Diagnosis Related Homebound Statements

DIAGNOSIS RELATED HOMEBOUND STATEMENTS

©2014 Kathy Quan RN BSN ALL RIGHTS RESERVED

PLEASE NOTE:   CMS released new guidelines that took effect November 19, 2013. Please be sure to read the rules carefully. There are MUSTs to follow. The information on these pages will help guide to you to comply with these new guidelines. 


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. 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

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 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

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
  • 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
  • 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

NEXT SKILLED NEED

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