The number of people age 85 or older will grow the fastest over the next few decades.
With the elderly population growing at record levels, much research is being done to figure out the best solutions to meet this group’s health care needs.
According to a Congressional Budget Office (CBO) report, by 2050, one of every five Americans will be categorized as a senior (age 65 or older). The number of people age 85 or older will grow the fastest over the next few decades, comprising 4 percent of the population by 2050. A surge in the elderly population brings with it a corresponding spike in the number of elderly people with functional and cognitive limitations. Functional limitations are physical problems that limit a person’s ability to perform routine daily activities, such as eating, bathing, dressing, paying bills, and preparing meals.
Cognitive limitations are losses in mental acuity that may also restrict a person’s ability to perform such activities. On average, about one-third of people age 65 or older report functional limitations of one kind or another; among people age 85 or older, about two-thirds report functional limitations.
Home health care has risen as one possible solution.
“Government programs that assist frail elderly people, such as Medicaid, have experimented with several different models of health care financing and delivery,” the report states. “One major change has been the gradual shift to providing care to people as they continue to live in private homes rather than in institutional settings.”
To 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.
Home health nurses identify individual needs, coordinate available resources and set up a plan that will allow many elderly patients to stay in their homes safer and longer.
Physicians see it all the time: High-needs elderly patients who don’t qualify for skilled care, but who have complex conditions that may compromise their health and safety at home. These patients often have one or more caregivers, but their basic medical needs still go unmet. The solution? Management and Evaluation (M&E) services offered under the home health care benefit.
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