Diagnosis Related Homebound Statements

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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 home care and for reimbursement. Any additional data you can provide such as photographs, measured changes and statements of where the patient was functionally prior to this episode of illness will help to paint a picture of his decline and justify the need for home health care. Your OASIS data must also serve to substantiate the homebound status, especially in the functional limitations and/or ADL/IADL categories.

Remember these will likely be TEMPORARY and your documentation should include changes as they occur such as learning to adjust and navigate with recent blindness, improvements in function post stroke, recovery from recent URI, healing from fractures or joint replacement, etc. The skilled need should also help to support the homebound status. Documentation of measurable gains reinforces it, and as patient becomes independent - the need to discharge becomes evident.
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The following phrases can be included in your documentation to support the homebound status - adjust them to fit the unique situation for your patient:

CARDIOVASCULAR (i.e. MI, CHF, Hypertension, Unstable Angina, PVD, CVA/TIA)
  • Cardiac restrictions due to unstable angina
  • Experiences angina even at rest
  • Experiences angina with minimal activity
  • Poor endurance, experiences SOB with minimal activity; takes 15-20 minutes to recover
  • Experiences SOB at rest
  • Able to ambulate only short distances (20 ft. or less) before experiencing SOB, angina
  • Oxygen dependency (specify PRN or continuous and flow rate)
  • 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
  • Severe weakness and deconditioning due to exacerbation of cardiac symptoms
  • Frequent syncopal episodes with mild exertion

PULMONARY (i.e. Pneumonia, Bronchitis, COPD, Asthma, Tracheostomy care)
  • SOB at rest
  • Must rest 15 minutes after ambulating 25 feet
  • Respiratory distress with minimal activity or speaking
  • Oxygen dependency (l/min prn or cont.) - document pt's O2 SATs on room air and on oxygen (settings)
  • Minimal activity induces asthmatic attack
  • Profound weakness/deconditioning due to hospital stay due to pneumonia, COPD, etc.
  • At risk for further respiratory infection (esp. if in "flu season")
  • Present weather conditions (high heat/humidity or extreme cold rain/snow/wind) 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
  • Aspiration risk due to secretions

  • 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 - Risk for falls
  • 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 or learning to use
  • Unable to use prosthesis due to: stump wound, size change, malfunction etc.
  • New pathological fracture (osteoporosis, Cancer) 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/quadriplegia, etc. (Foley alone does not establish 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: home care 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 (should be very emporary situation!)

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)
  • Open wound (where) with large amount of drainage
  • Large open wound (size); at risk for infection
  • Medical restriction -- non weight bearing status due to wounds, decubs, ulcers
  • At risk for falls, further injury
  • Patient vulnerable to blisters or other breakdown on feet (esp. with history of) when ambulating >100 feet
  • Movement restricted due to pain

ENDOCRINE (Diabetes)
  • Unstable blood sugar levels, experiences severe fluctuations without warning causing lightheadedness, dizziness, confusion
  • Blindness (newly acquired)
  • BKA/AKA - DME required ie.e wheelchair, walker, crutches
  • 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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