Homebound Or Not?

  1. Here's the situation:
    Patient attends water aerobics at least 1-3 times per week. Her son states it is a considerable and taxing effort to get her out of the home. 8 months ago patient had skilled HH physical therapy episode, pt/family was taught transfer techniques and home exercise program.

    Son wants us to come back into the home for the exact same reason. My concern is that she gets out of the home on a frequent and regular basis. She is participative in an excercise program. The pt/family was instructed on transfers and HEP less than one year ago.

    Does this scenario meet the Medicare criteria for home health admission?
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  2. 10 Comments

  3. by   TazziRN
    I don't think so. Criteria includes inability to leave the home to seek medical care/treatments, etc. If she can get out to water aerobics she can go other places.
  4. by   CardioTrans
    This patient wouldnt meet a skilled need either. If the family has been taught the HEP, and nothing else has changed as far as diagnosis, then she doesnt have a skilled need. Also, who takes her to water aerobics? Does she require a special lift, walkers, how many people have to assist her to ambulate??

    Like the other poster said, if she is going out 3 times a week for aerobics, then she can go to outpatient therapy, and unfortunately that is exactly how Medicare would look at it.
  5. by   NRSKarenRN
    Quote from CardioTrans
    This patient wouldnt meet a skilled need either. If the family has been taught the HEP, and nothing else has changed as far as diagnosis, then she doesnt have a skilled need. Also, who takes her to water aerobics? Does she require a special lift, walkers, how many people have to assist her to ambulate??

    Like the other poster said, if she is going out 3 times a week for aerobics, then she can go to outpatient therapy, and unfortunately that is exactly how Medicare would look at it.
    :yeahthat:

    Leaving home needs to be infrequent basis per MC regs. Able to leave 1-3 for aquatics, can get PT as output.

    Case dismissed. Do not admit.
  6. by   Jo Dirt
    When my father-in-law was at home the social worker from home health insisted we send him to the senior citizens center several times a week so he could have a social life.

    To me, this disqualifies a person as homebound. So, I would like to know as well...what exactly constitutes being homebound? Because the agency I worked for (which also happens to be the agency that came out to see my fil) seemed to have pretty loose standards about what they consider homebound, and they never would give me a good definition, but the impression I was left with was they were allowed to have their caregiver take them to the doctor and back and still be considered homebound.
    But I'm like you, if they can go to exercise class (or the senior citizens center) they can go other places.
    There is enough Medicare waste as it is.
  7. by   DutchgirlRN
    It was to be a taxing effort for the patient to get out. I wouldn't consider it a taxing effort if the patient is able to do water aerobics once they arrive. No skills. No admit.
  8. by   SWRN84
    Agree with everyone else. Definitely not homebound and no skill. We would not admit this patient.
  9. by   JennyHHRN
    I really appreciate all the feedback. It makes me feel better to know I'm not being the Grinch of Home Care. People get really upset when we try to explain that they do not meet criteria.
  10. by   NRSKarenRN
    if medicare (mc) is payer, don't forget to get advanced beneficary notice a b n (abn) signed too indicating mc won't pay for care.
  11. by   CapeCodMermaid
    I've been reviewing recert 485's and am just amazed at some of the things I read. One nurse wrote the patient was homebound because they were fatigued after 120 minutes of activity!! I am 45 years younger than that patient and I get tired after 2 hours of activity.
  12. by   caliotter3
    I was homebound out of semi-choice. My condition was such that if I stood up just to go to the bathroom I might lose consciousness. I, too, would be tired after 120 minutes of exercise. When I'm well, I can't walk around the mall for any length of time without getting extremely fatigued, SOB, and sometimes developing panic attacks. I wish I could go gallavanting for water aerobics. It would do me some good.

    Agree with all the others. This person does not meet the criteria for homebound status. But I find it strange that several of my wheelchair bound quads with vents leave the house to go to appts. But their appts. are few and far between, it is a big production, and most of the time, they are at home, flat on their backs in bed. I suppose they are talking about routine, scheduled trips outside the home. I suppose an occasional foray, if not frequent, or routine, would be allowed.
    Last edit by caliotter3 on Dec 26, '07

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