HHABN and homebound status

[MomRN0913]

This home health stuff is a whole new ballgame.

I have a younger patient who i knew was going to be trouble from the start. Won't get into the deatils, but he is medicare and i just had to do an HHABN and end coverage because he pretty much proved he's not homebound anymore. One weekend he spent the whole weekend at his girlfriends and "went out". Then this weekend he refused a visit because he was going to be "away" all weekend. Then when I tried to visit him yesterday he wasn't home from his weekend yet and then refused a visit that day. He has also refused a few visits from PT. I asked my supervisor and said he is no longer homebound and ot document, notify phycisian and patient.

I did this, the patientts father has been handling everything, explained it to him and asked when the patient wakes up to have him call me, which he never did, so i called.

he tells me "you told me I could go out as long as someone else drove" I explained yes, for short durations. I did explain he is getting out and about with him father to appointments and because of the refusals and being away I couldn't even make the visits this week. The father agrees, and we believe he will benefit from outpatient PT which the father will take him too and it will prevent him from going "stir crazy" which is why he is escaping every weekend.

I feel bad. I really do. Did I do the right thing? Family is independent in care, patient is getting out, I just couldn't see having one week of missed visits then having one week left. I felt it to be fraud.

Ugghhhh, I hate this, i feel like I am never off the job and it haunts me.

[merlee]

Homebound means just that. They can go to the dr's., to church (but not out to eat afterward) and to the barber/beauty shop once a month. They cannot drive at all, and it must take extra effort to get to the car.

Do not feel bad, at all. This happens all the time.

I had a double amputee who frequently got himself into his wheelchair and out to his van. I needed to tell him that he could go to the urologist's office to get his SP cath changed.

Best wishes!