on fall prevention was not merely cautious — it was protecting the entire rehabilitation investment from being undone by a single event. This is why mobility and fall prevention planning was integrated into every aspect of her daily routine rather than treated as a separate concern.
Fall Risk Factors Identified at Initial Assessment
Recovery Outcome
12-Week Outcome Summary
Indoor mobility became largely independent with walker. Walking distance increased from ~25 metres to ~300 metres with rest breaks. This represents a ten-fold improvement in functional walking capacity.
Movement-related pain reduced from 7/10 to 3–4/10 during routine activity. Pain at rest remained stable at approximately 3/10. Morning stiffness continued but was better managed through structured morning routines.
No major falls occurred during the entire 12-week rehabilitation period. This is a critical outcome — fall prevention success preserved the gains achieved through rehabilitation and avoided potential setbacks.
Bathing required only occasional supervision. Dressing became mostly independent. Simple meal preparation was possible in a seated position. Multiple activities that previously required physical assistance now needed supervision only or no assistance.
Blood pressure remained controlled. No new medical conditions emerged. Medications were well-tolerated. No signs of infection or other complications were observed throughout the care period.
Confidence in walking improved significantly. The initial fear of movement — which was causing activity avoidance — was substantially reduced through graded exposure and positive reinforcement during physiotherapy sessions.
Remaining Challenges
It is important to document what was not achieved, to maintain clinical honesty and set realistic expectations:
The rehabilitation outcome positioned Mrs. Jha at a significantly higher functional level than at discharge. However, osteoarthritis is a chronic, progressive condition. Long-term management would need to include continued home exercises (possibly with reduced physiotherapy frequency), periodic medical and orthopedic review, ongoing weight management efforts, vitamin D supplementation monitoring, and adjustment of mobility aids as her function changes. The family was educated that maintaining gains requires ongoing effort — the end of the 12-week program was not the end of management, but a transition to a maintenance phase. This aligns with principles of long-term elderly care at home that emphasizes sustainable routines over short-term intensive programs.
Family Education
Family education was not a single session — it was an ongoing process integrated into every interaction with the home healthcare team. The daughter and son-in-law were taught not just what to do, but why each instruction mattered. This approach transforms family members from passive observers into informed partners in the care process.
Medication Adherence
- •Give medicines exactly as prescribed — at the correct times and in the correct doses
- •Avoid adding over-the-counter pain medicines without medical advice — this is particularly important in elderly patients where drug interactions and renal effects can be significant. Medication management for seniors requires careful attention to polypharmacy risks.
- •Maintain a simple, visible medication schedule to prevent missed or duplicated doses
- •Report any unusual side effects — drowsiness, dizziness, stomach discomfort, or changes in bowel habits
Nutrition
The family was advised to focus on balanced meals containing:
Because excess body weight increases stress on weight-bearing joints, gradual weight management was discussed with the treating team. Protein intake was emphasized to support muscle maintenance during rehabilitation. Adequate hydration was stressed to help manage constipation — a common side effect of reduced activity and pain medication. Nutrition and hydration in elderly care plays a direct role in rehabilitation outcomes.
Safe Mobility and Fall Prevention
Critical transfer rule: Family members were specifically instructed not to pull Mrs. Jha by the arm during transfers. Arm-pulling can cause shoulder dislocation, rotator cuff injury, and loss of balance. Proper transfer technique involves using the patient’s stronger leg, appropriate equipment, and body mechanics rather than upper-body pulling force.
Infection Prevention
Although osteoarthritis itself is not an infectious condition, the family was instructed to report unexplained fever, a hot and very swollen joint, or sudden worsening of symptoms — as these could indicate a septic arthritis or other infection that would require urgent medical intervention rather than continued home rehabilitation.
Follow-Up Record Keeping
The family maintained a daily record of the following parameters, which helped the clinical team identify trends and make timely adjustments during follow-up reviews:
Key Clinical Learnings
Osteoarthritis Affects Far More Than Joints
Severe osteoarthritis can reduce walking ability, confidence, independence, social participation, and psychological well-being in ways that are not captured by pain scores alone. Effective management must address the whole functional picture — not just the joint. In Mrs. Jha’s case, her fear of movement was as limiting as her pain, and addressing it was essential to recovery. This broader impact is well-documented in discussions of recognizing mobility issues in aging loved ones.
Graded Movement Is Essential — Not Optional
Carefully planned, progressively graded exercise can maintain and improve strength, joint movement, balance, and functional ability even in patients with advanced degenerative changes. The key is that the exercise must be graded — not too little (which leads to deconditioning) and not too much (which worsens symptoms and reinforces fear). Mrs. Jha’s initial avoidance of movement was understandable but counterproductive; the physiotherapist’s role was to find the therapeutic window between these extremes.
Home Rehabilitation Is Not Inferior to Clinic-Based Therapy
For patients like Mrs. Jha, home-based physiotherapy offers distinct advantages: exercises are practiced in the actual environment where they will be used, travel-related risks are eliminated, and the therapist can directly assess and modify home hazards. The future of recovery is increasingly oriented toward home-based physiotherapy for appropriate patients — particularly the elderly and those with mobility limitations.
Over-Assistance Can Be as Harmful as Under-Assistance
Doing everything for a patient can unintentionally increase dependence and accelerate functional decline. The attendant’s instruction to encourage independence — performing grooming and upper-body dressing herself whenever safe — was a deliberate clinical decision, not merely a preference. This distinction between providing necessary support and creating unnecessary dependence is a core principle of clinical versus emotional care in senior home nursing.
Conservative Management Does Not Mean No Surgery — It Means Informed Decision-Making
The rehabilitation period served a dual purpose: it improved Mrs. Jha’s current function AND provided valuable information about her rehabilitation potential, pain trajectory, and functional ceiling. If joint replacement is eventually required, both the surgical team and the family will have a clearer picture of what to expect from the post-operative rehabilitation phase. This is a more informed approach than proceeding directly to surgery without attempting conservative management.
The Post-Discharge Period Requires Active Management, Not Passive Observation
Discharging an elderly patient with severe mobility limitations to home without a structured rehabilitation and monitoring plan places them at significant risk of functional decline, complications, and emergency hospitalization. The post-hospital discharge period for senior citizens is a well-recognized vulnerable phase that requires the same level of clinical attention as the hospital stay itself — just delivered in a different setting.
Frequently Asked Questions
Can severe osteoarthritis be managed at home?
Is walking good for someone with severe knee osteoarthritis?
Should an elderly patient with arthritis remain on bed rest?
When is a walker useful for arthritis patients?
Can physiotherapy cure osteoarthritis?
How can families prevent falls at home for arthritis patients?
When should an arthritis patient contact a doctor urgently?
Does every patient with severe knee osteoarthritis need knee replacement?
Medical Disclaimer
This case study is entirely fictional and created solely for educational purposes. It does not represent a real patient. Any resemblance to actual individuals is purely coincidental. The information provided is intended for education only and should not be used as a substitute for professional medical advice, diagnosis, or treatment.
If you or a family member are experiencing severe joint pain, mobility difficulties, or any other medical symptoms, please consult a qualified healthcare professional for personalized assessment and treatment recommendations. Do not attempt to self-diagnose or self-treat based on this or any other online content.
Emergency advice: If you or someone in your care experiences sudden inability to walk, severe unexplained pain, significant injury after a fall, chest pain, severe breathlessness, or new neurological symptoms, seek emergency medical attention immediately. Do not wait for a scheduled home care visit.