Fain's Private Duty
Fain's Private Duty Home Care is a nationwide private duty operator built on 17 years of New Jersey home care operating experience. New Jersey is our first launch market.
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Post-orthopedic home care

Post-orthopedic home care at FAINS is a private duty CHHA case scoped to the specific recovery arc after a total hip replacement, total knee replacement, shoulder replacement, spinal fusion, rotator cuff repair, or fracture repair. Every case has a Registered Nurse Supervisor of record, a written plan of care that tracks weight-bearing status and joint-specific precautions, and chemistry-matched caregivers trained in transfer technique, DME use, and the discipline of holding a PT and OT home exercise program between therapy visits. The methodology draws from seventeen years of Irina Fain operating home care in New Jersey, since 2009.

Minimum credential: NJ-certified CHHA with orthopedic-recovery in-service training
Starting rate: $46 per hour (CHHA tier)
Shift minimum: Four hours (per The Fain Standard pillar 3)

What post-orthopedic home care looks like day to day

Post-orthopedic home care means a caregiver is in the client's home for a scheduled shift, holding the household together through the specific recovery arc after a joint replacement, fusion, repair, or fracture procedure. What stays constant across every FAINS orthopedic case is that a Registered Nurse Supervisor wrote the plan of care after reviewing the discharge paperwork and doing an in-home assessment, the CHHA on shift is license-verified against the NJ Board of Nursing registry, and the plan of care names the specific weight-bearing status and joint-specific precautions the surgeon ordered.

For the client, a typical shift is built around safe transfers using the assistive device the OT has fitted, ambulation inside the weight-bearing order, personal care matched to the client's current mobility (bathing setup with the shower chair, dressing sequence that respects any precautions, toileting with the raised toilet seat), pain medication supervision against the discharge regimen, ice or elevation as the surgeon ordered, meal preparation, and consistent practice of the home exercise program the PT and OT have prescribed. The caregiver logs each of these in the shift note.

For the family, the first two weeks after an orthopedic discharge often carry a level of physical demand the household did not anticipate. A client who was independent before surgery is suddenly unable to reach the second-floor bathroom, unable to dress without assistance, and unable to get in or out of a car without help. A caregiver in the house holding the daily care lets the family sleep, work, and support the client emotionally rather than being pulled into being the aide. Many families find that the difference between a smooth recovery and a fall-and-readmission scenario is the caregiver in the first two weeks.

For the caregiver, orthopedic recovery work asks specific technical skills. Transfer technique for a client with a specific weight-bearing order is a specific skill. Walker or crutch ambulation supervision inside a household layout is a specific skill. Enforcing hip precautions during a shower without shaming the client is a specific skill. Reading a client's pain level and knowing when to prompt the next dose of pain medication versus when to call the RN Supervisor is a specific skill. The FAINS matcher screens for these at the chemistry-match interview and the RN Supervisor's in-service adds the specific orthopedic protocols on top of the base CHHA curriculum.

The recovery arc FAINS plans around

Orthopedic recovery follows a fairly predictable arc, though the exact timeline varies by procedure and by the client's pre-surgical baseline. The plan of care at intake names where the client is today and what the next window typically requires.

Acute recovery (weeks 0 through 6) is typically the highest-intensity window. The client is dealing with post-surgical pain, the mobility limits of the weight-bearing order, the joint-specific precautions, the surgical incision and any drain, the discharge medication regimen (often including opioids in a controlled tapering plan, anticoagulants for DVT prevention, and antiemetics as needed), and the Medicare home health PT and OT visits two to three times a week. Shift structure in this window is often eight to twelve hours a day, six to seven days a week, with morning-through-early-evening emphasis. The RN Supervisor visits at intake and again at week two.

Rehabilitation phase (weeks 6 through 12) is when the weight-bearing order typically progresses, joint-specific precautions may lift, home health PT and OT transition to outpatient PT and OT, the client returns to independent transfers, and functional gains become visible week to week. Shift structure often steps down to four to eight hours a day, five to six days a week, focused on holding the home exercise program between outpatient PT visits, providing transportation to outpatient PT, continuing meal preparation, and providing personal care where the client still needs it. The RN Supervisor revisits every 60 days.

Return to function (months three through six) is when the client typically returns to most usual activities, sometimes including driving once the surgeon clears it, and functional recovery approaches or reaches the pre-surgical baseline. Some clients taper off private duty coverage entirely at this stage. Others continue with a lighter shift schedule because pre-existing comorbidities compound the recovery. The plan of care follows the client's actual trajectory.

What FAINS commits to for orthopedic cases

Every FAINS orthopedic case is governed by all seven pillars of The Fain Standard. The pillars do specific work when the client is recovering from a joint procedure, and the family sees each of them in the intake conversation and on the invoice.

Every orthopedic case has a Registered Nurse Supervisor of record who reviews the discharge paperwork, does the in-home assessment, walks the home for fall hazards, verifies the DME setup, writes the plan of care, coordinates with the surgeon's office and the home health PT and OT team, and returns at week two and at the 60-day cadence thereafter. In orthopedic cases the RN's visits check the incision status, the transfer technique the caregiver is using, the DME condition, the home exercise program compliance, the pain management pattern, and any signs of post-surgical complication. The RN is the family's clinical phone line between visits.

Every CHHA on a FAINS orthopedic case is license-verified against the NJ Board of Nursing registry before the first shift and re-verified monthly. Orthopedic case assignments carry an additional internal screen for orthopedic recovery experience, transfer technique confidence, walker and crutch ambulation supervision, and the discipline to hold weight-bearing status and precautions across every ADL. Seventeen years of watching orthopedic home cases has taught Irina that the caregiver's transfer technique and precaution enforcement in the first two weeks home is often the single largest determinant of whether the surgical outcome holds.

The chemistry-matched commitment applies with particular weight in orthopedic cases, because the client is often experiencing significant pain, frustration with dependency, and identity strain from being suddenly unable to perform ADLs they performed independently a week earlier. The caregiver becomes one of the emotional constants in the room. The FAINS matcher proposes candidates the family interviews before the first shift, and if the fit is wrong inside the first week the swap happens without penalty.

The four-hour minimum shift applies. Shorter shifts do not fit a post-orthopedic case in the acute recovery weeks. Weekly invoicing runs Monday through Sunday under weekly transparent invoicing at the published CHHA rate, with the shift log matched line for line.

Post-orthopedic home care at FAINS is private pay and private insurance only, including long-term care insurance policies that cover home-based post-acute care. Medicare home health remains available separately for the skilled therapy services the family is entitled to under Medicare Part A after a qualifying hospital stay. Families whose primary payer needs to be Medicaid are referred to a fit-for-purpose provider with specifics named.

Three composite case examples

Barbara, 74, post right total hip replacement with posterior approach, Chatham (Morris County). Barbara's hip replacement at Overlook Medical Center went well and she was discharged home on postoperative day two with a walker, standard posterior hip precautions for eight weeks, and a Medicare home health referral for PT and OT. Her husband Robert, 76, was willing but not physically able to help with transfers. The FAINS RN did the in-home assessment on day one, verified the raised toilet seat and shower chair delivery, walked the ranch-style home for fall hazards, and wrote the plan of care. Shift structure landed at ten hours a day, seven days a week, for the first two weeks, then a step-down to six hours a day for weeks three through six, then four hours a day for weeks seven through twelve. The caregiver enforced hip precautions during every shower and every transfer, held the home exercise program between the PT visits, and drove Barbara to outpatient PT starting at week five.

Gerald, 82, post right total knee replacement with weight-bearing as tolerated, Randolph (Morris County). Gerald lives alone and his adult daughter Sarah lives out of state. The knee replacement at Morristown Medical Center was done under enhanced recovery protocol and discharged on postoperative day one. Sarah flew in for the surgery and needed to return to her job by day four. The FAINS RN scoped a CHHA twelve hours a day, seven days a week, for the first ten days to bridge the window after Sarah's departure, then a step-down to eight hours a day for weeks two and three, then six hours a day through week eight, then four hours a day through week twelve. The plan of care emphasized weight-bearing progression tracking, home exercise program compliance, medication supervision against the tapering opioid regimen, and safe overnight setup so Gerald could sleep alone without fall risk.

Linda's mother, 79, post lumbar spinal fusion at L4-L5 with lifting restrictions and a back brace for twelve weeks, Denville (Morris County). After a three-day admission at Saint Barnabas Medical Center Linda's mother was discharged home with a back brace to wear whenever out of bed, lifting restrictions of no more than five pounds, no bending at the waist, no twisting, and a Medicare home health referral for PT. Linda lived twenty minutes away and worked full-time. The FAINS RN scoped a CHHA ten hours a day, six days a week (Monday through Saturday) for the first four weeks, then eight hours a day for weeks five through eight, then six hours a day through week twelve. The plan of care emphasized brace application and removal at appropriate times, log-roll transfer technique to protect the fusion, meal preparation and household setup that kept everything within reach so the client did not need to bend or twist, and home exercise program compliance. Linda's mother returned to independent transfers at week eight and to independent ambulation with a cane at week twelve.

How a family verifies orthopedic care quality

Verifying private duty home care is a family's right and a family's responsibility. Every FAINS commitment on this page is verifiable by specific questions and specific paperwork.

Ask to see the plan of care. In an orthopedic case it should name the specific procedure, the surgical approach, the weight-bearing status, the joint-specific precautions and the duration, the DME in place, the pain medication regimen and any tapering plan, the anticoagulant regimen if in place, the home exercise program, the coordination points with the surgeon's office and the home health PT and OT team, and the escalation triggers. The plan belongs partly to the family.

Ask for the assigned CHHA's certification number and verify it against the NJ Board of Nursing registry at newjersey.mylicense.com. FAINS does this internally before the first shift and monthly thereafter. A family can do it any time.

Ask to see the shift log. In an orthopedic case the log should include the transfer method used and any concerns, the ambulation distance achieved and any pain, the home exercise program tasks completed, the medication times, the incision observation, the meal intake, and any concern escalated to the RN Supervisor.

Ask when the RN Supervisor last visited and what she wrote. In the first two weeks the visit cadence is more frequent than the standard 60-day rhythm.

Ask what the escalation path is for a fall, a suspected DVT (calf swelling, unilateral leg pain), a suspected infection (fever, incision changes, drainage), an uncontrolled pain pattern, or a suspected DVT prophylaxis complication (bleeding). The plan of care names it.

What FAINS does NOT do for orthopedic cases

FAINS does not deliver physical therapy or occupational therapy. Those are licensed professions with their own scope of practice. The FAINS CHHA holds the client to the home exercise program the PT and OT have prescribed and supports the client between therapy visits, but the therapy itself is delivered by the Medicare home health team in the early weeks and by outpatient PT and OT afterward.

FAINS does not substitute for the surgeon or the primary care physician. Prescription decisions, imaging orders, and surgical follow-up remain with the treating physicians. The RN Supervisor is the clinical bridge, not the treating clinician.

FAINS does not hold on to a case past the point where it fits. When the client's functional recovery reaches the point where private duty coverage is no longer needed, the RN Supervisor names the taper openly and the coverage steps down or ends. FAINS does not extend a case past its natural end.

Common questions

When does home care typically start after an orthopedic procedure?
Most FAINS orthopedic cases start on the day of discharge. Total hip and total knee replacements are often discharged within one to three days of surgery under current enhanced recovery protocols, and the client typically arrives home with a walker or crutches, a specific weight-bearing order, joint-specific precautions, and a Medicare home health referral for PT and OT visits. The FAINS RN Supervisor arrives on day one or day two to assess, walk the home for fall hazards, verify the DME setup, and write the plan of care.
What is the difference between Medicare home health PT/OT and FAINS post-orthopedic support?
Medicare home health provides skilled physical therapy and occupational therapy on a visit basis, typically two or three visits a week for four to six weeks after a qualifying procedure. Those visits are the clinical care of the joint. FAINS private duty provides the daily coverage between the visits: personal care, ambulation supervision inside the weight-bearing order, safe transfers, DME use, medication supervision, meal preparation, and consistent practice of the home exercise program the PT and OT have prescribed. The two are complementary and most FAINS orthopedic cases run alongside a Medicare home health episode.
How does FAINS handle hip precautions after a total hip replacement?
The plan of care names the specific hip precautions the surgeon ordered (typically no hip flexion past 90 degrees, no crossing the leg across midline, no internal rotation for a posterior approach; the exact set depends on the surgical approach and the surgeon's protocol). The CHHA is trained to enforce those precautions during every ADL: chair selection with the right seat height, toilet use with a raised toilet seat, bed transfers using the surgical side, dressing sequence that avoids restricted motion, and bathing setup that keeps the client inside the precautions. Precautions typically remain in place for six to twelve weeks depending on the surgeon.
What about weight-bearing status after a knee replacement, spinal fusion, or fracture repair?
The plan of care names the weight-bearing status the surgeon ordered (weight-bearing as tolerated, partial weight-bearing, touch-down weight-bearing, or non-weight-bearing) and the assistive device the OT has fitted (walker, crutches, or wheelchair). The CHHA is trained to hold the client to that status during every transfer and every ambulation. Deviation from the weight-bearing order is a serious risk to the surgical outcome, and the caregiver's discipline is a primary protection against that.
Can the caregiver transport the client to PT and OT outpatient appointments?
Yes, in the family's vehicle, once outpatient therapy replaces home health therapy (typically at the four-to-six-week mark). Home health PT and OT come to the client in the early weeks; outpatient PT typically follows and requires transportation. Attendance rate at outpatient orthopedic PT is one of the strongest predictors of full functional recovery, and having a caregiver drive is often more reliable than family scheduling. FAINS caregivers do not use their own vehicles to transport clients.
What is the shift structure for the first two weeks after an orthopedic procedure?
The first two weeks are typically the highest-intensity window. FAINS orthopedic cases often scope eight to twelve hours a day, six to seven days a week, in this window, with a morning-through-early-evening emphasis to hold the medication schedule, breakfast and lunch, the home health PT and OT visits, the home exercise program between visits, ambulation and transfer supervision, and the personal care the client's mobility and pain level require. Shift structure typically steps down at the two-week and six-week milestones.
How does FAINS coordinate DME (walker, wheelchair, raised toilet seat, shower chair)?
The RN Supervisor confirms the DME order at intake and verifies the setup at the in-home assessment. Common orthopedic discharge DME includes a walker or crutches, a raised toilet seat, a shower chair or bench, a bed rail, and sometimes a wheelchair for longer distances. If the DME vendor has not delivered by the time of the assessment or if a piece is missing, the RN coordinates with the vendor or with the family to close the gap before the first full shift. Safe transfers and ambulation depend on the equipment being in place.
When does home orthopedic care typically end?
Most total joint replacement cases taper off private duty coverage between weeks six and twelve as the client returns to independent transfers, independent ambulation with or without an assistive device, and independent self-care. Some clients need extended coverage because of pre-existing comorbidities (dementia, prior stroke, cardiac diagnosis) that compound the orthopedic recovery. The RN Supervisor's 60-day visits are the formal moments to reassess whether coverage still fits. FAINS does not extend a case past its natural end.