How do you determine the homebound status for the homeless?

[shondaRN]

1. How do you determine the homebound status for the homeless??

2. What if you had a patient that lived in a motel at night, checked out during the day, and then lived in his car? I'm new in home health. What do you think?

The skilled need is wound care. The patient is noncompliant. He does not pick up a glucometer when encouraged to do so. Frequently he does not take his medication too.

I know some nurses that give noncompliant patients a good amount of time before they discharge them because they make no effort to educate, practice, etc. whatever skilled need. I do agree with this.

3. After a reasonable amount of time, can we continue care legally if the patient is not taking their meds, checking their blood sugar, etc.? If their noncompliance is prohibiting them from healing, etc., I believe that after a reasonable amount of time, they should be discharged.

I'm really curious to hear from nurses that have been in home health and know the all the regulations. Thanks!

[anticoagulationurse]

Homebound does not mean they are not allowed to leave the premises. I swear some days it is a taxing effort for me to go to work or the store and that "could" qualify me for HH if I needed it! The root cause of homeboundness is, is it difficult for them to leave home in any way? Pain, tired, exhausting, risk for illness due to weather and no shelter, can't handle the walker/wheelchair by themselves, etc. It is subjective and variable.

Also, "home" has little to do with it. Simply being without a home would really not come into the equation for homebound criteria. Their primary "residence" could be a shelter, the library during daytime hours, or under a bridge but the point is, is it a taxing effort to leave said place? If someone is literally roaming the streets at all hours of the day they are most likely not homebound.

Think of it this way, why should an insurance company pay HH to come see a patient if the person is perfectly capable of getting themselves to the help they need via other methods that are cheaper for the insurance company? If we patients were paying for these services (our)themselves, (we)they would understand the cost/benefit of various healthcare options and probably go with the cheapest method of meeting our needs (which is probably NOT HOME HEALTH). Why should it be any different just because insurance is paying?

After documenting numerous reasonable attempts and methods (perhaps the patient cannot read) of educating the patient and their response, as well as non compliance issues and how they are directly addressed with the patient it is your duty to discharge them. Perhaps they need to be in SNF and are incapable of properly caring for themselves. Maybe they need alternative resources outside of what HH can offer. It is wasteful and pointless to continue attempting education on a deliberately noncompliant patient.

Just my opinion. :)

[KateRN1]

I hope there's been a referral to MSW.