Tuesday, January 3, 2012

Defining Homebound

With many conflicting ideas,  interpretations, and vague guidance, determining if a patient is homebound can often be challenging.

Some will automatically assume a patient is not homebound if they hear they drove or left the house. But this isn’t necessarily true. A December 2010 survey we conducted to test home care professionals knowledge of homebound confirmed this notion. We found many people jumped to the conclusion that a patient was not homebound if they left the house for any reason or drove. 

Home care professionals are doing patients a disservice by not knowing the proper homebound definition. With a clearer understanding of what it is, patients can get the care they really need.

We shared Medicare’s specific homebound definition previously on our blog here. In summary, just because a patient leaves the house, or even drives, it does not mean they are not homebound. For one, any excursions related to medical appointments or religious activities cannot be taken in consideration  to a patient’s homebound status. Also, it says that a person is homebound if leaving “requires a considerable and taxing effort.” So perhaps they did drive to the grocery store, but if it took them 30 minutes to get into the car and needed the assistance of a friend or relative, they may be homebound.

The problem arises is how do you prove a “considerable and taxing effort”? The answer is documentation. Instead of saying it was difficult for a patient to get around the house, you can be more specific and say the patient was “unable to ambulate more than 100 feet without having to rest.” Its all opinions until you give quantities and specifics and even then you may still have a patient who is on the fence because there are not specific guidelines on what physical limitations qualify  someone homebound There will be some judgment calls. But with documentation which quantifies the physical or sometimes mental limitations you then have  proper documentation to back it up your decision.

Understanding homebound status will not only help us provide better care for in-need patients, but it will also save money in the long run. For example, if a patient is disqualified from homebound status, then they must leave the house frequently to receive all care and/or they miss critical appointments, which can cause them to take a downturn and end up in a hospital or nursing home. This would be much more expensive than if they got their care in the home and were able to heal there.

If you still have questions about homebound status, please contact us at nick [at] daymarck.com.

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