Homebound, Home Health, Medicare

Help for the Homebound

Staying independent and living in the least restrictive home environment are very important concerns for most seniors, as well as for all of us. Whether we are residing in a house that we own, an apartment, independent/assisted living, nursing home or otherwise, we all value the freedom to live the way we choose to.

There are times in one’s life when a serious health episode or some significant event may impact one’s functional abilities enough to where one may become “homebound.” This can either be short-term or long-term. If one happens to live in a setting other than a nursing home, where 24-hour care has usually been arranged, services like Home Health can be used. This involves Skills like nursing, occupational/physical/speech therapies and social work.

Having worked in many health care settings in the past as a Clinical Social Worker, including hospitals, nursing homes, adult day health care, sitter services and home health, I can attest that home care criteria can appear to be very confusing to most elders and their caregivers.

First, I have found it helpful to give some simple definitions of what “Homebound” means, since that is an important criteria for one to be eligible to receive Home Health Care services that are covered by MediCARE and most insurance carriers when ordered by a Physician with relevant Patient Conditions and Diagnosis. Some illustrations of what Homebound is can also be useful to one’s understanding.

HOMEBOUND:

An individual is confined to the home due to physical or psychiatric limitation;
An individual experiences a normal inablility to leave the home;
Leaving the home requires a considerable and taxing effort;
Being bedridden is not a requirement;
An individual may be confined due to psychiatric conditions – such as refusal to leave home and/or a condition that makes it unsafe for him or for others if he leaves home;
an individual who has no other means of transportation and has to get to the doctor by driving himself infrequently and the outing requires considerable and taxing effort may still be considered homebound;
allowance for being absent from the home includes if for short periods of time, to receive medical care (such as dialysis or chemotherapy) or to attend worship services.

Secondly, it is helpful to understand another term: “Custodial Care:” like personal care and bathing per CNAs, private duty personnel. These are usually available per Home Health but only intermittently and in conjunction with Skill services, such as Nursing and therapies.

Thus, eligibility for various Skilled Home Health Care Services can be varied and are usually covered by insurers when the recipient is homebound. Custodial Care services, like personal care, are important but not covered by most carriers if they are stand alone services. Often, Custodial care is also rendered by Private Duty, Sitter Services for private pay or per long-term care and/or State Licensed Waiver Programs.

Home Health Compare is an independent and impartial tool on the Internet that gives you detailed information about Medicare-certified home health agencies. This site provides quality measures for your review in a format that compares how each agency scores in comparison to National and State averages.

Quality measures give you information about how well home health agencies provide care for some of their patients. Some of these include:

Patients who get better at walking or moving around.
Patients who get better at getting in and out of bed.
Patients who have less pain when moving around.
Patients who get better at bathing.
Patients who get better at taking their medications correctly.
Patients who are short of breath less often.

These are just some of the quality measures that can be found at: "http://www.medicare.gov/HHCompare".

Hospice Care, another important home care service that is for the terminally ill, will be covered in a future column. Long-Term Care Insurance Policies often include all of the above mentioned home care terms in their policies, which need to be reviewed as to specific eligibility criteria for coverage.

Keith Horcasitas, LCSW, MHA