A broken pelvis and knee-replacement surgery couldn't keep Doris Hufford down.

The Lititz woman, who suffered a pelvic break in March and had knee replacement in October, wasn't sure she'd ever walk again.

Thanks to Visiting Nurse Association Community Care Services, Lancaster, and its in-home rehab program, Hufford was on her feet in no time.

"My therapist was so outstanding," Hufford says. "She kept encouraging me that I would be normal again. She helped me realize I could do it."

Hufford, who is in her 70s, was impressed with her therapist's ability to use her home setting for rehab.

"She didn't have any instruments when she came in the house. We did everything manually," she says. "We would use a chair for exercises. She taught me how to go up and down steps, how to lie down or get out of bed -- things that are difficult with one good leg."

In-home rehab services are just one of the many programs the Lancaster VNA offers.

"When people hear 'visiting nurses,' they think of nursing, and we are so much more than that," says Dawn Murr-Davidson, director of branch operations. "We are a collaborative organization. We have therapists, social workers, home health aides."

Lancaster's VNA, which marks its 100th anniversary in 2008, is affiliated with Lancaster General Hospital. It is not part of the national VNA organization but is a United Way agency.

The branch handles about 500 new admissions a month.

November is Home Health Care Month, and it's a great time to spotlight the unique features of caring for patients in the comfort of their own homes, says Susan Teter, rehab supervisor for VNA.

According to the National Association for Home Care, 20,000 providers deliver home-care services to more than 7.6 million people in the United States, and more than $41 billion is spent on home health-care services annually.

"One of the biggest reasons home health care is important is from a therapeutic standpoint," Teter says. "A therapist can address specific issues for a patient in the environment they live in day to day. In a clinical setting, you can only do so much to replicate the home environment."

Many of the VNA's clients were hospital patients before beginning home treatment. The agency also gets referrals from doctors' offices, nursing homes and clients themselves.

"We handle clients with temporary needs because of a recent decline," Teter says, noting that the agency does not provide private-duty care.

"We offer intermittent care, although someone is on call 24 hours a day to answer questions," she says.

Medicare covers services for some patients, while others pay by private insurance or out of pocket, Murr-Davidson says.

VNA patients range in age from new moms to the elderly.

"Most of our clients are people who don't want to go to a nursing home but need some care," Teter says.

The Lancaster VNA's rehab program features physical, occupational and speech therapists.

Teter says patients are often confused about the differences between the types of therapy.

"Occupational therapy has nothing to do with your occupation," she explains. "I've had people say to me, 'Honey, I'm retired. I don't need therapy.' "

Occupational therapy focuses on the activities of daily living, including bathing, grooming and preparing simple meals. Some cognitive and fine-motor skill exercises are also covered.

Physical therapy focuses more on walking, balancing and improving a patient's strength.

The VNA's speech-therapy program covers swallowing difficulties that a patient may experience after a stroke or just from general weakness.

Therapists get creative when offering treatment in a client's home, Teter says.

"We are out-of-the-box thinkers," she says. "We can use soup cans for weights or socks with pennies in them."

It's helpful, she says, for patients to see what they can do with everyday objects around their home.

"When they leave outpatient therapy, they are not going to go and buy a $4,000 machine," she notes.

Home care also allows family members and other caregivers to participate actively in a patient's recovery.

"Family education is important, and when we're in the home, we can involve the caregiver in the process," Teter says, adding that feedback indicates home therapy reduces the burden on the caregiver.

All of the VNA's services are geared toward one goal: increasing patient independence.

"We also try to incorporate technology into our care," Murr-Davidson says.

For the agency's telemedicine program, for example, a special machine takes clients' vital signs and asks questions specific to their needs before sending the information through the phone lines to the VNA.

"Patients who live alone say this reduces their anxiety," she says. "They feel like someone is checking up on them."

From telemedicine to rehab, the VNA offers an alternative for clients who need care but don't want to leave their homes to receive it.

"All of the things we offer improve the outcome for the patient," Murr-Davidson says.

That was certainly the case for Hufford, who is now completing her rehab at an outpatient facility.

"I would like to encourage people to try home health," she says. "I didn't know it was going to be as beneficial as it was. I felt that inâ€"home care is more personal.

"You get more individual care, and you are more comfortable in your own home than you are anywhere else."