This is outline i use with my new staff and students to get picture of patient.
How to obtain Homecare services
1. Homebound status: need reason
SOB on walking 20 ft
Wheelchair bound and unable leave home unassisted
Unable to use stairs
Restricted to home post surgery per Dr.: no stairs, lifting, driving
Oxygen dependent high flow using l or 2 liquid tanks, unable walk more thatn 5-10 ft
Bedbound with contractures
Hoyer lift transfer bed-chair only
WC bound, unable to self transfer
2. Functional status: think of the word DEFICIT
Diagnosis: what aspect of illness is MOST ACUTE illness /reason for care
Any issue re non-compliance, misunderstanding meds/treatment regimen
Need teaching regarding meds, wound, injections, foley care, or
tube care, tube feedings
Environment: Any issues with home - heat, electricity, running water available;
have windows/doors intact; rodent/bugs issues?; dirty or cluttered, poor repair
live in high rise--elevator working? ;
# stairs person needs to enter/exit building ;
live high crime area-need AM visit or escort/ 2 person visit
Fire alarm present; oxygen safety followed?
Family: supportive or non existient; Able and WILLING to assist?
Insurance: Medicare, Medical assistance or Managed care issues?
Problems obtaining or paying for meds? Large unpaid bills
Caregiver: Lives aline? Who is asssiting client: family/friends, availablilty issues
Care giver willing AND able?
Caregiver issues: own health poor, frail elderly, forgetful, refusing assistance
Independence: Pt self care or dependent on assist devices/ others for meals,
food prep, bill paying, house keeping
Therapies: History of falls, balance issues -need for ptdafety assement;
Any need for adaptive equipment or equipment poor repair,
Support Services/friends/supervision: Need for 24hr supervision - ?receiving it
Involved in office of aging program, Adult day care, meals on wheels
3. Amount of services to request for Managed Care clients:
Eval: Home Safety/Situation/ Medication Management
if unable to get much clinical info to ask for more visits upfront
1-2 wk/2wks (will usually approve) for
Physical assessment check BP, Medication Management + Eval compliance,
Teaching : care giving, Diabetic, COPD, CHF Mgmt; insruct disease process,
simple wound care to eval compliance and wound healing;
eval nutrition/hydration/diet compliance if wt loss/ gain in recent hospitalized
pt or noted at Drs.
Daily: wound care (measurements), SQ/IV Meds list