After a successful stay at a rehabilitation hospital - the latest stop in a medical saga that had lasted nearly six weeks and had also involved two hospital visits as well as time in a skilled nursing facility - Joan was grateful to be back home. She had made a lot of progress, but she was still weak and needed help with both medical issues and non-medical ones such as bathing.

For details about how organizations that provide such services work, see previous columns "What are the requirements for home health services?" (Feb. 17, 2013) and "How might you select an agency to provide home health services?" (Feb. 24, 2013).

The agency that she and her husband chose sent a nurse to evaluate her needs. The nurse came for an hour or two a few times a week, and oversaw an aide who helped Joan with tasks that can be hard to manage when you've been very sick, such as taking a shower.

Care got off to a promising start, but, "Two weeks later, an aide came in to help me take a shower. I was really unsteady on my feet, and she had to be with me the whole time. It was the first time she'd come to do that. I went to get into the shower."

Joan's husband Greg had carefully installed a bench and grab bars in the shower before Joan had come home. But the grab bars were at the back of the shower, out of Joan's reach as she entered. The aide had not brought any equipment such as a specialized belt with handles to put on Joan that would make it easier for the aide to hold onto her and help ensure that she did not fall.

"I stepped into the shower, and my foot went out on me. I fell and went into the corner of the shower. There was no room for the other leg, and it snapped. I was lying there and the aide called 911. The next thing I know, there are six EMTs standing over me, discussing how they are going to get me up. And off to the hospital we go again."

What happened? How is it possible that a well-intentioned aide operating under the direction of a medical professional could manage a patient in a way that resulted in this serious injury?

Joan's husband Greg offered one answer. "I requested all of her records from the home health agency. One thing I noticed in there was that one of the questions they ask (on the evaluation form used by the nurse who assessed Joan before the agency started providing services) is whether this patient is at risk of falling. They did not have that checked off, so from the nurse's perspective, she was not at risk of falling. I think that was an error. She'd just had knee surgery."

Joan had also just been in and out of the hospital and rehab for more than six weeks straight, suggesting that she was likely to be weaker than normal. She added, "Also, I had been diagnosed with congestive heart failure," some symptoms of which are dizziness, fatigue and weakness. Further, she was 68 years old, meaning that she was at a higher risk of falling than a similar individual a decade or two younger would be.

But because the agency had not recognized that Joan was at risk of falling, they would not have instructed the aide to take special precautions in helping Joan with her shower.

How can you avoid similar problems?

First, don't take anything for granted. Make sure that you give a concise summary of your medical history to anyone newly treating you (in this case, the nurse who evaluated Joan). Don't assume that they got this information from someone else.

Second, if you feel unsteady on your feet, say so and ask specifically what will be done to help you avoid falls when you get out of bed, get up from a chair, use the toilet, and use the tub or shower.

Third, if you are not comfortable with the answers, ask what types of assistive devices or equipment could help and how to get them. And don't delay.