Homebound Status

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    Hello All,

    I am in the process of getting my MSN in Health Policy and have to pick a topic that I would like to see changed within the health care arena. I have chosen homebound status due to the ambiguous way it is written. My dilemma is do I move to have it abolished or do I move to have it clarified where there is less room for it to be interpreted? My personal feeling is to have it abolished as I think we can provide more short term care to more individuals for disease prevention and management thereby preventing future hospitalizations. My examples would be new diabetics, CHF, HTN patients that with some personal intervention at the time of diagnosis would provide a better outcome in the long run. I am wondering how other homecare nurses feel about homebound status and would they keep the law the same, abolish it or make it stricter. Any opinions and thoughts welcome! Thanks.
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  3. 9 Comments so far...

  4. 0
    Yeah !! home health advocates would love that........however, the government wouldn't like it because it would triple their medicare spending, which is already through the roof.
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    hmm. I like the idea of getting rid of it. But then, I was just reading a forum on HH fraud, so I am thinking there would have to be some sort of restrictions or all of a sudden every American over 65 will be getting daily visits! I see patients all the time who could benefit from HH, but we have to DC when they tell us they are driving. as far as cost youngheartoldhead, I think that the idea would be to save money. If everyone with mobility issues was sent a single visit from HH, how many loose floor boards and unsafe bathrooms do you think we'd find? how many slightly forgetful grannies out there have a shoe box with 20 years worth of expired meds? The worst problems I have found are usually blaringly obvious within minutes of entering a house and asking a couple questions. if The paperwork was not too restrictive, we could do cheap "preliminary" visits and 30 minutes could free up some hospital beds.
    salvadordolly likes this.
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    I'm pretty sure, in fact, that the criteria for 'homebound' was just tightened up a couple years ago? Anyone?
  7. 1
    Actually, HB status has been relaxed over the last few years as I understand it. Clients are now allowed to drive if they have to one else to help them obtain supplies such as food, meds, MD visits. Attending Adult day care no longer automatically excludes a client from being homebound. When I started in HC almost 17 yrs ago, reasonable and taxing effort was defined as causing the client the need to rest when returning home, stopping and sitting for more than 3 minutes to have SOB resolve, ect. As it stands now, anyone requiring an assistive device may be considered homebound in some instances. The vague wording of HB status now leaves a lot of room for interpretation. IMHO, HB status should be eliminated and HC should be provided to anyone with a skilled need for education, wound care or any other preventative measure that will keep clients out of the already overburdened hospital systems.
    KelRN215 likes this.
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    I think the HB standard should stay the way it is. HC nurses are already in short supply especially experienced ones. If a person is able to safely drive to the doctors office, then they should. As a HC nurse, I can't imagine having to wait for the patients while they are out to breakfast, going grocery shopping, etc.

    A better idea is to have case managers at physicians offices. They would explain the new medications to the patients, teach diseases, diets,etc. The doctors do not have time to do this. Usually the offices are staffed with medical assistants who are not trained to do this. Here's an example: A 50 y/o person, goes to his doctors and he finds out he has a new diagnosis of COPD. Its a mild case, no hospitalization. The doctor explains the disease in about a minute and then gives him some prescriptions for inhalers, nebulizer and meds. The patient leaves the office confused about his treatment so he isn't compliant and ends up in the hospital. What should happen is the CM in the office sees him right away and teaches him and follows up on him. Hospitalization prevented! I think they are trying a pilot program like that now. I would love to be that CM!
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    Medicaid in most states doesn't require homebound status. Our company does a lot of Medicaid and we have problems with a lot of missed visits because they aren't required to be homebound. It makes sense to me that if you can drive, you can seek care at a PCP or ambulatory center.
  10. 0
    Strange. Friend works in a SNF. They are directed to try to keep people in a few day longer to max their rehab, because the HB rules say that if they are mobile, even requiring a wheelchair, they no longer qualify for any home health assistance? They must be reading the regs from another planet?

    Am I reading this stuff right- a nurse goes to a visit, and the patient is not THERE? And that it's common, even? Meaning, you waste you time driving there, and lose the $, then waste more time driving back? Aren't the visits scheduled for set times?
  11. 0
    Quote from SuzieVN

    Am I reading this stuff right- a nurse goes to a visit, and the patient is not THERE? And that it's common, even? Meaning, you waste you time driving there, and lose the $, then waste more time driving back? Aren't the visits scheduled for set times?
    Yes, your friend is WRONG about the regs.

    Yes, missed visits happen all the time. We even have a special form because it happens so frequently. We do call the patient and set up a time and we have a calendar in the home that shows the date and time of the next visit. But if the patient feels ok, the family may take them to lunch or the grocery store or hair salon and forget? about the nurse. Sometimes they have a doctors appointment that they forgot to tell you about.

    Most companies have some kind of compensation for the nurse when its a missed visit. The nurse will still get paid mileage and travel time if she works hourly. One company I worked for per visit still paid you $20 for the visit. I used to get some IV only cases, that were not HB and it was a pain in the butt trying to find this guy every week to change his PICC dressing. Its annoying, so I don't think HomeBound status should be changed or we'd be chasing more patients down constantly.
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    I hardly ever have to deal with "homebound statuses" as I do pediatric visits and have no Medicare patients. Almost none of my patients are truly homebound. I have many patients who need things like central line care or short term injections that their parents are not capable of giving. I work inner city so many of my patients are Medicaid patients and many of them have irresponsible parents. I had one today who didn't answer when I arrived, despite the fact that they knew I was coming. When I called the mother later in the day she said "I don't feel good so I just decided to sleep all day and not answer the phone." These patients have true nursing needs (central line care, G-tube teaching, subq or IM injections, lab draws) and in many of the cases, they wouldn't get the care they needed without home nursing. Some of the parents I deal with can't be relied on to follow through which is why we're out there... thinking of one patient in particular who has an autoimmune disorder and receives weekly methotrexate. Every year, it seems, her family doesn't fill out the paperwork to renew her Medicaid. It took me several weeks of communicating with the nurse and Social Worker at her Rheumatologist's office to get her reinstated a few months ago. When I called them to tell them what happened, they said "again?" I call in the refills for her methotrexate because the family just wouldn't do it if it was left up to them. She has been on our caseload for around three years and will remain there until the MD discontinues the med. She needs this medication and has good symptom relief with it but her parents can't be trusted to give it or manage it. She doesn't need to go to a doctor's office (which is on the other side of the city and is either two trains, a train and a bus or 2 buses away) and her parents couldn't necessarily be trusted to bring her there on a weekly basis.
    SuzieVN likes this.


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