Relating the homebound status to a diagnoses is one approach to utilizing documentation to support the need for home care.
	When the homebound status and skilled need are both tied to a diagnosis, your documentation should provide adequate justification of meeting the criteria for homecare and for reimbursement.
	Your OASIS data must also serve to substantiate the homebound status especially in the functional limitations, ADL/IADL categories

The following phrases can be included in your documentation to support the homebound status:

	Medical restriction due to Immunosuppression
	On IV antibiotic therapy for complications (i.e. CMV retinitis)
	Requires continuous oxygen therapy
	Impaired mental status affects decision making skills
	Terminal status
	Severely weakened condition due to impaired nutrition/hydration status
	Requires 24 hour care and supervision
	Pain impairs mobility; pain medication impairs decision making ability

	Cardiac restrictions due to angina
	Experiences angina even at rest
	Experiences angina with minimal activity
	Poor endurance, experiences SOB with minimal activity
	Experiences SOB at rest
	Able to ambulate only short distances (20 ft. or less) before experiencing SOB, angina
	Oxygen dependency (specify PRN or continuous)
	Edema in lower extremities limits ambulation
	Medical restriction to elevate LES due to edema
	Medical restrictions due to HTN-- BRPs only
	Orthostatic hypotension - symptomatic - at risk for falls
	Medical restriction to elevate LE due to PVD
	Activity or weight bearing status restrictions due to PVD
	Cardiac restrictions post CABG (X # vessels)
	Post op pain and weakness (S/P CABG X __)
	Right or Left Hemi paresis/paralysis due to CVA
	Requires assist with most ADLs/IADLs

	SOB at rest
	Respiratory distress with minimal activity or speaking
	Oxygen dependency (l/min prn or cont.)
	Minimal activity induces asthmatic attack
	Profound weakness due to hospital stay due to pneumonia
	At risk for further respiratory infection (esp. if in "flu season")
	Present weather conditions (high heat/humidity) exacerbate condition; requires air conditioned environment for optimum respiratory status
	Medical restrictions due to risk of post op infection
	Copious secretions- at risk for airway obstruction frequent suctioning of new tracheostomy

	Pain (include site(s) and intensity impedes mobility. (Pain medication impairs safety)
	Immunosuppression due to: chemotherapy, radiation, bone marrow transplant
	Profound weakness due to side effects of chemo/radiation (frequent N/V, diarrhea)
	With bone mets… at risk for pathological fractures
	Terminal status/ impending death
	With brain mets… impaired decision making capabilities

	Medical restrictions on activity due to (partial/non) weight bearing status
	Unsteady gait, poor balance S/P surgery
	Unable to navigate uneven terrain, stairs (specify #) into/out of home-- no elevators or ramps available
	Activity limited due to brace, cast, traction etc.
	Pain with minimal activity
	Activity restricted due to pain
	S/P Right/Left/Bilat AKA/BKA awaiting prosthesis
	Unable to use prosthesis due to: stump wound, size change, malfunction etc.
	New pathological fracture (osteoporosis) with severe pain and limited mobility

	For Foley Catheter also see any underlying reasons such as Alzheimer's, CVA, MS, para/quadraplegia, etc. (Foley alone does not support homebound status.)
	Fatigue from anemia due to Acute Renal Failure, CRF, ESRD; with or without dialysis
	Medically restricted to home to reduce exposure to infection
	Significant lower extremity edema requires activity restriction and elevation of LES

	Requires continuous feedings with non ambulatory pump
	At risk for infection due to immunosuppression
	S/P major surgery with medical restrictions
	Pain and weakness due to recent major surgery
	Pain and decreased mobility due to severe constipation/ fecal impaction
	New ostomy (specify)- patient fearful of lack of control of odors, leakage, noises

	Requires 24 hour care due to fluctuating mental status, confusion, combative state
	Unable to leave home unattended due to confusion
	Deteriorating mental status makes it unsafe for patient to leave home unsupervised
	Decision making capabilities are impaired
	Unsteady gait, dizziness, syncope
	At risk for falls due to shuffling gait
	Impaired neurological status
	Frequent seizure activity; requires supervision/assist of another

	Medical restrictions, site to be elevated
	Open wound with large amount of drainage
	Large open wound (size); at risk for infection
	Medical restriction -- non weight bearing status
	At risk for falls, further injury
	Movement restricted due to pain

	Unstable blood sugar levels, experiences severe fluctuations
	Blindness
	BKA/AKA
	Requires assist or assistive device due to neuropathy/ paresthesia in LES
	Activity restrictions due to diminished sensation/circulation in LES. Patient vulnerable to blisters or other breakdown on feet (esp. with history of) when ambulating >100 feet
	Severe SOBOE due to obesity