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Definition of Homebound / Housebound
In simplified terms, being homebound or housebound means an individual is unable to leave their home without difficulty. And due to this difficulty, generally does not leave their home. It is usually due to advanced age, illness, or a disability. Both Medicare and the U.S. Department of Veterans Affairs (VA) use homebound / housebound status as eligibility criteria to receive specific services, such as in-home care or increased pensions.
Medicare more commonly refers to this status as homebound, while the VA more frequently calls it housebound. However, for the sake of this article, the words will be used interchangeably. Each organization has its own criteria for determining homebound status, which will be discussed in much greater detail below.
Did You Know?
There are over 500 programs that help seniors who cannot afford their cost of care.
Importance of Homebound / Housebound Designation
Having a formal designation of homebound determines if an elderly individual will be able to receive certain types of care or financial assistance from Medicare or the VA.
Medicare’s Home Health Services
In order to receive home health services via Medicare, a physician must determine a senior to be homebound. These home health services include periodic skilled nursing services (such as injections, injection instructions, tube feedings, catheter changes, and wound care), physical therapy, as well as necessary medical equipment. Make note, one is able to receive hospice services without a determination of being homebound.
VA Housebound Allowance
The VA uses a housebound status as the major determining factor for a veteran (or surviving spouse) to receive the Housebound Allowance. This allowance is added to the pension of veterans who have a permanent disability. But the disability does not need to result from their military service, it can be a disability that results from the natural aging process. The pension provides additional monetary compensation for housebound veterans, above and beyond their regular monthly pension.
VA Skilled Home Health Care (SHHC) Services
A senior veteran may receive Skilled Home Health Care Services based on a housebound status. This short-term care program provides an individual help with activities that are associated with daily living, such as grooming, dressing, mobility, meal preparation, and medication management. Case management and nursing services may also be provided.
Criteria to be Homebound / Housebound
Medicare and the VA use different criteria when determining if an individual is homebound, as indicated below.
Medicare’s Homebound Criteria
With Medicare, there are two criteria that must be met in order for a senior to be designated as homebound.
- First, one must be unable to leave their home without assistance, whether that assistance is from another person or from mobility equipment, such as a wheelchair or a walker. OR the individual’s physician believes the individual’s condition will decline if he or she leaves their place of residence.
- The second criteria is that it is problematic for one to leave their home and leaving home requires considerable effot. It is one’s physician who makes the determination if one meets the criterion to be labeled as homebound.
It is important to note that one is still able to leave their house for certain conditions without jeopardizing their homebound status. For instance, one can leave their home to attend church, seek medical attention, go to adult day care, attend a funeral, or go to a family event.
Department of Veterans Affairs’ Housebound Criteria
In order for a veteran or their spouse to be considered housebound, one must be eligible for community care and meet the clinical criteria for the service.
To be eligible for community care, a veteran need meet only one of the following six criteria:
- Need a service not available at a VA medical facility
- Live in a U.S. state or territory without a full-service VA medical facility
- Qualify under the Grandfather provision related to distance eligibility for VCP
- The VA cannot provide are within certain designated access standards
- It’s in the veteran’s best medical interests
- A VA service doesn’t meet certain quality standards
Make note, the disability does not have to be service related. In most cases, housebound status is determined based on medical records following an examination by a private doctor or nurse practitioner, instead of a medical professional that works for the VA.
Specific Reasons for Homebound / Housebound Determination
A variety of issues may be cause for qualification including mental problems, like anxiety and depression, as well as a number of physical illnesses, such as cancer, diabetes, heart conditions, and late stage Parkinson’s disease.
There are also a variety of reasons a senior might receive a homebound status when it comes to Medicare. For instance, a senior who has had a stroke and requires a wheelchair, or who is unable to walk without a walker, may qualify as being homebound. A senile elderly individual who is unable to leave his or her home without help from someone else is another example of someone who may be considered homebound. However, make note, while a diagnosis of Alzheimer’s disease or a related dementia will not qualify one for homebound status, the symptoms of moderate to severe Alzheimer’s disease might be cause for qualification.