Chemotherapy at home. It certainly isn’t for everyone. But for some homebound patients, it soon may be an alternative to hospitalization or difficult trips to an outpatient clinic.

“We started about five years ago to do intravenous therapy in the home,” said Donna Sargent, director of health services for Community Health and Counseling Services in Bangor. The IV therapy has been used in administering antibiotics, managing pain and feeding patients.

“We couldn’t imagine the day we would be doing chemotherapy,” Sargent said. That day is almost here. After Nov. 15, CHCS will begin accepting patients for chemotherapy, to be administered in the home by one of 14 registered nurses trained and certified in this therapy — five in the Bangor office, three in Lincoln, and two each in Ellsworth, Dover-Foxcroft and Machias.

Chemotherapy at home is provided already by Androscoggin Home Health Care, Kennebec Valley Home Health, and many home health agencies around the country.

“We want to make it clear that it isn’t appropriate for everyone — nor is it possible for everyone,” Sargent said. “Most people will still make the trip into the outpatient department” or oncology clinic, she said.

Those who receive the service will have been referred by their physicians, and they will be people who are “essentially homebound,” Sargent said, with conditions that are “acute or unstable.” Those patients are “too ill to easily access” the treatment, she said.

For such clients, outpatient treatment might mean regular lengthy trips in an ambulance, an ordeal that can be “really taxing,” said Orella Chandler, clinical nursing consultant for the Home Health Division of CHCS.

As with other services provided by the CHCS nurses, chemotherapy done in the home has two advantages. “It may delay or prevent a hospitalization,” Sargent said, “and it sometimes makes early discharge from the hospital possible.”

CHCS already has conferred with physicians in the area, and found that they will be receptive to this program. The agency has the cooperation of pharmaceutical companies that have agreed to deliver the medications to the home and be responsible for the waste products afterward.

Home health patients are “referred by physicians or discharge planners at hospitals,” Chandler said. Clients may have Medicare, Medicaid or private insurance, or pay for the care themselves. Because home care is cheaper than hospitalization, insurance companies often cover aspects of home care, and Chandler urges families to check with their companies.

Sargent said this kind of care is possible because of “the strong home- care industry,” an industry “that started out small.”

“We’ve come full circle,” Sargent said. Health care used to happen only in the home, then moved to medical facilities, and now is moving back into the home when possible. “It’s a continuum of care,” Sargent said, one in which the home, hospital and nursing home all may play a part “according to where your needs can best be met.”