‘Homebound’ for Aging Adults: What to Expect?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

You may have heard the term “homebound” in two situations. One is if you are interested in qualifying for Medicare home health benefits. The other is if you are a veteran who is applying for specific programs to assist with care.

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The concept of being homebound plays an important role in determining benefits because if you can’t leave your home, there must be compelling reasons why. For most of us, leaving our home to drive to work, visit friends, or go shopping is a normal part of everyday life. Most older people wish to age in place, which means they and their families need to arrange and accept assistance in the home.

As people age, they can decline due to exacerbation of a chronic medical condition or an accident like a fall. The inability to leave your home without significant assistance implies that you have a serious enough condition to qualify for help. However, being homebound is just one of the criteria necessary for Medicare to pay for home health or qualify for VA benefits.

Definition of Being ‘Homebound’ for Older Adults

If you are not a veteran and need home health services, your physician will need to certify that you are “homebound” for Medicare to pay. Home health care is time-limited and includes nursing, physical and occupational therapy, and aides to assist with activities of daily living.

Medicare definition of homebound

First, your physician must write in an order for home health services. As part of that process, indicate that you meet homebound status. Being homebound does not mean you are confined to your residence without the ability to leave if you need to. Medicare allows for special circumstances, but in general, these are the criteria one must meet for homebound status:

  • You need significant assistance such as a walker, wheelchair, crutches, and help from another person to leave your home. Or your physician thinks that leaving your home could worsen your condition or illness that qualifies you as homebound.
  • It is challenging to leave your home, and you typically do not do so—including driving.
  • You can leave your home for short time periods necessary for medical appointments, religious services, adult day care, and special family events such as a graduation or funeral.
  • If you regain the ability to leave your home independently, you may no longer qualify under Medicare for home health care.

VA definition of homebound

The Veterans Affairs definition of homebound is similar but uses a disability formula to determine homebound status. A veteran or their spouse is homebound if they receive a 100 percent disability rating from the VA, but the disability does not have to be service-related.  The disability must be permanent. The older veteran has to demonstrate that they are unable to leave their home. Medical records can determine homebound status after the examination from a physician.

Examples of Being a Homebound Older Adult

In thinking of examples of being a homebound older adult, it can be helpful to think about conditions and situations that contribute to someone not being able to leave their home. Some examples will include sudden unexpected accidents, and others will result from gradual decline. Being homebound can be temporary or permanent.

Falls

More than one in four older adults falls each year. Many people break a hip or another bone requiring hospitalization and rehab. Depending on the severity of the injury and a person’s ability to recover, many come home requiring significant assistance. Until an older adult  regains the ability to manage stairs, drive and perform activities of daily living, they will remain homebound.

Chronic medical conditions

If you are an older adult with a chronic medical condition, you may be managing well. For others, increasing age, decreased strength, and mobility can contribute to difficulty remaining independent. Examples include congestive heart failure, diabetes, kidney failure and dialysis, neurological conditions like Parkinson’s and COPD.

Dementia and depression

Dementia and Alzheimer’s disease can cause significant problems with judgment and reasoning. Of particular concern is driving and wandering. People with dementia start to lose their ability to drive safely or wander outdoors and get lost. Mental health issues like depression can worsen chronic medical conditions, and a vicious cycle leads to increasing isolation and challenges with physical recovery. 

COVID

The risk of getting infected with COVID keeps many older adults at home more than usual. Unless someone is diagnosed with COVID, it is unlikely they will meet the homebound requirement under Medicare. 

What Can You Expect When a Loved One Is Considered Homebound?

When you have a loved one who is homebound it can be a shock. The amount of care and tasks that someone needs daily can add up. You may be overwhelmed by increasing caregiving duties to keep your loved one functional and safe.

Resources like home health are limited to a few times a week, leaving gaps in care. If your aging loved one lives alone, the challenges are even more significant because there isn’t a spouse or partner to help and support them.

Transportation needs

When your loved one is homebound, they can’t leave the house without your or someone else’s assistance. In practical terms, you will want to think about getting them to doctor’s appointments, shopping, and other important places. If your loved one is accustomed to going to the senior center or church services, they will miss those activities. 

Grocery shopping

Shopping for food will become a priority so that your loved one will have groceries. Many families turn to grocery delivery services for help with this task.

Medication management

Your loved one may be accustomed to picking up and managing their medications independently. Their being homebound makes it difficult for them to continue on as normal and may require your help.

Household maintenance needs

Taking care of a home requires effort, organization, and the physical ability to keep things clean and safe. Everything from housekeeping, lawn care, home repairs, snow removal are some of the household tasks that your loved one may no longer be able to do now that they are homebound. 

Activities of daily living

Home health care can generally offer an aide up to three times a week to help your loved one with bathing, dressing, walking, toileting, and grooming. But that leaves a lot of time when your loved one may not be able to do some of those tasks independently. Either family or other caregivers will need to help.

Mental health concerns

Isolation is not good for anyone, and for an older adult who lives alone and can’t get out, the consequences can be grave. Increasing symptoms of depression and anxiety are typically associated with isolation.

Resources for Caregivers or Family of Homebound Loved Ones

There are resources available for caregivers or families of homebound loved ones, and what works for you may depend on finances and/or availability. Try to be patient as you may end up going through trial and error to find the best combination of resources.

Home health

If your loved one is homebound due to illness, a decline, or accident, they may qualify for home health through Medicare. Although time-limited, the benefits may be enough to get your loved one back to being independent. Ask your loved one’s physician for an order for home health. Be aware, however, that aides through home health can’t do housework, cook meals, or provide transportation.

Home care

Home care caregivers are paid by the client privately but can help with tasks like bathing, dressing, shopping, cooking, companionship, and transportation. That said, in most states, they are legally unable to administer medications or perform any medical tasks.

Hiring in-home caregivers through an agency can relieve family caregivers of many day-to-day tasks if finances allow. Home care caregivers can do some minor cleaning, but they will not do deep cleaning or yard work. Every state dictates the tasks that home care caregivers can perform, so inquire about the specific duties you need.

Adult day care

Adult day cares are centers that help older adults who need supervision and some help with activities of daily living. Adult day care can be a good choice for your loved one if they have dementia and need extra care. Centers vary in what they provide, but generally, they offer meals, snacks, activities, and some health-related services.

Medication delivery service

More and more aging adults are setting up and relying upon delivery services to get their medications. DevvyDOSE and Amazon are just two of the companies that do mail-order medications. Often, your local pharmacy will have delivery, but you may still have to set up the pills in a weekly medicine dispenser.

Home meal delivery services

There are so many options for home meal delivery services available these days. You can have meals delivered to your loved one’s address and have a choice of pre-cooked meals or ingredients only. Meals on Wheels is another option for meal delivery. With Meals on Wheels, they ask that said recipient be unable to head outside to eat and is otherwise challenged by shopping and cooking.

Senior transportation

Most larger communities have a senior transportation system to take older adults to healthcare appointments. Specific criteria might apply. Eldercare Locator is the best place to see if transportation is offered in your area. 

Assisted living respite

Caregiving for an aging adult who is homebound can be stressful and time-consuming. Everyone needs a break now and then, but how can you leave your loved one alone? One possible resource is respite care in assisted living.

The way this works is that you arrange for a few days’ stay for your loved one in a fully furnished room in assisted living and pay a per-day rate. All of the services and care needed are provided during that stay. Most assisted living communities have a time limit of about a week to ten days.

Other resources

Other local resources include faith-based and aging services resources. Most local aging services departments can direct you to other supports for someone who is homebound. Use Eldercare Locator to find the office nearest you. Other resources include lawn care and house cleaning services. 

What Does Homebound Mean for an Aging Adult?

Being homebound does not mean having to be helpless. You as a caregiver and your loved one can work towards more independence while taking advantage of the support and resources available. 

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