Patient Pathway for Spine Surgery

You are having a Spine/Back surgery. We expect that you will have a safe and uneventful recovery. Depending on the type of procedure and how you do after surgery, you may be discharged directly from the Post-Anesthesia Care Unit (PACU) or be admitted for a short stay in the hospital. The health care team begins discharge planning prior to your surgery. Each person progresses at an individual pace through completion of post-operative goals. For some people these objectives are met several hours after surgery while others require a short hospital stay. As your health care team, we will be working with you to meet these goals. The list below outlines goals for your surgery and your recovery. Please discuss these goals with your health care team as you achieve them or if you have any questions surrounding them.

PRE-OPERATIVE GOALS

Attend the Pre-operative Spine Class offered at EvergreenHealth Medical Center (scheduled through your surgeon’s office)

Complete a list of all medications, including herbal and over-the-counter medications Obtain consults, if indicated, by any medical specialists involved in your care Pre-operative screening via a phone call from Evergreen’s Pre-Anesthesia Clinic (PAC) Pre-Anesthesia Clinic screening including possible lab testing Obtain any medical equipment that will be needed after surgery (walker, cane, etc.) Arrange transportation for follow-up appointments until cleared to drive by your doctor Call to pre-register and provide insurance information (425.899.2722) Call to obtain surgery time on the business day before surgery (425.899.2717) Arrange for a ride to and from the hospital

DAY OF SURGERY

Nothing to eat or drink after midnight the day of surgery (including mints, gum or tobacco) Take only medications you were instructed to take by your doctor or the PAC nurse, with only a sip

of water Shower and dry hair thoroughly. Do not use make-up or hair-styling products Bring inhalers, nasal sprays or eye drops (do not bring other medications to the hospital)

POST-OPERATIVE GOALS

Medication Goals

IV fluids have stopped Resume your regular medication as ordered by your doctor Adequate pain control (using pain pills, ice and positioning) to do self-care and exercises without

being too sleepy Activity Goals

Know precautions and restrictions specific to your surgery Readjust and turn (log rolling) myself in bed Start your ankle pumps and ankle circles

Activity Goals (continued)

Start your ankle pumps and ankle circles Dangle at the bedside Able to move in and out of bed with minimal assistance from staff Start your physical therapy sessions (or understand your plan for follow up outpatient physical

therapy) if ordered by your surgeon Up, walking with nursing staff or caregiver using assistance of a walker/cane if needed If you have stairs to get in to your house upon discharge, learn how to safely go up and down them Can apply your brace back/neck, etc., if required, with little or no assistance from staff/caregiver

Diet Goals

Able to take liquids and solid foods without nausea (with or without anti-nausea medications) Understand measures to help prevent constipation

Self Care Goals

Using your incentive spirometer, coughing and deep breathing every 2 hours Able to use the bedside commode or bathroom with only minimal assistance Take care of personal needs (dressing, brushing teeth, etc.) with little help Understand how to care for your incision site at home

Caregiver Goals (person who will be caring for patient upon discharge from hospital)

Understand precautions and restrictions specific to surgery Ensure care provider presence for a minimum of 24 hours after discharge Feel comfortable transporting patient home in private car and assist from car to home Feel comfortable to assist with dressing changes, personal needs following restrictions specific to

the surgery Understand the plan for follow-up care (physical therapy, occupational therapy, physician, other

clinics) Know who to call with questions immediately after surgery ____________________________

Home Care Goals

Resume normal pre-surgery diet Resume normal pre-surgery medications as ordered by your doctor Adequate pain control while decreasing the amount of pain medications needed Able to perform self-care activities (with increasing independence) as instructed by your surgeon Schedule follow-up appointment with surgeon Schedule outpatient physical therapy sessions as ordered by your doctor Work on exercises on your own between physical therapy sessions Continue precautions and restrictions specific to your surgery until cleared by your surgeon Continue walking and exercise program as instructed by your surgeon or physical therapist

What to Bring to the Hospital

A list of your home medications (but not the actual medications)

Inhaler, nasal sprays or eye drops

Dentures and/or hearing aids

Loose fitting, warm, comfortable clothing and shoes that are easy to get on and off

Copies of insurance and pharmacy cards, along with any co-pay for medications if you have any

If you have sleep apnea and have a CPAP, bring it with you

A copy of your advance directive (Living Will, Durable Power of Attorney, etc.)

Any mobility equipment (walker, cane, etc.)

If you know you are going to be spending the night, you may want to bring personal care items

Arrange for a ride home after discharge

What Not to Bring to the Hospital

Jewelry, including rings or any piercings

Electronics or valuables

Perfume or scented lotion

Please don’t come to the hospital if you have a cough or fever (this includes family and visitors)

If you become ill prior to the day of surgery, please call your surgeon’s office as you may need to reschedule your surgery for another time

What to Expect on Day of Surgery Check-In

On your day of surgery you will check in at the 3-Green Registration Desk in the main hospital. Your check-in time is only 90 minutes prior to your scheduled procedure, so please be on time. Pre-Surgical Care Unit (PSCU)

You and your family will be escorted to PSCU and introduced to the Patient Support Assistant, or a volunteer, who will maintain contact among you, your family and our surgical team.

You and your family will be meeting your EvergreenHealth Surgical Team, comprised of your surgeon, the anesthesiologist, the admitting nurse and the OR nurse. Your family is also invited to be with you, if you desire, until the time of your transfer to the operating suite.

We will be confirming the health history you have provided, listing the last dosage times of your medications and verifying your allergies. Expect to have your armband checked multiple times for correct name and birth date. Prior to movement to the operating suite we will do a verification hand-off which includes a confirmation with you of your consented procedure, and we will ensure that the surgical site has been marked by the surgeon or his assistant.

We also participate in the Surgical Care Improvement Project and follow their recommendations for best surgical outcomes.

The anesthesiologist will give you a light sedative in your IV just before wheeling you to the operating suite. You will feel and remember nothing of the procedure.

In the Operating Suite

The length of the surgery varies depending on the type and extent of your planned procedure. Your nurse or surgeon can tell you and your family the expected length of the procedure.

Our anesthesiologists will ensure that you remain in deep sedation and comfortable. Post-Anesthesia Care Unit (PACU)

At the completion of your surgery, you will be taken to PACU.

The typical stay here is 1 to 2 hours. You can expect to wake up with an oxygen mask, heart monitoring, blood pressure monitoring and measurement of your oxygen intake by finger probe.

The goals in PACU are to return you to consciousness, tolerable pain and absent or controlled nausea.

Occasionally vomiting can occur due to the anesthetic and might last up to 24 hours, until your body can eliminate the effects.

During the time you are awakening, your surgeon will meet with your family in the waiting area.

Post-Anesthesia Care Unit (PACU) (continued)

Information about the surgery is shared with your family or designated party, as you will generally not remember this information due to the effects of the anesthesia.

Discharge from PACU is based upon a nationally recommended scoring system that indicates patient readiness.

Patients being admitted for an overnight stay to the hospital will be escorted, with their family, to their room (generally on 7th floor Silver).

Phase II or Day Surgery

If you are being discharged on the day of surgery, you will be moved to an area called Phase II or Day Surgery where family or your selected care giver will join in our post-op teaching process.

Generally you will be up in a recliner while you start drinking fluids. Crackers and broth are available as well. Ideally, resuming a diet slowly minimizes the risk of nausea or vomiting. Oral pain pills are given as needed to provide tolerable pain relief. You can expect some incisional pain that will be bothersome for a few days, but will ease off over one to two weeks.

A typical stay in Phase II (Day Surgery) is one hour. Discharge to home is based upon completion of any necessary teaching and patient readiness, again determined by a nationally accepted scoring system. Absent or controlled nausea or vomiting, with ability to take oral fluids, tolerable pain and transfer into a wheelchair are expected.

At this point, we will start talking to you about your discharge to home.

Discharge instructions, including physician recommendations and emergency contact numbers are given to your care provider. Patients continue to be sleepy and forgetful during the next 24 hours and need assistance when up.

Prescription Medications

Pain medications, anti-nausea medication or antibiotics are the only new medications you will receive a prescription for on the day of surgery.

A complete medication form is given to your care provider.

We have an outpatient pharmacy at Evergreen that can deliver any discharge medications to Phase II/Day Surgery until 6 p.m. If you prefer, prescriptions can be filled at the pharmacy of your choice.

Follow-Up Care

One to two days after your procedure a nurse will call to check on you and ensure your understanding of post-operative instructions, since post-operative instructions were addressed to your home care provider.

Our goal is to provide a quality surgical experience for both you and your family.

Answers about Anesthesia

PROCEDURES & RISKS

Once you and your doctor have determined that an operation is necessary, one of your concerns may be the anesthetic. We hope that this information will help answer some of your questions.

PERSONAL PRECAUTIONS PRIOR TO SURGERY

There are a few personal precautions that enhance your safety and well being during your procedure.

If you wear dentures or partials, you are encouraged to bring them, but they may be removed prior to surgery.

Precautions to protect your eyes are routinely taken during surgery and eye make-up such as mascara or eyebrow makeup can cause irritation to your eyes. To avoid all problems, all make-up should be removed before surgery. Contact lenses should also be removed prior to surgery.

All medications that you are taking, allergies, chronic (ongoing) health problems, and past serious illnesses are important details for your anesthesiologist to know.

It is also important that the anesthesiologists know when you last consumed food or drink prior to surgery. When an anesthetic is given, any material in the stomach may “come up” or go into the lung and cause serious respiratory problems, even death. This is why you are not allowed to eat or drink for several hours before being given a scheduled anesthetic.

Your anesthesiologist will ask you about any family history of complications with anesthetics that you may be aware of. Certain anesthetics can cause serious side effects, when some rare inherited traits are present. These traits are often not obvious or even detectable under ordinary circumstances. If such an abnormality is known to exist, special precautions can be taken.

The anesthesiologist must know about any previous complications you have had from anesthetics and about any problems you have had after other surgeries, including problems with your heart, lungs, or any disease.

MEDICATIONS AND MONITORS

Upon arriving in the surgery area, you will be greeted by Operating Room (O.R.) personnel and you will have an intravenous (IV) catheter placed in your arm or your hand.

Your IV catheter will be used to quickly and safely administer fluids, anesthetic agents, and other medications.

Various monitors may be used during surgery to monitor your condition such as a blood pressure cuff and an electrocardiogram (ECG) monitor. Occasionally, additional monitoring equipment may be required, again depending on your condition and type of surgery.

WHAT ARE THE KINDS OF ANESTHESIA? General Anesthesia

General anesthesia is used to provide pain relief during surgery by producing sleep so sound that you do not feel pain. General anesthesia is induced in the Operating Room with IV medications. After you are asleep, the anesthesiologist may put a small plastic tube through your mouth or nose and into your windpipe through which an anesthetic gas will be delivered. On other occasions, an oral airway will be used which is simply a breathing tube placed in your mouth.

Regional Anesthesia

Regional anesthetics are used to provide pain relief during surgery by numbing particular parts of the body. There are three common types of regional anesthetics. The name of each type relates to the area of the body where the anesthetic is administered. An epidural/caudal anesthetic involves an injection near the spinal cord. A nerve block involves an injection of an anesthetic near a peripheral nerve. In addition to the numbing agent, an IV medication is often given to provide sedation or sleep during your surgery.

Local Anesthesia

Local anesthetics are used to provide anesthesia for a small area during minor procedures. The anesthetic is injected at the surgical incision, which numbs that area and blocks pain. Local anesthesia is safe and effective and involves very little risk. IV medications are often given to provide sedation if desired. If you are considering a procedure involving a local anesthetic, you should ask your surgeon to see if your surgery is amenable to this form of anesthesia.

POST OPERATIVE PAIN MANAGEMENT

There are various methods used to provide pain relief, all having certain benefits and side effects. Management of your post-operative pain will likely be addressed prior to your surgery.

Modern anesthesia has become very safe and effective. However, the laws of the State of Washington require that you be informed of the possible risks of anesthesia and the complications that sometimes occur. Ask your physician for a detailed explanation of any particular risks involved with your anesthesia.

For any questions or concerns regarding your anesthesia, please call the Anesthesia Department at EvergreenHealth Medical Center at 425.899.3446.

Your anesthesiologist will take good care of you!

Helpful Tips & Reminders If you are a caregiver or have small children please arrange for assistance until cleared by your surgeon. Lifting children is a common source of re-injury for spine surgery patients. Bathing

For many people, sponge bathing will be the safest method of bathing until their incisions heal. Do not take a tub bath or shower until you receive an OK from your doctor. Your incision could get infected if it gets wet before being sufficiently healed.

A long handled sponge can be used to wash your feet.

A towel (and the reacher) can be used to dry your feet. If you have good sensation in your feet, you can apply prolonged heat. Take care not to burn your skin. Use a hair dryer to dry your feet or you can also put a towel on the floor and grip it between your toes.

Use soap on a rope to avoid dropping the soap when showering.

Moving Items:

Utilize assistance if possible.

Wear an apron with pockets.

Attach a bag to your walker.

When possible slide objects along a counter top instead of carrying them. Take a step with the walker, move the object a step, take a step with the walker, move the object a step, etc.

Use a thermos to transfer coffee, tea and soups safely. If necessary, put it in your apron pocket or in the bag attached to your walker.

Use a slotted spoon or sieve to remove food from hot liquid (boiled potatoes, pasta, etc.) This allows the liquid to cool before you carry or move the food.

Use a fanny pack to carry small items with you.

Reaching Items

Use a reacher to pick up items from the floor. It can also be used to retrieve lightweight items from high or low cupboards.

You may need to rearrange items in your cupboards and refrigerator prior to your surgery:

Keep the most frequently used and heavier items within easy reach. (i.e. keep teakettle or heavy pot on the stove).

Lighter weight items, such as cereal boxes, can be placed at other levels and the reacher can be used when you need them.

Walking Safely

Remove throw rugs from the floor.

Be extra careful when going from one room to another.

Some doorways have slightly raised sills.

Floor coverings can also be different heights.

Do not leave spills on the floor.

Use your reacher and towels to mop up spills.

Your reacher can be used to pick up the towels from the floor.

Do not leave dropped items on the floor.

The reacher can be used to pick up the items from the floor. Laundry

Use your reacher to remove items from your washer and/or dryer.

Put your laundry basket on a wheeled cart, a chair or on the dryer to reduce bending.

Sit while you unload the dryer (if it is front-loading). Use reacher to remove clothing. Reach with the hand on the same side of your body as the dryer. Do not reach across your body.

Feeding Pets

Utilize assistance if possible.

If you have no assistance available, place pet food where you can safely reach and lift it.

Place food bowls where you can safely reach them. This may mean putting food for cats or small agile dogs on a low table.

If you have to feed large or non-agile pets that cannot climb to a higher level to be fed, you may need assistance. You need to be able to safely maintain your balance utilizing the safe reaching technique and be able to reach the floor to retrieve or place bowls without spilling their contents.

Working at the Counter

Face your task squarely.

Do not rotate your body as you reach for items or place items on the counter.

Move your feet and body so your toes point to the area that you need.

Sit on a high stool when you are doing counter-top activities.

Checklist for Preventing Falls In Your Home

Increase lighting in your home by using the highest watt bulb allowed for the light fixture. Use frosted bulbs to reduce glare.

Always turn on lights before walking into a dark room.

Keep the light on the bathroom at night, or use a nightlight.

Make sure stairs are well lit and there is a light switch at both the top and bottom. Mark edges of steps with non-skid contrasting strips.

Have sturdy handrails that run the full length on both sides of all stairways, extending slightly beyond the first and last step.

Slip-proof the bathtub or shower with a rubber mat or non-slip decals.

Make sure all carpets have short, dense pile and edges lie flat. Tack down loose edges. No shag carpets!

Keep walking areas and stairs free of clutter. Keep cords out of the flow of traffic.

Use a sturdy step stool or ladder to reach high places.

Wipe spills as soon as they occur.

Don’t block your vision by carrying bulky packages. Make more trips with smaller loads.

Give yourself time to adjust your balance when getting up from a sitting or lying position.

© 2000-2013 Krames StayWell

Resource List

Evergreen Outpatient Rehabilitation-

Deyoung Pavilion

12039 NE 128th Street, Suite: 200 Kirkland, WA 98034 Ph: 425-899-1960 Fax: 425-899-3670

Orthopedics and General Outpatient Rehabilitation Joint Therapy, Hand Therapy, Posture and Ergonomics, Spine Disorders, Osteoporosis/Osteopenia, Geriatric Care

Neurological Rehabilitation Services

Stroke and Brain Injury, Parkinson's Disease and other Movement Disorders, Multiple Sclerosis (MS), Balance and Fall Prevention, Vestibular Rehabilitation

Specialty Care Programs Balance and Fall Prevention, Clinical Driver's Screening, Lymphedema Therapy, Safe Swallowing, Speech Therapy, Vestibular Therapy, Women's Health

Name Address Hours Phone Fax Website AllCare 1048 116

th Ave. NE

Suite 130 Bellevue, WA 98004

M-F 9:30-6 Sat 11-4 Sun 11-3

(425) 455-8330

(425) 453-7294

www.allcareweb.com

Apria Healthcare

14935 NE 87th

St Suite 101 Redmond, WA 98052

M-F 8-5 Sat 8-3 Resp. dept 10:00-1:00

(425) 881-8500

(425) 895-3865

www.apria.com

Bellevue Healthcare

2112 116th

Ave NE Bellevue, WA 98004

M-F 8-6 Sat 9-5

(425) 451-2842

(425) 467-6661

www.bellevuehealthcare.com

Care Medical Equipment

4135 Stone Way N Seattle, WA 98103

M-F 8-5 Sat 9-3

(206) 547-2200

(206) 971-3883

www.caremedical.com 1-800-869-7020

3010 Grand Ave Everett, WA 98201

M-F 8-5

(425) 252-6456

(425) 258-6843

CPO Prosthetics & Orthotics

12911 120th

AVE NE Suite E-60 Kirkland, WA 98034

M-F 8:30-5

(425) 821-4276

(425) 821-4277

http://cpo.biz/

Hanger Prosthetics & Orthotics

616 120th

AVE NE Bldg C, Suite 111 Bellevue, WA 98005

M-F 8-5 (425) 451-8831

(425) 450-1598

www.hanger.com

Juanita Bay Pharmacy

13520 100th

Ave NE #90 Kirkland, WA 98034

M-F 9-6 (425) 821-4009

Sizewise Bariatric

22409 72nd

Ave. S Kent, WA 98032

1-800-814-9389

(253) 872-9290

www.sizewise.net

Choice Medical Supplies/Byram Healthcare

15110 NE 95th

ST Suite 101 Redmond 98052

M-F 8:30-5

(206) 329-1668

(206) 328-5986

www.byramhealthcare.com 1-800-456-3500

Stat Medical 12447 116th

AVE NE Kirkland, WA 98034

M-F 10-4:30

(425) 216-3903

(425) 481-8365

http://statinc.com/

Otto Bock

19219 West Valley Hwy Suite# M-107 Kent, WA 98032

M-F 8-5 (425) 260-3788

(425) 291-5308

www.ottobockus.com 1-800-736-8276

United Seating & Mobility (Wheelchairs Only)

19019 36th Avenue W Suite E Lynnwood, WA 98036

(425) 673-6191

(425) 673-6075

www.unitedseating.com 1-877-347-7361

Places online to get DME (usually cheaper)

www.amazon.com www.costco.com www.walmart.com

Borrowed Equipments: Bridge Ministries (M-Thurs 12-4:30)

Bellevue Used equipment 425-885-1006 Minimum suggested donation

Northshore Senior Center (M-F)

Bothell Used equipment 425-487-2441

MS Helping Hands (M-Sat 10-3)

Edmonds Used equipment 425-712-1807 Minimum suggested donation

Two Wheel Walker

Four Wheel Walker

Quick Change Crutches

Platform Walker

Attachment

Quad Cane

Single Point Cane

Tub Transfer Bench

Raised Toilet Seat

Bedside Commode

Drop-arm Commode

Toilet Safety Frame

Shower Chair

Grab Bars

Standard Hand Shower

Hip Kit

02/01/2012

Evergreen Home Health offers a range of skilled services to treat patients in the comfort and Evergreen Home Health offers a range of skilled services to treat patients in the comfort and familiarity of their own homes.familiarity of their own homes.

Skilled Services Provided:Skilled Services Provided: • Nursing (including psychosocial), physical therapy, occupational therapy, speech therapy, social • Nursing (including psychosocial), physical therapy, occupational therapy, speech therapy, social

work, and home health aides.work, and home health aides.

The Quality of Our Work:The Quality of Our Work:

• Evergreen Home Health has the lowest (19%) re-hospitalization rate of all agencies in King and • Evergreen Home Health has the lowest (19%) re-hospitalization rate of all agencies in King and Snohomish Counties. The average rate in Washington is 25% and the national rate is 29%.Snohomish Counties. The average rate in Washington is 25% and the national rate is 29%.

*These results are based on Medicare/CMS Home Health Compare Outcomes*These results are based on Medicare/CMS Home Health Compare Outcomes

Eligibility Requirements:Eligibility Requirements: 1. Physician certification of homebound status-leaving the home requires taxing and 1. Physician certification of homebound status-leaving the home requires taxing and

considerable effort.considerable effort. 2. Patient is required to be under the care of a physician in the community and needs to see a 2. Patient is required to be under the care of a physician in the community and needs to see a

physician 90 days prior to services or 30 days after services.physician 90 days prior to services or 30 days after services. 3. Physician order stating type and frequency of service of one or more of the following 3. Physician order stating type and frequency of service of one or more of the following

intermittent skilled services:intermittent skilled services:

• Joint replacement rehabilitation • Joint replacement rehabilitation • Frequent hospitalizations • Frequent hospitalizations • Gait training • Gait training • Muscle strengthening • Muscle strengthening • Diabetic management • Diabetic management • Safety assessments • Safety assessments • Multiple medication changes or additions • Multiple medication changes or additions • Fall prevention • Fall prevention • Assessments and instructions of new • Assessments and instructions of new

treatments such as tube feeding, drains, treatments such as tube feeding, drains, blood glucose monitoring, home oxygen blood glucose monitoring, home oxygen and ostomiesand ostomies

Home Health Services

evergreenhealth.com

• Wound management • Wound management • Pain control • Pain control • New diagnosis,or exacerbation of an • New diagnosis,or exacerbation of an

existing diagnosisexisting diagnosis • Nutrition and diet management • Nutrition and diet management • Swallowing and speech difficulties • Swallowing and speech difficulties • Dementia and other problems with • Dementia and other problems with

memory and judgmentmemory and judgment • Depression and/or anxiety • Depression and/or anxiety • Long term planning to determine • Long term planning to determine

needs for residential and community needs for residential and community resourcesresources

Geographic Areas Served:Geographic Areas Served:King and Snohomish Counties and Camano IslandKing and Snohomish Counties and Camano Island

Fee: Fee: Services are covered by Medicare, Medicaid and most insurance plansServices are covered by Medicare, Medicaid and most insurance plans

To make a referral please call 425.899.3970To make a referral please call 425.899.3970

Fax 425.899.3228Fax 425.899.3228v.2010DEC15v.2010DEC15

Care Management

ROLE OF CARE MANAGEMENT STAFF – RN CASE MANAGERS & SOCIAL WORKERS

Review cases for clinical progress

Identify care needs and issues

Communicate with physician for clinical issues

Monitor care path progress

Identify discharge needs and assist with necessary resources Home Acute Rehabilitation Unit Home with Home Health follow-up Skilled Nursing Facility (short term) Nursing Home (long term – private pay)

PREOPERATIVE DISCHARGE PLANNING WITH BACK-UP PLANS

Home with spouse or someone else who can stay with you and help with meals, groceries, chores for 3-5 days or until you’re comfortable being alone

Skilled Nursing Facility – if this is anticipated, check into some possible options/choices before surgery

Physical Therapy progress/ expectations – up with standby assistance or moderate assistance of one person – goal for bed mobility and transfer; ambulating 50 feet (household ambulation), stairs

INSURANCE ISSUES

Medicare Benefits

Skilled Nursing Facility – care needs must require a licensed person to qualify for benefits

Home Health – must be homebound

Acute Rehabilitation Unit – must meet specific criteria Private Insurance

Depends on specific plan, authorization required

Talk to insurance company before surgery regarding benefits for post hospital care Durable Medical Equipment

Walker: Medicare will not pay if they have paid for one in the past 5 years. Private insurance usually covers one ambulatory device, may have a co-pay.

Crutches: will pay for a walker OR crutches, not both

Commode/ Bath Bench: Depends on insurance plan you have. Some bathroom equipment is covered in some plans. Call insurance to inquire.

Obtaining this equipment in advance allows time to practice with it and makes discharge more efficient.

Home Health Care Private Pay List

Agencies Services Available/Fee Range

Agency Name Phone Number Min.

Hrs

Companion/

Homemaker Per hr

Home Health Aide

Per Hour

LPN/RN

Per Hour

Live-In/24 Hr Care

Per Day

Bath Visit

Per Visit

Advanced Health Care 800-690-3330 2 25.50 25.50 LPN $50

RN $65 Live-In $350 1 hr $37

All About Care 425-678-8400 4 $21 - 25 $22 - $28 Yes call for rates Live-In $250 - $350 No

Andelcare 206-838-1844

425-283-0408 1

$25 - $27

(4 hours +)

$28 - $38

Varies with hrs

RN delegation $60/hr

2 hr min

Overnight $195

Live-In $325 $38

A-One Medical Services 800-767-8518 4 $22 - $25 $22 - $25 Yes – call for rates $250 and up No

Bellevue-Synergy Home Care 425-462-5300 flex $22 - $28 $25 - $28 RN delegation Overnight (10 hrs) $165

24 Hour $275 - $350 $45 - $50

BrightStar 206-777-1190

425-679-0310 1 Varies Varies Yes – call for rates Yes – call for rates Yes

Capability Home Care 425-679-5770 4 $25 - $28 $25 - $28 RN delegation Overnight $215 - $230

Live-In $300 - $325 No

CareForce 877-426-8800 1.5 $60/1.5 hr visit

$80/2 hr visit $27.50

LPN $45 - $60

RN delegation

Overnight $185

Live-In $325 $60

Catholic Community Services

Requires Deposit = 1 Month Service 800-722-3479 2 $20.50 $21.25 - $22 RN delegation

Overnight (8-10 hrs)

$130.50

24 Hour $234

$37

CHC Services 425-275-5858

877-907-6013 4 $27 $27

LPN $42 - $55

RN $60 - $80

Overnight (8 hrs) $22/hr

Live-In $350 $60

Companion Care 425-488-7575 2 $21.25 - $21.75 $21.25 - $21.75 No Overnight (8 hrs) $188

Live-In $255 - 280 $45

Concierge Care 425-802-6613

866-992-9257 1 $25 - $27 $25 - $27

RN delegation

RN/LPN call for rates

Overnight $195

Live-In $300 Varies

Elite In Home Care 206-653-1141 2 $20 $23 RN $75 10 hours $280-$360 Yes

Family Best Care 425-647-8510

206-779-6424 1 $20 - $29 $20 - $29 Yes $200 - $350 $40 - $50

Family Resource Home Care

East King County

206-545-1092

425-455-2004 2 $25 - $29 $23 - $30

LPN $65

RN delegation $110

Overnight (10 hrs) $200

24 Hour $290- 325 $54

Fedelta Care Solutions 425-454-4548 1.5

$59 $25.50 – 29 $25 - $29 RN/LPN $50 - $70

Overnight (10 hrs) $185

24 Hour $300 - $350 $59 - $95

Home Health Care Private Pay List

Agencies Services Available/Fee Range

Agency Name Phone Number Min.

Hrs

Companion/

Homemaker Per hr

Home Health Aide

Per Hour

LPN/RN

Per Hour

Live-In/24 Hr Care

Per Day

Bath Visit

Per Visit

Griswold Special Care 425-922-1617 flex CNA $21 CNA $21 No Overnight (10-12 hrs) $120

Live-In $220 Yes

Health People 425-454-1947 4 $24 - $30 CNA $24-$30 LPN $75

RN $90 24 Hour $300 $60

A Helping Hand 206-686-7440

877-281-7111 4 $25.25 - $27 $25.25 - $27 RN delegation Live-In $330 No

Home Care Associates 206-861-3193 4 $22 $25 LPN

RN Delegation 24 Hour $300 $60

Home Instead Senior Care

East King County

Snohomish County

425-454-9744

425-670-2292 1 - 3 $25.85 $25.85 No Overnight (10 hrs) $185 Yes

Homewatch Caregivers 425-889-2627 flex $24.95 $25.95 No Overnight (12 hrs) $209.95

24 Hour $299.95-$399.95 $49.95

HomeWell Senior Care 206-440-5500 3 $21.95 $22.95 - $26.95 RN delegation 24 Hour $280 - $320 Varies

Maxim Health Care Services 425-643-0200 flex $22 - $26 $22 - $26 LPN $38 - $44

RN $40 - $55 Live-In $250 - $350 Varies

One More Daughter 425-255-5940 2 $25 - $30 $25 - $30 No Overnight $190 - $210

24 Hour $300 - $335

Yes (2 hr

min)

Pacific Home Care 425-454-0360 4 $19.50 $22.00 No Overnight (10 hrs) $220

24 Hour $280 - $360

$24/hr (2

hr min)

Rescare Home Care 206-368-7667 flex $23 $26 LPN $50

RN $55

Overnight (12 hrs) $21/hr

Live-In (3 day min) $300 $65

Right at Home 425-818-7744

206-774-1100 1 $23 - $25 $24 - $29 RN delegation $95 Live-In $280 - $320 $45 - $55

Sound Options 800-628-7649 3 $25.50 $25.50 RN/MSW $132 Overnight (10 hrs) $180

24 Hour $310 $70

Visiting Angels

Snohomish Co (Everett)

425-828-4500

425-348-9914 1 $24.95 $24.95 - $35 No

Overnight (12 hrs) $22/hr

Live-In $275 - $325 $50

With A Little Help 206-352-7399 2 $27.50 - $29

$32 per couple $27.50 - $32 No

(10 -12) $190 - $260

(24 hrs) $320 - $365

$27 - $29

(2 hrs) Evergreen Community Healthcare Access Team (CHAT) offers this list as a resource to you, but does not endorse or suggest you use any of the agencies listed. Fees subject to change. Most agencies are licensed and bonded with the state of Washington, however, for your protection, ask for verification.

Unless otherwise noted, agencies serve both King and Snohomish Counties. Updated May 2013