What happens in the first week of home health (Day 1 to Day 7)
A day-by-day walkthrough of what the visiting nurse does, who else shows up, what Medicare covers, and how to prepare — written for Central Florida families navigating the first home health episode after a hospital discharge.
The first week of Medicare home health begins with a visiting nurse arriving at the home within 24–48 hours of the hospital discharge. The nurse opens the case, performs a head-to-toe assessment, reconciles medications, and schedules the rest of the team — physical therapy, occupational therapy, speech therapy, a home health aide, or a medical social worker — over the next six days based on the physician's orders.
Five terms families need on day one
These five words come up over and over again in the first week. Knowing them out loud makes every conversation with the agency, the hospital, and the doctor's office shorter.
- Visiting nurse
- The registered nurse (RN) who comes to the house for short, scheduled visits — usually 45 to 75 minutes — to assess the patient, manage medications, change dressings, and coordinate the rest of the team. Often called the "case manager" or the "primary nurse." This is not the same as a "skilled nursing facility" (SNF). A visiting nurse goes home at the end of the visit.
- Home health aide
- A trained caregiver who helps with bathing, dressing, toileting, and walking safely — the "bath aide" or "morning helper." Under Medicare home health, the aide is only covered when there is also a skilled need (nursing or therapy). Aide visits are intermittent, not all day.
- Plan of care
- Also called the "485" or "the paperwork the doctor signed." A physician-signed document that lists the patient's diagnoses, the disciplines that will visit (nursing, PT, OT, ST, aide, MSW), how often, and the goals of care. Medicare requires it before visits can be billed.
- OASIS
- A head-to-toe assessment the visiting nurse completes during the first visit (and again at discharge or recertification). It's required by Medicare and drives the plan of care. As of April 1, 2026, the version in use is OASIS-E2. Families don't have to memorize it — just know that the long first visit is normal and expected.
- Certification period
- The 60-day window during which the physician has authorized home health. If the patient still qualifies at the end of 60 days, the physician can recertify for another 60. There is no fixed number of recertifications — coverage continues as long as the patient is homebound and needs skilled care.
What happens day by day: a visiting nurse timeline
Every plan is individualized, but most Medicare home health episodes follow this rhythm in the first seven days. Use it as a yardstick, not a contract.
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Day 1 — The intake call and the start-of-care visit
The agency calls the family within hours of receiving the referral to schedule the start-of-care visit, usually within 24 to 48 hours of discharge. The visiting nurse arrives, introduces the team, completes the OASIS assessment, reviews every medication, takes vital signs, examines wounds or surgical sites, and writes the plan of care. The first visit typically runs 60 to 90 minutes — longer than later visits — because the paperwork happens here.
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Day 2 — First therapy evaluation
If physical therapy or occupational therapy is ordered, the therapist evaluates on Day 2 or Day 3. The PT measures strength, balance, and walking; the OT measures the patient's ability to bathe, dress, and use the bathroom safely. Each writes their own short plan of care. Expect a second long-ish visit — this one is the therapy version of the OASIS.
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Day 3 — Second nursing visit and medication reconciliation
The visiting nurse returns to check vital signs, follow up on any unstable findings from Day 1, and complete the medication reconciliation — matching the bottles at home against the discharge summary against the doctor's most recent orders. Errors at this step are the single most common cause of avoidable readmissions, which is why front-loaded nursing visits matter.
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Day 4 — Home health aide starts (if ordered)
If a home health aide is part of the plan of care, the first aide visit usually begins mid-week. The aide helps with bathing, dressing, and personal care — typically 1 to 2 hours, 2 to 3 times per week. The aide is supervised by the nurse and follows a written aide-care plan; this is not a 24-hour caregiver service.
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Day 5 — Therapy session and physician communication
PT or OT returns for the first treatment session (the Day 2 visit was the evaluation). By Day 5 the nurse has usually faxed or sent the plan of care to the certifying physician for signature, and either the nurse or the agency liaison has called the physician's office with the assessment summary.
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Day 6 — Third nursing visit and family teaching
The nurse uses the third visit to teach the patient and the family how to manage between visits: when to weigh, how to read blood sugars, what counts as a red-flag symptom, when to call the agency's 24-hour line, and when to call 911. Front-loaded teaching is what keeps the patient out of the emergency department in week two.
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Day 7 — First-week review and schedule for week two
By the end of the first week, the family should know: who the case manager is, the agency's 24-hour phone number, the visit schedule for the next two weeks, the patient's red-flag symptoms in writing, and what the physician has been told. If any of those four things is missing, ask the case manager directly. This is the moment to fix it.
What home health does — and what it doesn't
The single biggest first-week disappointment families report is the gap between what they expected ("a bath aide all day") and what Medicare home health actually is (intermittent skilled care). This table clears that up before the first visit.
- Skilled nursing visits Wound care, IV therapy, catheter care, injections, education, medication management.
- Physical, occupational, and speech therapy At home, including maintenance therapy when a skilled clinician is required to keep the patient safe.
- Home health aide visits Bathing, dressing, and personal care — typically 1–2 hours per visit, 2–3 times per week.
- Medical social work Community resource connections, advance care planning support, caregiver coaching.
- Care coordination with the certifying physician Sending the plan of care, communicating changes, ordering equipment.
- Most durable medical equipment Walkers, commodes, hospital beds, oxygen — ordered through Medicare Part B suppliers.
- 24-hour or live-in care Medicare home health is intermittent. Around-the-clock care is private-duty, hospice, or a facility — not Medicare home health.
- Long-term personal care alone A home health aide is covered only when there is a continuing skilled need. When the skilled need ends, so does the aide benefit.
- Meal prep, grocery shopping, housekeeping, or companionship These are non-medical home-care services, not Medicare home health.
- Transportation to appointments Medicare Part B does not pay for transportation as a home health service. Some Medicare Advantage plans cover rides; check the plan.
- Filling the pill organizer indefinitely The nurse can teach the system and do an initial setup. Day-to-day fills transition to the patient or caregiver once stable.
- Emergency response devices, ramps, or home modifications These are out-of-pocket or covered through other programs (Veterans Affairs, Medicaid waivers, community grants).
How to prepare for the first visit (six steps)
Do these six things in the 24 hours before the visiting nurse arrives. The first visit will be shorter and the plan of care will be sharper.
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Gather every medication bottle
Collect every prescription, over-the-counter pill, vitamin, supplement, eye drop, inhaler, and patch. Include any new bottles from the hospital pharmacy. Put them on a kitchen table or counter where the nurse can see them all at once. Do not throw out the old bottles yet — the nurse needs them to reconcile against the discharge list.
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Find the hospital discharge papers
Locate the discharge summary, after-visit summary, and any printed instructions or wound-care orders from the hospital. Keep them next to the medications. If they were lost or never received, call the hospital's medical-records line and ask for the discharge summary to be sent before the home health visit.
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Write down recent doctor names and phone numbers
List the patient's primary care physician, hospitalist, cardiologist, surgeon, or other specialists by name. Add phone or fax numbers when you have them. The visiting nurse will need this to send the plan of care for signature and to call with significant changes.
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Clear a path and set out a chair
Move loose rugs, electrical cords, and clutter from the front door to the bedroom and bathroom. Place a chair near the bed where the nurse can sit and write. Make sure the bathroom light works. These same fixes are the falls-prevention basics the occupational therapist will check on Day 2 or Day 3 anyway — do them now and the home is safer immediately.
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Have Medicare and insurance cards ready
Put the patient's red, white, and blue Medicare card, photo ID, and any Medicare Advantage, Medigap, or secondary insurance cards in one place. The intake nurse will copy them, verify benefits, and explain any prior authorization the Medicare Advantage plan may require.
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Write down your questions in advance
Write every question on one sheet of paper — about pain, medications, who comes when, what is covered, what you are supposed to do between visits, who to call after hours. Keep the sheet visible during the visit and add the answers next to each question. Hand it to whoever in the family will manage care next.
Why front-loaded visits matter — and what Central Florida data shows
The first week is not just an administrative on-ramp — it is the clinical window during which most preventable hospital readmissions are prevented. Approximately one in five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and the most common drivers are medication errors, missed follow-ups, and unaddressed red-flag symptoms (AHRQ Patient Safety Network, "Readmissions and Adverse Events After Discharge," 2024). Front-loaded home health visits in the first seven days — especially the Day 3 medication reconciliation and the Day 6 family-teaching visit — are the structural intervention that closes that loop.
Medicare's rules for these visits live in the CMS Medicare Benefit Policy Manual, Chapter 7 (Pub. 100-02), Home Health Services, which defines the four pillars of eligibility: a patient who is homebound, in need of intermittent skilled care, under a physician's plan of care, and who has had a qualifying face-to-face encounter. The assessment the visiting nurse completes on Day 1 is governed by OASIS-E2, the version effective April 1, 2026.
For families in Central Florida, the population this guide is written for is large and growing. Census QuickFacts (vintage 2024) report that adults age 65 and over make up 16.4 percent of Orange County, 19.4 percent of Seminole County, 16.7 percent of Osceola County, and 28.0 percent of Brevard County — with Brevard among the oldest county populations in Florida (U.S. Census Bureau QuickFacts, four-county comparison). Chronic-disease prevalence by county is published by the Florida Department of Health on FLHealthCHARTS County Health Dashboard, and is the local-data baseline behind Kassy Health's clinical pathways for heart failure, COPD, diabetes, stroke recovery, and dementia.
Some families arrive at the first visit having been told something that isn't true: that Medicare will stop paying once the patient stops making therapy gains. That is the so-called "plateau myth," and it has been incorrect since 2013, when the federal Jimmo v. Sebelius settlement clarified that Medicare covers skilled care to maintain a patient's condition or prevent further decline — not only to improve it (CMS Jimmo Settlement Information page). It is repeated by well-meaning hospital staff, nursing-home staff, and even some agencies. If you hear it in the first week, name it and ask the case manager to confirm in writing.
First-week questions families actually ask
These are the eight questions we hear most often during a Central Florida intake call. Each answer is short, practical, and what we would tell our own family.
Call the home health agency listed on the discharge paperwork directly. If you cannot reach them, call the hospital case manager or discharge planner who set up the referral. Medicare requires that you be told about every certified agency in your area that serves your address — the hospital's list is not your only option. You can look up agencies and their star ratings yourself on Medicare Care Compare or, for Florida-specific licensure and inspection history, on FloridaHealthFinder. If you still cannot get a visit scheduled, any Medicare-certified agency that serves your ZIP code can pick up the case.
Yes. Medicare requires that you be told about all agencies in your area that serve your address, and you can change agencies during the episode. The new agency will pick up the plan of care, contact the certifying physician, and coordinate the transition. There is no penalty and your benefit is not interrupted. The patient-choice rule is part of the Home Health Conditions of Participation (42 CFR Part 484), specifically the patient-rights provisions.
A Medicare home health team typically includes a registered nurse, one or more therapists (physical, occupational, or speech), a home health aide, and sometimes a medical social worker. Each visit is scheduled by discipline, not by person, so several team members may arrive in the first week. Some agencies also rotate aides for scheduling reasons — this is the most common first-week complaint. The visiting nurse who opens the case is the case manager and the single point of contact when something feels off. You have the right to ask for the same aide each visit; the agency may or may not be able to commit, but the question is reasonable and should be answered honestly.
Yes. For patients who meet the four eligibility rules — homebound, intermittent skilled need, physician plan of care, and a qualifying face-to-face encounter — Original Medicare covers approved home health visits with no copay. Medicare Advantage plans must cover the same benefit but may require prior authorization. You should not receive a bill for the nursing, therapy, aide, or social-work visits listed in the plan of care. If the agency asks you to sign an Advance Beneficiary Notice (ABN), ask what specific service is not covered and why — it is supposed to be specific, not a blanket form.
The first certification period is 60 days. If the patient still needs skilled nursing or therapy and is still homebound, the physician can recertify for another 60-day period, and again after that. Home health ends when the patient no longer needs skilled care, no longer meets the homebound criterion, or when the family and care team agree the goals have been met. A patient who has stopped making therapy gains can still qualify for maintenance therapy if a skilled clinician is needed to keep them safe. That is the holding of the federal Jimmo v. Sebelius settlement — the "plateau" rule families and discharge planners sometimes repeat is not the law.
Yes, with limits. The visiting nurse can teach insulin administration, draw blood when ordered by the physician, and perform a one-time medication reconciliation and pill-organizer setup. Day-to-day insulin injections and weekly pill organizer fills are usually transitioned to the patient, a family caregiver, or a home health aide once the patient is stable, because Medicare home health is intermittent skilled care — not a 24-hour service. If no one in the home can manage the pills or shots, tell the nurse on Day 1; the team can include daily nursing visits short-term and explore community options for the long term.
Tell the case manager. The nurse can adjust the schedule, request a different aide, or shift the bath visits to a different time of day. The aide service is tied to a skilled need but is not required — your parent has the right to refuse and the patient-rights protections in 42 CFR 484 apply. The case manager will document the refusal, keep the rest of the plan of care active, and revisit the conversation at the next nursing visit. If the refusal is rooted in safety fears, the nurse or social worker can introduce the same aide each week, sit through the first visit, and check in afterward. None of that requires a paperwork change.
The home health agency is required to communicate with the certifying physician under the Conditions of Participation (42 CFR Part 484). The visiting nurse will send the plan of care for signature, call the physician with significant changes, and report at the end of each certification period. You are not the messenger — but you should make sure the agency has every relevant physician's name and phone or fax number at the very first visit. If a specialist is missing from the chart and you know they manage a key condition, say so before the nurse leaves.
Sources cited on this page
Every statistic, regulation, and clinical claim above is linked inline and listed in full here. URLs were click-tested on 2026-05-13.
- Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 7 — Home Health Services. Pub. 100-02. Accessed May 2026. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c07.pdf
- Centers for Medicare & Medicaid Services. Home Health Conditions of Participation (42 CFR Part 484). eCFR, current edition. Accessed May 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-484
- Centers for Medicare & Medicaid Services. OASIS User Manuals (OASIS-E2 effective April 1, 2026). Accessed May 2026. https://www.cms.gov/medicare/quality/home-health/oasis-user-manuals
- Centers for Medicare & Medicaid Services. Jimmo v. Sebelius Settlement Agreement Fact Sheet. Accessed May 2026. https://www.cms.gov/Center/Special-Topic/Jimmo-Center
- Medicare.gov. What's Covered: Home Health Services. Accessed May 2026. https://www.medicare.gov/coverage/home-health-services
- Medicare.gov. Care Compare — Home Health. Accessed May 2026. https://www.medicare.gov/care-compare/?guidedSearch=HomeHealth
- Agency for Healthcare Research and Quality. Patient Safety Network: Readmissions and Adverse Events After Discharge. Updated 2024. https://psnet.ahrq.gov/primer/readmissions-and-adverse-events-after-discharge
- U.S. Census Bureau. QuickFacts: Orange, Seminole, Osceola, and Brevard counties, Florida (four-county comparison; vintage 2024 ACS 5-year estimates). Accessed May 2026. https://www.census.gov/quickfacts/fact/table/orangecountyflorida,seminolecountyflorida,osceolacountyflorida,brevardcountyflorida
- Florida Department of Health. FLHealthCHARTS County Health Dashboard — Leading Causes of Death & Chronic Diseases. Accessed May 2026. https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=CountyHealth.LCDAndChronicDiseases&tabid=LCDAndChronicDiseases
- Florida Agency for Health Care Administration. FloridaHealthFinder Home Health Agency Compare Tool. Accessed May 2026. https://quality.healthfinder.fl.gov/compare-tools/HHA
For related reading, see our pages on resources for families, home health for heart failure, stroke recovery at home, our home health services, and the physician hub for referring clinicians.