What does it mean to be homebound?
We’re glad you asked. To sum it up, you must be limited to your home and require assistance to leave it. If you’d like a more in depth explanation, check out the official homebound definition from Medicare:
For a patient to be eligible to receive covered home health services under both Part A and Part B, the law requires that a physician certify in all cases that the patient is confined to his/her home. For purposes of the statute, an individual shall be considered “confined to the home” (homebound) if the following two criteria are met:
1. Criteria-One: The patient must either:
- Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence.
- Have a condition such that leaving his or her home is medically contraindicated. If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet two additional requirements defined in Criteria-Two below.
- There must exist a normal inability to leave home; AND
- Leaving home must require a considerable and taxing effort.
If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment. Absences attributable to the need to receive health care treatment include, but are not limited to:
- Attendance at adult day centers to receive medical care;
- Ongoing receipt of outpatient kidney dialysis;
- The receipt of outpatient chemotherapy or radiation therapy.
Any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, or accredited to furnish adult day-care services in a State, shall not disqualify an individual from being considered to be confined to his home. Any other absence of an individual from the home shall not so disqualify an individual if the absence is of an infrequent or of relatively short duration. For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration. It is expected that in most instances, absences from the home that occur will be for the purpose of receiving health care treatment. However, occasional absences from the home for nonmedical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home.
Some examples of homebound patients that illustrate the factors used to determine whether a homebound condition exists are listed below.
- A patient paralyzed from a stroke who is confined to a wheelchair or requires the aid of crutches in order to walk.
- A patient who is blind or senile and requires the assistance of another person in leaving their place of residence.
- A patient who has lost the use of their upper extremities and, therefore, is unable to open doors, use handrails on stairways, etc., and requires the assistance of another individual to leave their place of residence.
- A patient in the late stages of ALS or neurodegenerative disabilities. In determining whether the patient has the general inability to leave the home and leaves the home only infrequently or for periods of short duration, it is necessary (as is the case in determining whether skilled nursing services are intermittent) to look at the patient’s condition over a period of time rather than for short periods within the home health stay. For example, a patient may leave the home (meeting both criteria listed above) more frequently during a short period when the patient has multiple appointments with health care professionals and medical tests in 1 week. So long as the patient’s overall condition and experience is such that he or she meets these qualifications, he or she should be considered confined to the home.
- A patient who has just returned from a hospital stay involving surgery, who may be suffering from resultant weakness and pain because of the surgery and; therefore, their actions may be restricted by their physician to certain specified and limited activities (such as getting out of bed only for a specified period of time, walking stairs only once a day, etc.).
- A patient with arteriosclerotic heart disease of such severity that they must avoid all stress and physical activity.
- A patient with a psychiatric illness that is manifested in part by a refusal to leave home or is of such a nature that it would not be considered safe for the patient to leave home unattended, even if they have no physical limitations.
The aged person who does not often travel from home because of feebleness and insecurity brought on by advanced age would not be considered confined to the home for purposes of receiving home health services unless they meet one of the above conditions.
If a question is raised as to whether a patient is confined to the home, the HHA will be requested to furnish the Medicare contractor with the information necessary to establish that the patient is homebound as defined above.
Do I qualify for home health services?
In order to receive home health services, you must receive a written order from a doctor. Also, your care needs must be short term, not continuous. Finally, you must have a limited ability to leave your home or require considerable effort to do so.
How soon can I start services?
As long as a doctor’s order is available, services generally start within 24 hours of initial contact.
Will you keep my doctor informed of my progress?
Yes. Your home health care team and support staff will work with your doctor to plan, monitor, and evaluate the outcomes of your care. Your progress will be assessed regularly, and your treatment plans can be adjusted to ensure care that’s right for you.
What insurance do you accept? How will I be billed?
Most major insurance plans, Medicare, and/or Medicaid provide coverage of home care, home infusion therapy, and hospice services. For your convenience, our staff will contact your insurance carrier to determine your exact coverage. You will be informed of your specific coverages and potential insurance gaps before services begin.
There are a lot of home health agencies out there. Why should I choose you?
Because we’ll treat you like family. We say that a lot, but that’s because it’s true! We provide excellent care and have been recognized for our efforts by being named a HomeCare Elite Agency eight years in a row. With Gallagher Home Health Services, you, the patient, are always the center of our attention, and it is our duty to leave you satisfied at the beginning, in the middle and at the end of your care.
I have been diagnosed with _______________. Will you be able to help me?
I live in ____________. Will you be able to visit me, or is it too far?
Most likely, it is not too far for us! We offer our services in eight western Pennsylvania counties and are constantly expanding. To check and see if we cover your area, please check out the areas we serve.
Will I be told when my care is over?
Your nurse and therapist will keep you up to date on the progression of your service plan. They will let you know when your last visit will be. During that last visit, they will perform a discharge assessment to ensure one last time that you are doing better.
Am I allowed to leave my house while on home health services?
Yes! We can’t stop you from leaving your house, nor do we want to! However, being on home health services generally means you are too weak to leave your home unassisted or without great difficulty. If you feel well enough to leave your home on a daily basis to complete ordinary errands, then our job may be complete. Our patients are homebound and only leave their home to see the doctor.
Can I request a male/female nurse?
Yes. Many patients have gender preferences and make specific requests before their service starts. Often, women are more comfortable with female nurses, as men are with male nurses. If you have a preference, let us know before care starts so we can assign you someone with whom you are comfortable.
What if I don’t like my nurse?
We hire only the best and brightest home health nurses in the field. That being said, sometimes you may not get along with the person assigned to you, and that is ok. If you find yourself unhappy with any of your medical staff, please give us a call at the office and we can find another nurse or therapist to care for you.
What if I need to miss a visit because family is visiting or I don’t feel well?
That is ok. Just kindly let us know by calling the office so we can alert your nurse and therapists. They will then reschedule your visit for a time convenient for both of you. Keep in mind that missing multiple visits is not encouraged as you are on a strategic home health plan. Any changes to this plan might slow down your recovery.
I don’t have any medical supplies at home! How will the nurse care for me?
Don’t worry – the nurse will bring all the supplies he or she needs to do the job. We will bill your insurance for supplies used, so you don’t have to pay extra.
What happens during a visit?
A nurse will come into your home and begin with a thorough assessment of your vital signs, such as taking your blood pressure and checking your heart rate. This ensures you are doing well and gives us a way to judge your improvement. The nurse then performs their skilled service, such as cleaning and repacking your wound or administering your IV. The nurse will also take the time to educate you on caring for yourself so that you will thrive once our home health services have been completed.
Will a different nurse come to my home every visit?
No! We assign each patient their own personal nurse for optimum quality of care. He or she will take the time to get to know you and your condition so that you are receiving the best treatment possible. By the end of your care, they will feel like family!
What if I don’t have a doctor’s orders and I just want someone to help me around the house?
Sounds like you are in need of home care, not home health services! Head on over to the Gallagher Home Care Services website for more information.
What happens if I go back into the hospital while under your care?
We try our best to make sure this doesn’t happen! But if it does, don’t worry, as we will continue to provide you home health services upon your hospital discharge as long as your doctor has ordered it.
Can I go to out-patient therapy while receiving home health services?
No. While you are receiving physical therapy from a home health agency, you cannot also receive out-patient physical therapy services. Our physical therapists will work with you and your physician to determine the best time for you to complete your home care therapy and begin out-patient services.
How many times will you visit me?
As many times as necessary! Generally, your doctor will order home health services for a certain period of time. During this time, we will reassess your needs to determine if you need continued care and relay your condition back to your doctor. You will not be discharged until it is medically safe to do so.
What is the difference between home health and home care?
Home health is a service ordered by your doctor. It involves a medical professional coming in to your home to provide skilled nursing or therapy services. Home care is not ordered by your doctor and is generally not covered by your insurance. It is performed by a certified nursing assistant and includes services such as care-taking or companionship.
What should I do if I have a question that isn’t answered here?
That’s easy – just contact us!
Or, fill out this form and we will get back to you with an answer.