Welcome to our frequently asked questions:
Q: How does home health care service begin?
A: A physician, patient or family member can initiate service. However, Medicare, Medicaid and most insurances require physician oversight. Once the physician prescribes home health care, he/she authorizes a coordinated treatment plan, commonly called a "plan of care," and periodically reviews services and the patient's progress. If a physician does not prescribe home health care, but the individual still desires services, a private duty agency can suggest a plan of care to meet a wide variety of needs and budgets. While some insurances may pay for private duty services, typically, they are an out-of-pocket expense.
Q: What qualifies one to receive home health services?
A:To receive home health services, the person receiving care must be HOMEBOUND. The definition of HOMEBOUND per the Medicare Act, that all insurances enforce reads as follows: An individual shall be considered to be "confined to his home" if the individual has a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device (such as crutches, a cane, a wheelchair or a walker), or if the individual has a condition such that leaving his or her home is medically contraindicated. While an individual does not have to be bedridden to be considered "confined to his home", the condition of the individual should be such that there exists a normal inability to leave home, that leaving home requires a considerable and taxing effort by the individual.
Q. What are some examples of homebound patients?
A. Some examples of homebound patients that illustrate the factors used to determine whether a homebound condition exists include:
1. A patient recently paralyzed from a stroke who is confined to a wheelchair or requires the aid of an assistive device in order to walk;
2. A patient who is blind or senile and requires the assistance of another person to leave his/her residence;
3. A patient who has lost the use of his/her upper extremities and, therefore, is unable to open doors, use handrails on stairways, etc., and requires the assistance of another individual to leave his/her residence;
4. A patient who has just returned from a hospital stay involving surgery suffering from resultant weakness and pain and, therefore, his/her actions may be restricted by his/her physician to certain specified and limited activities such as getting out of bed only for a specified period of time, walking stairs only once a day, etc.;
5. A patient with arteriosclerotic heart disease of such severity that he/she must avoid all stress and physical activity; and
6. A patient with a psychiatric problem if the illness is manifested in part by a refusal to leave home or is of such a nature that it would not be considered safe to leave home unattended, even if he/she has no physical limitations.
Q: I have a family member who has trouble walking, but refuses to use a walker or cane?
A: This is a situation many family members run into. What I have noticed is that sometimes, it is best to bring the family member to a physical therapist or have a physical therapist come to your home, so he or she can hear the message from a non-family member and a health care professional. The therapist will evaluate the client by doing various fall risk assessments and will then recommend the most appropriate assistive device. I've also heard many patients complain that a walker/cane makes them feel 'too old' so then, I will take the opportunity to suggest a rollator walker. I emphasize that this is an 'exercise device' that allows them to walk quickly and increase their distances, otherwise the legs will get progressively weaker. Allow the client to first use the rollator walker in private so that his/her confidence develops and he/she becomes more comfortable with the device. Also, emphasize to the client that a rollator walker is no different than going to the grocery store and using the cart.
Q: How long does it take to remove surgical staples?
A: Surgical staples are small, sterile metal staples developed for use in place of traditional suturing to close a surgical wound and is more consistent and less time-consuming than suturing. Once a wound has healed, surgical staples can be removed by a physician, nurse or physic...al therapist, using a specialized and sterile staple remover. Staples are usually removed after 10 to 14 days of surgery. Removal is a quick process and should take no more than a few minutes for an average-size wound. Removing surgical staples is a relatively painless process, often described as a "tugging" sensation, though the removal process may cause more discomfort in traditionally tender areas. Sedation is not usually required. When surgical staples are used to close a wound, it's important to keep the stapled area clean to avoid infection. The stapled area should be kept dry. Staples should not be removed by anyone other than a trained medical professional.
Q: Can you tell me what I should eat while I am taking warfarin (Coumadin)? What foods should I avoid?
A: Warfarin is a blood-thinning medication that helps treat and prevent blood clots. There is no specific warfarin (Coumadin) diet. However, certain foods and beverages can make it so warfarin doesn't effectively prevent blood clots. It's important to pay attention to what you eat while taking warfarin.
One nutrient that can lessen warfarin's effectiveness is vitamin K. It's important to be consistent in how much vitamin K you get daily. The average daily allowance of vitamin K for adult men is 120 micrograms (mcg). For adult women, it's 90 mcg. While eating small amounts of foods that are rich in vitamin K shouldn't cause a problem, avoid eating or drinking large amounts of:
- Brussels sprouts
- Collard greens
- Mustard greens
- Green tea
Certain drinks can increase the effect of warfarin, leading to bleeding problems. Avoid or drink only small amounts of these drinks when taking warfarin:
Talk to your doctor before making any major changes in your diet and before starting any over-the-counter medications, vitamins or herbal supplements. If you are unable to eat for several days or have ongoing stomach upset, diarrhea or fever, consult your doctor. These signs and symptoms may mean you need a different dose of warfarin.