So, people call me. They email me. I get the occasional comment on my blog. These are the ‘little things’ that make me useful to the home health community. I am aware of what is going on at the front lines of our industry. Usually, I can answer questions. Sometimes, I take a while and look things up. But sometimes, I get stumped. that’s when I turn to y’all.
In the past several weeks, I have had calls about two patients. Both are men. Both have been referred to clients. The question is the same for both of them. Do they meet the homebound status requirement?
Patient 1:
This is a man who drives a car. Not every day but at least weekly. It is a smaller economy car that gets ideal gas mileage. I sincerely hope that if this were all that you knew about the patient that you would declare him ineligible for services in a heart beat.
However, this gentleman weighs 400 pounds. He cannot get in the car by himself; nor can he get out of the car by himself. He just likes to drive and sit by the lake while his wife works. If he had to, he could drive up to the ER but then someone would have to come and get him out of the car. Fast food is available as are banks and dry cleaners who offer in car service. He cannot buy gas unless someone else pumps it for him, go to the MD’s office or outpatient therapy. In fact, he was at outpatient therapy for a while. His wife would get him in the car somehow and the therapy employees would get him out. At some point, it was deemed to dangerous for them to do that in the black asphalt parking lot.
I have a lot of issues with this patient besides homebound status. Blood clots seem a very real possibility. It is rumored that he pees in a jar. I am having a hard time imagining that he can do this without some spillage. So, now I have immobility, acidic urine and obesity threatening this patient. I get all that.
But, is he homebound?
Patient 2:
This patient has dementia with episodes of moderate confusion. Like the patient above they drive. They are not supposed to drive. Everyone knows that this is dangerous to the patient and to the community but no one has taken his keys away from him, yet.
Again, I have real issues with this. If the family is okay with him risking his life, that is up to them. I am not okay with his risking someone else’s life because they don’t want to take away the car keys. But it isn’t my feelings that we are assessing here.
I suggested that they approach the MD to get a medical restriction on his license and let him be the bad guy. But what should happen is again, not the question.
Is this patient homebound?
What do you think? Email me or comment below. I will share my thoughts after I hear some of yours.