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What to Do When Patients are Not Appropriate for
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 following criteria:

  1. Patients' clinical needs can be met at home.
  2. Patients can care for themselves or they have a paid or voluntary primary caregiver.
  3. 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 their families.
     
  • 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 care services.
     
  • 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 patient's chart.
     
  • 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' charts.
     
  • 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 patient.
     
  • 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.)

Copyright, 2002.
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
Office: 301-421-0143
Fax: 301-421-1699
E-mail: ehogue5@comcast.net