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Home Health: Legal Definition of Homebound, Agency Is Ordered To Serve Quad Patient
Legal Eagle Eye Newsletter for the Nursing Profession
Quick Summary: This patient is a quadriplegic who uses a motorized wheelchair. By law he is homebound and is eligible for home health benefits.
The Medicare statute says an individual is considered to be confined to his home if the individual has a condition, due to illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device (such as crutches, a cane, a wheelchair or a walker) or if the individual has a condition such that leaving his or her home is medically contraindicated.
While an individual does not have to be bedridden to be considered confined to his home, the condition of the individual should be such that there exists a normal inability to leave home, that leaving home requires a considerable and taxing effort by the individual, and that absences of the individual from home are infrequent or of relatively short duration, or are attributable to the need to receive medical treatment.
UNITED STATES DISTRICT COURT, HAWAII, 1999.The patient’s home health agency notified him his services were being terminated. He protested, and then filed a lawsuit in Federal court. In his lawsuit he claimed his discharge from Medicare home care was motivated by financial considerations. Caps on per-patient Medicare home health benefits were part of the Balanced Budget Act of 1997. The patient believed his home health agency wanted to discharge him as a Medicare client, then re-assume his care as a Medicaid patient, which he believed the agency believed would be more profitable for the agency.
The ostensible reason given the patient for his discharge from home care was that he was no longer "homebound" or confined to his home, and thus no longer eligible for Medicare home health benefits.
The U.S. District Court for the District of Hawaii ruled the patient had valid grounds to sue his home health provider for discharging him under a wrongful pretext. The court ordered the agency to continue serving the patient.
First, a home health client, as a disabled person, can sue any Federally-funded agency that discriminates on the basis of disability, under the Rehabilitation Act of 1973.
Second, just because the patient had been seen on occasion out of his home did not mean he was not a "homebound" person or confined to his home as that is defined by law for Medicare home health eligibility.
He was a forty year-old quadriplegic from an auto accident. He could not leave his bed or his home without the aid of at least one other individual. It took considerable effort to transfer him from his bed to his wheelchair.
Nor could he leave his home without his powered wheelchair. Leaving home required a considerable and taxing effort, that is, it took him one and one-half hours of preparation just to get ready leave his home for a visit to his doctor.
And his absences from home were infrequent and of relatively short duration. In the court’s judgment, he fit the legal definition of a "homebound" individual or person confined to his home.
The court further determined that being denied home health care posed a serious threat to this patient’s physical and psychological well-being. The court was convinced the legal criterion of irreparable harm was present as is needed for a court to issue an injunction in one party’s favor. Morris v. Hospital, 37 F. Supp. 2d 1181 (D. Hawaii, 1999).