What to Do When Patients are Not
Home Health Care Services
By Elizabeth E. Hogue, Esq.
Some patients are referred inappropriately for home care services.
Patients are appropriate for home care services, if they meet the
- Patients' clinical needs can be met at home.
- Patients can care for themselves or they have a paid or
voluntary primary caregiver.
- Patients' home environment supports home care services.
Only patients who meet all three of these criteria are
appropriate for home health care services.
Agencies must develop appropriate policies, procedures and practices
to control admission of patients so that patients who are inappropriate
for home care services are not admitted in the first place. Here are
some of the steps agency staff members must follow in order to
accomplish this goal:
- Staff must clearly state to patients and their families upon
arrival at patients' homes for the initial visit that, as a matter
of agency policy, no decision will be made about whether to admit
the patient until after an assessment has been completed. Staff must
document that they explained this agency policy to patients and
- If the assessment indicates that patients are not appropriate
for home care services, staff must immediately inform the patient
and/or family that the patient will not be admitted. They must also
notify the patient's attending physician and the referral source and
document that they have done so.
- If a patient who the agency is not going to admit needs
immediate attention, staff must call an ambulance to transport the
patient to the hospital. If the patient refuses transport by
ambulance to the hospital, staff must document this fact. When
patients agree to be transported to the hospital, staff must call
the hospital to tell them that the patient will not be admitted to
home care if the patient is not admitted. Staff must also document
this communication with hospital staff members.
But suppose patients who have already been admitted and received care
become inappropriate for further home care services? What steps should
agencies take to terminate services to patients?
- Staff must include specific documentation in the patient's chart
about why the patient is no longer clinically appropriate for home
- A case conference must be held to determine whether the patient
is no longer appropriate for home care services and, if not, what
constitutes reasonable notice prior to discontinuation of services.
The results of the case conference must be documented in the
- If the team decides at the case conference to discontinue
services, the patient and/or primary caregiver and the patient's
attending physician must be notified of the results of the case
conference both verbally and in writing. Documentation of verbal
notice and copies of written notices must be included in patients'
- Written notice should be hand-delivered to patients' homes. It
is desirable, although not essential, to obtain a signature from the
patient or family member upon receipt.
- Participants in the case conference should also decide whether
it is likely that the patient will suffer injury as a result of
termination of services. If so, an ambulance should be sent to the
patient's home on the date of termination to transport the patient
to the nearest hospital. If necessary, expenses of transport by
ambulance should be paid by the agency.
- Staff should determine whether the patient accepted transport to
the hospital and document this determination in the patient's chart.
If the patient accepted transportation, staff should notify the
emergency room of the hospital that the agency will not readmit the
- If the patient did not accept transport, the patient's attending
physician should be notified of this fact and notification should be
documented in the patient's chart.
- Staff should then make written reports to protective services
agencies, as appropriate and include a copy of the written report in
the patient's chart.
Patient who are discharged from care because they are no longer
appropriate for home care services should not be readmitted to the
agency unless a case conference is held during which participants
conclude that, without a doubt, the patient is again appropriate for
home health services.
Agencies that follow the guidelines described above will have taken
key steps toward the protection of the organization and its staff
members from legal liability.
(To obtain a complete set of policies and procedures governing
termination of services, send a check for $105.00 that includes shipping
and handling to Elizabeth E. Hogue, Esq. at the above address.)
Elizabeth E. Hogue, Esq.
All rights reserved.
No portion of this material may be reproduced in any form
without the advance written permission of the author.
Elizabeth E. Hogue, Esq.
15118 Liberty Grove
Burtonsville, Maryland 20866