A 79-year-old woman is brought to the office by her daughter for a follow-up visit after a fall. Two days ago, her knees gave out while standing up from bed, and she fell to the floor. There was no loss of consciousness, and evaluation in the emergency department revealed no significant trauma. The patient has a history of frequent falls and has been prescribed a walker but does not use it consistently. Other chronic medical problems include hypertension, type 2 diabetes mellitus, osteoarthritis, and obesity. The patient uses oxygen therapy for idiopathic pulmonary fibrosis. She lives with her daughter and performs basic activities of daily living independently. The patient no longer drives; her daughter shops for food for her and takes her to family events and church services. Her daughter says, "I am working 2 jobs and am finding less time to care for my mother. I worry that she may fall again and break her hip. I have also found that sometimes she forgets to take her medications." Blood pressure is 156/80 mm Hg and pulse is 72/min. Gait is unsteady but no focal weakness or sensory loss is present. The patient's daughter would like to learn more about home health services for her mother. Which of the following conditions qualifies this patient for home health services?

Question

A 79-year-old woman is brought to the office by her daughter for a follow-up visit after a fall.  Two days ago, her knees gave out while standing up from bed, and she fell to the floor.  There was no loss of consciousness, and evaluation in the emergency department revealed no significant trauma.  The patient has a history of frequent falls and has been prescribed a walker but does not use it consistently.  Other chronic medical problems include hypertension, type 2 diabetes mellitus, osteoarthritis, and obesity.  The patient uses oxygen therapy for idiopathic pulmonary fibrosis.  She lives with her daughter and performs basic activities of daily living independently.  The patient no longer drives; her daughter shops for food for her and takes her to family events and church services.  Her daughter says, "I am working 2 jobs and am finding less time to care for my mother.  I worry that she may fall again and break her hip.  I have also found that sometimes she forgets to take her medications."  Blood pressure is 156/80 mm Hg and pulse is 72/min.  Gait is unsteady but no focal weakness or sensory loss is present.  The patient's daughter would like to learn more about home health services for her mother.  Which of the following conditions qualifies this patient for home health services?

Quizplus · Accepted Answer

Explanation: Home health services allow infirmed patients to receive skilled care at home. To qualify, individuals must have a serious illness or injury that makes leaving the home exceedingly difficult or taxing. Patients must also meet the criteria for being "homebound," which includes >1 of the following: Use of a supportive device (eg, crutch, cane, wheelchair, walker) for mobility Ability to leave home only with the assistance of another individual Medical contraindication to leaving home This patient meets the criteria for being homebound based on the use of a walker and her inability to leave home without her daughter's assistance. She would likely benefit from skilled care such as physical and occupational therapy and medication adherence assistance. (Choice A) Having a terminal disease with <6 months of life expectancy would qualify a patient for hospice services; terminal illness is not a requirement for home health services. This patient has no clear evidence of illness that is likely to result in death in a short time. (Choice B) This patient is homebound but able to perform basic activities of daily living. As such, she does not currently need nonskilled care (eg, bathing, grooming, dressing). This patient requires skilled care. (Choice D) Lacking support and having an overburdened caregiver are qualifications for a caregiver relief program, not home health services. Caregiver relief programs aid caregivers in the care of chronically ill patients. (Choice E) Patients who are not homebound can receive skilled care in the ambulatory setting and do not generally require (or qualify for) home health services. Educational objective: Patients are considered homebound if they use a supportive device (eg, walker, wheelchair) for mobility, are unable to leave home without another person's assistance, or cannot leave home due to a medical contraindication. Homebound patients generally qualify for home health services if leaving the home is exceedingly taxing or difficult. Common skilled home health services include physical and occupational therapy, medication compliance monitoring, and wound care.

A 79-Year-Old Woman Is Brought to the Office by Her