"It's scary to give your husband drugs in the vein," she said.

She has had to learn that and a lot of other things to care for her husband, Willis, while he's incapacitated without a left knee joint.

She wasn't told when he was released from the hospital that she'd have to give him intravenous drugs, she said.

But she soon found she wasn't alone: "The doctor recommended home health care. I didn't know they had such things."

Home care services have grown dramatically to meet the demands since the first home health agency was established in 1962 at St. Francis Hospital. Hawaii now has 22 Medicare-certified home care agencies, with Medicare, Medicaid and other insurance plans covering most services.

About 25,000 patients received the services in their homes last year, according to the state Health Planning and Development Agency.

Susie Ferreira, a registered nurse, was sent from St. Francis Home Care Services to help Willis Barnhouse and train his wife to administer antibiotics, among other things. "I held Shirley's hand. I told her she could do it. I gave her a lot of support."

The Barnhouses were at a stoplight on Nimitz Highway on a Sunday afternoon in January when a bus rammed the back of their car. "Through a whole series of events, I ended up with no knee at all, and an upset lifestyle too," he said.

He's had five surgeries since April, including a knee replacement that was removed the fifth time because of infection, his wife said. A "spacer" was inserted in the knee until the infection disappears. Ferreira goes to the Hawaii Kai home almost daily. Another nurse goes on weekends and a physical therapist visits as often as needed.

"Twenty years ago, I would have had to stay in the hospital," Barnhouse said.

"So the economics of it is great."

Ferreira ordered supplies and medical equipment for the home, including a wheelchair, walker and exercise weights. "My best present to him was getting him a cushion for his wheelchair," she said. "It's not meant to sit in it for a long time ... "

After being in the hospital so long - 33 days last fall - Barnhouse didn't want a hospital bed, his wife said. He sleeps on the living room sofa because the bedrooms are on the second floor.

He can walk around the lower level with his wife's help. "I have no directional ability with the spacer," he said.

"Shirley has to walk behind me. Nothing is private."

She gave up her work as a volunteer guardian at Family Court. So when does she get a break from home? "When I go to Safeway," she laughed.

Barnhouse, 65, is on disability leave as director of pharmacy services at Interstate Pharmacy Corp., providing consultant services to nursing homes.

He said he had to have his right knee replaced in June, last year, because of osteoarthritis and he was back to work in four weeks - a feat he intends to repeat after his left knee replacement.

"Working is my life and I plan on it being again," the determined patient said.

Meanwhile, the couple is coping with major logistical problems just to get him out of the house and into the car to go to doctors.

"When we brought him home (from the hospital), we couldn't get in the front door," Shirley Barnhouse said. A physical therapist who lives next door showed her how to maneuver it.

Ferreira, one of the first nurses in Hawaii to get national home care certification, said she sees about 20 patients in their homes.

She types all information about their medical condition, medicines and care into a laptop computer so "if another nurse is doing it, there's continuity." She talks to the doctors about what patients need, especially if they're just going home from the hospital.

"A lot of teaching goes on," she said. "People aren't left high and dry. We not only need to look at the patient, but at home care."

It's called "home care." Services may include skilled nurses, physical, occupational and speech therapists, home health aides, homemakers and social workers.

Susie Ferreira said she had never heard of home care until joining St. Francis Home Care Services seven years ago. A pediatric nurse for 12 years at Kapiolani Medical Center for Women and Children, she helped train St. Francis employees at Kapiolani for family home care.

"It spurred my interest," she said, so she joined the St. Francis home health agency. "After the initial shock of going into peoples' homes ... after six months, I told my husband, 'I love this job.' I keep on thanking that I did this move.

"I like the independence and my knowledge being challenged a lot of times," Ferreira said.

"It's very rewarding knowing a whole team of us got this man well and he's living the best quality life that he can."

Sisters Maureen Keleher and Aileen Griffin established the first home health agency at St. Francis in 1962 with federal seed money.

They were concerned because Hawaii didn't have a Visiting Nurses' Association like other states to provide nursing services to the community.

One of the first lay administrators was Rose Ann Poyzer, now executive director of the Hawaii Association for Home Care.

She said the program began with a generic name, Honolulu Home Care, and she contacted all hospitals to provide services. Nursing services were primary, then therapists and other professionals gradually were added.

St. Francis worked with the state and insurance firms to obtain coverage for home care services and, when the Medicare law was enacted in 1965, it became a Medicare-certified home health agency.

The state now has 22 Medicare-certified home health agencies - some privately owned and others hospital-based, Poyzer said.

Services are covered by Medicare, Medicaid and other insurance plans because they're prescribed by a doctor and a skill is required, she said.

Poyzer, who managed the St. Francis agency 12 years, stresses the importance of home health care in meeting community needs, from newborns to the elderly or terminally ill. Long-term care needs are growing with the aging population, she pointed out.

"There is no wait-listing like you have in care homes and that kind of thing," she said. "When they get a call, they usually can make a visit that day or the next."

Besides providing medical services, home care agencies arrange for home medical equipment and supplies, transportation, home infusion pharmacy, laboratory and nutritional counseling, patient and family education, respite and live-in care.

The agencies must be certified by the state and are constantly reviewed "to assure the public they are giving quality patient care," Poyzer said.

She said the association is "trying to develop care plans and good coordination between hospital and home care." People of some cultures don't want people in their homes, she noted, so that also is being addressed.

A Home Health Resource Handbook listing organizations that provide services and products to people in their homes may be obtained from the Hawaii Association for Home Care.Call 735-2970 or write to the association, P.O. Box 37114, Honolulu 96837.