General Guidelines for Psychiatric Home Care Admission:



PURPOSE:

To understand and follow general guidelines for Psychiatric Homecare Admission.

EQUIPMENT:

None

PROCEDURE:

1. Patient must be Homebound:

a. For the patient who has a primary diagnosis of a medical condition, he/she must meet the clinical justification for homebound status defined as the inability to leave the home on a frequent and regular basis and is a taxing effort that may require the assistance of another person, use of wheelchair, walker or other assistive device.

b. For the patient who has a primary diagnosis of a psychiatric or psychological disorder, he/she can be homebound by one or more of the criteria for primary medical diagnosis or it may also include patient refusal to leave home related to paranoia or other psychiatric condition or if leaving home places the patient at risk due to a cognitive, psychological or behavioral impairment. In the case of primary psychiatric diagnosis, physical impairment is not mandatory to constitute homebound.

c. Some private insurance sources may be more lenient with homebound criteria.

2. In addition to established routine admission criteria, the following conditions should be met:

a. Be 18 years of age or older.

b. Function at a level that indicates he/she is safe in a home environment.

c. Does not pose threat to self or others.

d. Able and willing to adhere to plan of care.

3. Appropriate referrals to psychiatric home health include:

a. Mood disorders.

b. Anxiety disorders.

c. Adjustment disorders.

d. Depression.

e. Geriatric-psychiatry disorders.

f. Individuals and their caregivers with impaired coping skills related to disease process, health crisis, grief or loss.

g. Those at risk for repeated hospitalizations due to serious and/or chronic medical illness.

h. Those at risk for repeated hospitalizations due to serious and/or chronic mental illness.

i. Patients requiring medication instruction.

j. Recently discharged from inpatient care and needing follow-up to prevent relapse.

k. Requiring evaluation of behavioral response to new psychotropic medications.

l. Suffering behavioral or emotional problems associated with physical illness.

m. Diagnosed with Alzheimer’s Disease and other dementia (vascular, Lewy body, etc).

n. Cognitive impairment and confusion following surgery, stroke or other acute physical illness.

o. Patients suffering from suicidal ideation.

4. Care must be able to be safely provided in the residence.

5. The ineligible patient includes:

a. A person who does not wish to receive services.

b. Lack of self control or currently out of control behavior or with a known, suspected or history of assault or violence.

c. The person’s environment is threatening and deemed unsafe for the clinician.

d. A person who is not homebound.

e. A person who requires physical restraint.

6. Services that are not provided:

a. On call psychiatric service.

b. 24-hour Emergency Services.

c. On-site crises intervention with threats of violence.

AFTER CARE:

1. Be sure to document details into patient’s record.

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