What Does Homebound Status Mean in Home Health Care?

One of the main eligibility criteria for receiving home health care under Medicare and other private insurance options is being considered “homebound.” This blog defines homebound status and provides examples to help you and your family better understand this important part of home health care eligibility.   

What Does Homebound Mean for Home Health Care Eligibility?

Medicare and most private insurance require that a patient be considered homebound. A physician or other authorized provider must determine this during a face‑to‑face encounter with the patient and it must occur within 90 days before the start of care or within 30 days after. During this encounter, the physician evaluates the patient’s current physical limitations, medical condition and ability to safely leave home.

The clinician must document the specific reasons the patient is considered homebound on the date of the assessment, including any physical, cognitive or safety-related barriers to leaving home. This determination is based on the patient's current condition, not past limitations or possible future decline.

It’s important to know that being homebound does not mean being bedbound. Here’s what being considered homebound involves: 

Difficulty Leaving Home

To be considered homebound: ¹

1. Patients either need help from another person to leave home because of illness or injury, need to use assistive devices like a cane, crutches, walker or wheelchair or have a condition that could worsen if they leave home—for example, patients that are at risk for infection. 
2. The patient normally isn't able to leave home, and leaving home requires a "considerable and taxing effort." For example, leaving home may require significant planning, assistance or recovery time afterward. 
3. A diagnosis like agoraphobia, paranoia or severe depression with a vegetative state causes behaviors of a refusal to leave the home, or
4. The illness and its symptoms make it unsafe for the patient to leave the home.

For psychiatric patients: 

1. A diagnosis like agoraphobia, paranoia or severe depression with a vegetative state causes behaviors of a refusal to leave the home, or
2. The illness and its symptoms make it unsafe for the patient to leave the home.

Types of Allowed Outings

When patients are homebound, their outings are infrequent and short. While occasionally leaving home for some reasons is allowed, it still must be difficult for the patient to do so. These are some examples of outings still permissible for homebound patients: 

• Receiving healthcare services that can’t be provided at home 
• Participating in therapeutic, psychosocial or medical treatment in an adult day care program that’s licensed, certified or accredited by the state 
• Attending religious services 
• Attending a unique or special family event, like a graduation ceremony
• Going to the barber or salon 

Examples of Being Homebound

The following are fictional representations of what being homebound can look like in different situations:  

Mobility Limitations

Jane has severe osteoarthritis, making it painful for her to walk or stand for more than a few minutes at a time. She has difficulty leaving her home except for essential medical appointments. Even with the help of a walker, Jane struggles to navigate stairs or uneven surfaces and requires physical help from another person. Jane can be considered homebound. 

Chronic Respiratory Conditions

John suffers from chronic obstructive pulmonary disease (COPD) and needs the help of an oxygen tank to breathe, but even using his oxygen as ordered, he gets short of breath very quickly and needs to sit down to recover. He needs to sit and rest after walking about 50 feet. His condition makes it challenging for him to exert himself or expose himself to environmental triggers like pollution or allergens. John’s doctor has advised him to stay indoors and to avoid situations that could make his symptoms worse. John can be considered homebound. 

Recovering from Surgery

Maria recently had major surgery and is in the early stages of recovery. Her physician instructed her to avoid any strenuous activity and to rest as much as possible. Maria experiences significant pain and fatigue with any movement, which limits her ability to leave her home except for medical appointments or emergencies. Maria is also usually more tired and in more pain after leaving home, needing a day or two to recover. With her mobility and energy levels compromised during this critical recovery period, Maria can be considered homebound. 

Cognitive Impairment

Robert has been diagnosed with advanced Alzheimer’s disease, which has resulted in severe cognitive impairment. He experiences confusion, disorientation and memory loss, making it unsafe for him to venture outside without assistance or supervision. His spouse finds it increasingly challenging to aid him in unfamiliar environments. To ensure Robert’s safety and well-being, his doctor has recommended that he remain at home. Robert can be considered homebound. 

Every patient's situation is unique. Meeting one of these examples does not automatically qualify someone for home health care. Eligibility is determined by the patient's healthcare provider and documented clinical condition.

What Are the Other Eligibility Criteria for Home Health Care?

In addition to being homebound, patients must meet the following criteria to be considered eligible for home health services under Medicare: 

Skilled Medical Need and Doctor’s Orders

The patient’s physician or qualified provider collaborates with the home health team to decide whether they need intermittent skilled nursing, physical therapy, speech therapy or ongoing occupational therapy. The care must be complex enough to require the skills of a licensed professional.

Intermittent skilled nursing can be as often as daily for up to three weeks in certain circumstances, or as infrequently as once every 60 days. Care needs must be predictable and finite, meaning they will not last forever. 

As part of the referral to home health care, this collaboration between the physician and the home health nurses and therapists decides which home health services are medically reasonable and necessary. The physician must also document a face-to-face consultation with the patient showing that they need skilled care and explaining how the patient meets homebound criteria.  ²

Medicare Certification

 The agency providing home health services must be certified by Medicare. To find a certified home health agency and compare quality scores among different providers, visit Medicare’s Care Compare website. 

What is Included in Home Health Care?

Home health care can include nursing, occupational, speech and physical therapy to help patients stay safe at home. The type of care you receive is based on your needs and your doctor’s orders. 

The home health care team helps monitor your health and provide high-quality care to empower you and your caregivers to manage your illness or recovery in the comfort of home. 

Along with nursing and therapy services, home health care companies also offer home health aides for assistance with activities of daily living and medical social workers to connect patients and families with resources, making long-term care plans and more. 

Some home health care companies like Amedisys also offer specialized programs to care for patients with specific diagnoses, like COPD, diabetes and heart failure and to help reduce falls in the home. 

Is Home Health the Answer?

No matter where you and your family are in finding the right care for your loved one, Amedisys has the resources to help you navigate healthcare at home. 

Take our home health care quiz to help determine if you or your loved one might be eligible to receive home health care. If you’re ready to speak to a specialist, complete the form at the bottom of this page or call a location near you. 

Melanie Morris, MBA, MSN, RN, COS-C is the Assistant Vice President of Care Delivery Management for Amedisys. In her 28 years as a nurse, she has enjoyed caring for many types of patients and is passionate about providing holistic care to patients in their homes, especially those with chronic conditions such as wounds.