Mrs. Smith Case

Few years ago, Mrs. Smith, a 74-year-old woman, was referred to our health care center after a debilitating stroke affected her left side. Mrs. Smith was admitted under home health after running out of Medicare allowable days at a skilled nursing facility. Mrs. Smith needed considerable assistance with all activities of daily living and was primarily wheelchair-bound due to her inability to walk independently. She lived with her 80-year-old husband Mr. Smith, who was also not in the best of health. Due to financial constraints the couple opted against long-term or assisted living placement in favor of their trailer home. Mrs. Smith demonstrated good rehabilitation potential and progress with all her home health services.

One day, approximately two after her return home from the nursing facility, Mr. Smith suffered a massive heart attack. He was hospitalized and underwent cardiac catheterization. It indicated diffuse blockage of multiple vessels and he was deemed a poor candidate for surgery. Subsequent medical interventions were primarily conservative with a poor prognosis. He was later transferred to a nursing home. Mrs. Smith obviously was very concerned and depressed about the situation. She was devoted and would visit Mr. Smith for four to six hours every day at the nursing home after being driven there by her friends and family. No one could persuade Mrs. Smith to avoid the exertion. She would simply want to be with her husband in his critical times.

Soon after her husband's admission to the nursing home, Mrs. Smith began to have difficulty keeping up with her appointments with the doctors at our health care center and the other home health providers. Medicare's guidelines for clients to receive home health under Insurance Plan require them to meet certain "homebound" criteria. The Center for Medicare and Medicaid Services describing homebound status states that, "there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort. If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment”. This issue was brought to my attention and I was asked to advise the course of action for Mrs. Smith’s treatment.

As per organizational requirements (Medicare's as the regulatory and the home health agency as the regulated body), Mrs. Smith was clearly homebound

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