To receive home health benefits patients typically must be homebound – unable to leave the home without assistance. Being homebound can exacerbate already-present conditions: shortness of breath, mobility limitations and skin breakdown to name a few. All patients should be taught the following procedures - regardless of diagnoses.

1.    Coughing & Deep Breathing and/or Incentive Spirometry
2.    2-3 Isometric Exercises (adapted for the patient’s mobility limitations)
3.    How to Prevent Falls.
4.    Adequate Hydration.
5.    5 Symptoms that Require a Call to the HHA or Physician (to prevent an ER visit or Hospitalization).

1. Coughing & Deep Breathing and/or Incentive Spirometry

The Goal: The patient and/or caregiver can demonstrate effective coughing/deep breathing and/or spirometry use.

Such a small thing brings such big rewards! Anybody can do coughing and deep breathing (CDB) and it can be practiced anywhere anytime! CDB contributes to lifelong health!

And Medicare regards respiratory health as a critical indicator: M1400 Shortness of Breath has been included since the very first OASIS assessment in 1998. Respiratory health is so important that Medicare calculates your performance in Medicare Star Ratings. Keeping lungs healthy is a critical important step to management of health, recovery, preventing hospitalizations.

2. 2-3 Daily Isometric Exercises Adapted for Patient's Mobility 

The Goal: The patient and/or caregiver can demonstrate 2-3 isometric exercises and recall how frequently the exercises should be performed.

Isometric exercise is highly beneficial to the homebound patient because it doesn’t require the cardio-respiratory exertion (unlike aerobic or isotonic exercises), doesn't require equipment, and can be done anywhere and including in bed or in a chair. Since isometric exercises are done in a still (static) position, they can improve stabilization and help to progress to other types of strength training. Isometric training also contributes to cardiovascular health.

3. How to Prevent Falls.

The Goal: The patient and/or caregiver can recall and/or demonstrate how they will prevent falls.

One of our most important home health objectives is to teach patients how to avoid seeking emergency room care or a re-hospitalization, since Medicare punishes the provider who was providing services when the emergent care was performed. Falls are a top reason why patients seek ER care.

CDC Facts: https://www.cdc.gov/falls/data-research/facts-stats/index.html

1. One out of 10 falls results in an injury that causes the older adult to restrict their activities for a day or more or to seek attention from the healthcare system.1
2. Each year, there are about 3 million emergency department visits due to older people falls.2
3. Each year, there are about 1 million fall-related hospitalizations among older adults.2
4. In 2019, 83% percent of hip fracture deaths and 88% of emergency department visits and hospitalizations for hip fractures were caused by falls.3
5. Each year, nearly 319,000 older people are hospitalized for hip fractures.3
6. Falls are the most common cause of traumatic brain injuries (TBI)

The top reasons for falls?

1. Generalized weakness. 
2. Walking and balance difficulties.
3. Medications that cause drowsiness or weakness
4. Limited vision and poor lighting
5. Tripping hazards such as throw rugs and electrical cords 

4. Adequate Hydration.

The Goal: The patient/caregiver can recall how much water they should consume daily.

The benefits of adequate hydration cannot be overstated. If you consume 8x8oz glasses of water each day you already know the benefits of adequate hydration: more energy, better sleep, less muscle pain, reduced fatigue, regulated GI system, prevention of UTIs, kidney stone prevention, fewer headaches, healthier heart. 

5. 5 Symptoms that Require a Call to the HHA or Physician (to prevent an ER visit or hospitalization).

The Goal: The patient/caregiver can recall 5 symptoms that will prompt a call to the HHA.

The 2010 Affordable Care Act introduced an initiative to address the problem of excessive readmissions. The Hospital Readmission Reduction Program (HRRP) imposes financial penalties (as much as 3% of total annual Medicare inpatient operating expenses) on hospitals with rates above the national readmission-rate average.

In the eyes of any payer - Medicare, Medicaid, commercial payers included - a re-hospitalization SUGGESTS poor care... 'Why was the patient discharged in the first place if they now need to be re-hospitalized?'

Focus on FIVE (5) of the most important symptoms related to the patient's most serious condition for which the patient is receiving home health services. For example - for wound or catheter, ANY amount of related pain, foul smell or discharge or change in mental status. For cardiac or respiratory conditions, any amount of unexpected shortness of breath or chest pain.

As part of your routine visit protocol, remind the patient/caregiver to recall the list of 'alertable' symptoms at every visit. Reinforce the need to be vigilant with reporting any new or unusual symptoms. Reinforce the HHA's desire to implement EARLY INTERVENTION to avoid hospitalization.