Home Safety Evaluation: Can I send this patient home?

Add to Favorites
Collapse All

Home Safety Evaluation: Can I send this patient home? - #22

Take Quiz

How will a home safety evaluation benefit your geriatric patient?

Assessment

What is a Home Safety Evaluation?

A Home Safety Evaluation is an assessment of a patient’s home living environment with a goal of increasing the safety of the home for the elderly person who resides there.  It is an attempt to obtain the best “patient and environmental match” to help minimize injury to the patient while in the home.  An occupational/or physical therapist visit and assess the home and patient, looking for aspects of the home that may be unsafe/less safe for the particular elderly individual.  These aspects are identified and noted in a report to the patient/family and referring provider, with suggestions for changes in the home also reported.

Possible safety hazards may include:

Kitchen Bathroom Bedroom Walkways
Stove Low toilet height Low bed height Stairs
Slippery flour Slippery floor Throw rugs

Throw rugs
Multi-tasking Bath mat Thresholds Thresholds
Reaching high cabinets No tub grab bars/ No bath bench Dim lighting Dim lighting
Low chair height Dim lighting Low chair height Dim Lighting
Spoiled food in refrigerator Humidity: meds break down    

 

Who benefits from a Home Safety Evaluation?

Patients who have losses in any of the 4 patient domains listed below are at risk for injury in the home.  Assessing your patient’s physical and cognitive state, as well as physical functioning and available social support is needed to identify risk for a possible “patient & environment mismatch”.

Domain Physical Cognitive Functional Social

Area

of

Weakness

 Sensory loss: vision/hearing Dementia Arthritis Low social support
Parkinson's disease Delirium Osteoporosis Decreased finances
End-stage CHF, COPD Depression Poor gait & balance Poor transportation
Polypharmacy   Muscle weakness Possible self-neglect

 

How does a Home Safety Evaluation get ordered and reimbursed?

A home safety evaluation must be ordered by the physician or primary provider.  Payment is made to the home health care agency that employs that occupational/physical therapist who conducts the assessment.  Medicare part B is the primary payer for the service if the patient is eligible for Medicare.  If the patient does not have Medicare, then their primarily medical insurance is billed, with the patient providing payment in the case of an insurance payer denial.

Context

Geriatric patient in the Emergency Department, physician considering the patient’s safety in light of a possible home discharge.

Action

List patient factors to consider when deciding if an elderly patient discharging to home from the emergency department will benefit from a home safety evaluation, and describe what occurs during that evaluation process.

Incidence / Prevalence

The home environment remains increasingly important as people age. While only 5% of those over 65 live in institutions such as nursing homes and 95% live in the community, it is estimated that between 10% and 15% of community-dwelling elders require considerable support and assistance from others.1

Underlying Sciences

The social science gerontological literature defines the phrase “Aging in place”. This phrase means that an aging adult is able to remain in their present residence despite changing functional abilities; usually requiring securing necessary supportive services and home modifications in response to changing needs.2

Science Principles

Behavioral & Social Sciences including Bioethics
Connective Tissue Changes

Objectives

  1. List safety hazards that are assessed in an elderly patient home safety evaluation (What)
  2. List the 4 patient domains to consider when determining whether an elderly patient is “safe” to return home after their visit to the emergency department. (Who)
  3. Explain the processes for ordering and reimbursement of a home safety evaluation (How)

Keywords/Tags

References

  1. He W, Sengupta M, Velkoff VA, Debarrow KA.,  65+ in the United States: U.S. Census Bureau Current Population Reports.  Washington, DC:US Government Printing Office; 2005, 23-209.
  2. Warren, J.L., Rodiek, S., Changing Living Environments for Older Adults: Environmental Supports for Aging in Place. Case Based Geriatrics: A Global Approach 2011, p207-223.
  3. Check for Safety: A Home Fall Prevention Checklist for Older Adults. http://www.cdc.gov/HomeandRecreationalSafety/Falls/CheckListForSafety.html
  4. Gill TM, Williams CS, Robison JT, Tinetti ME.  A Population-based study of environmental hazards in the homes of older persons.  Am J Public Health. 1999; 89:553-556.
This GFF ___ my competence in geriatrics.

Authors

Kathryn Denson MD, Judi Rehm, Coleen Crowe MD, Bambi Wessel

Author Affiliation

Medical College of Wisconsin, Milwaukee, Wisconsin

Copyright

Collapse All
Report a problem about this Fast Fact