Diagnosis Related Homebound Statements

DIAGNOSIS SPECIFIC DOCUMENTATION OF HOMEBOUND STATUS

©2009-12 Kathy Quan RN BSN ALL RIGHTS RESERVED

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 and/or ADL/IADL categories

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

HIV/AIDS

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

CARDIOVASCULAR (i.e. MI, CHF, Hypertension, Unstable Angina, PVD, CVA/TIA)

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

PULMONARY (i.e. Pneumonia, Bronchitis, COPD, Asthma, Tracheostomy care)

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

CANCER (general considerations)

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

MUSCULOSKELETAL (Fractures, Joint Replacement, Arthritis, Amputations)

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

RENAL/GU (Foley catheters, ARF, CRF, ESRD, Kidney transplant)

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


Remember: homecare nurses DO NOT deal with dialysis issues!

GI (Altered feeding routes: TPN, NG, G-Tube; Ostomy, Constipation/Fecal Impaction)

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


NEURO (Seizures, Dementia, Alzheimer's, Parkinson's)

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

INTEGUMENTARY (Decubs, Venous/StasisUlcers, Wounds)

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

ENDOCRINE (Diabetes)

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

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