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 element in home health care eligibility.
What Does Homebound Mean for Home Health Care Eligibility?
Medicare and most private insurance require patients to be considered homebound to qualify for home health care services.
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:
- Patients either require assistance from another person to leave home because of illness or injury, requiring the use of assistive devices like a cane, crutches, walker or wheelchair or have a condition that could worsen if they leave home.
- There must be a normal inability to leave home and leaving home must require a considerable and taxing effort, which means leaving is physically difficult or requires frequent rest breaks during the activity or prolonged recovery after the outing.
For psychiatric patients:
- Illness is manifested by a refusal to leave the home, such as for those with agoraphobia, paranoia or severe depression with a vegetative state; or
- Illness manifestation and symptoms would be 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
- Going to the barber or salon
Examples of Being Homebound
The following are fictional representations of what being homebound can look like with varying conditions and circumstances:
Mobility Limitations
Jane has severe osteoarthritis, making it painful for her to walk or stand for more than a few minutes at a time. Her condition restricts her ability to leave her home except for essential medical appointments. Even with the assistance of a walker, Jane struggles to navigate stairs or uneven surfaces and requires physical assistance of another. Jane can be considered homebound.
Chronic Respiratory Conditions
John suffers from chronic obstructive pulmonary disease (COPD) and requires supplemental oxygen to breath, but even using his oxygen as ordered, he gets short of breath very quickly and needs to sit down to recovery. 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 exacerbate his symptoms. 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. 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.
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 collaborates with the home health team to determine whether they need intermittent skilled nursing, physical therapy, speech therapy or ongoing occupational therapy. Intermittent skilled nursing can be as often as daily for up to three weeks in certain circumstances, or at least once every 60 days. Care needs must be predictable and finite.
The physician, in collaboration with the home health nurses and therapists, determines which home health services are medically reasonable and necessary and has a documented face-to-face consultation with the patient indicating the need for skilled care and how the patient meets homebound criteria to complete a referral to a home health company.
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 types 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 manage your illness or recovery in the comfort of home.
In addition to nursing and therapy services, home health care companies also offer home health aides for 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 particular 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.
