Does Your Patient Meet the Criteria for Homebound?

Questions, Referring to Home Health

Medicare Homebound PatientsTo qualify under Medicare for home health nursing and therapy services, Medicare requires that a patient be homebound (not necessarily bedbound). Your patients meet the Medicare requirements for homebound if:

  • They cannot leave home without “considerable and taxing effort.” Most patients have an injury or illness that makes it difficult to leave home.
  • They cannot leave home without help, such as the aid of supportive devices, special transportation, or the assistance of another person.
  • They leave home primarily for medical treatment that cannot be provided in the home (such as dialysis). They may also receive therapeutic, psychosocial, and medical treatment at a certified adult day care program.
  • They occasionally leave home for non-medical purposes with the absence being “infrequent and short in duration.” Some examples include attending a religious service or a special family event, taking a walk around the block, and getting a haircut.

Remember, a patient does not need to be bedridden to be considered confined to the home.

Homebound criteria applied to psychiatric patients:

  • Illness is manifested by a refusal to leave the home (e.g., severe depression, paranoia, agoraphobia).
  • Due to illness it would be unsafe for the patient to leave the home (e.g., hallucinations, violent outbursts).

NOTE: Psychiatric patients may have no physical limitations.