Homebound Status Assessment

Homebound Status is the most important factor in determining whether or not you are eligible to receive Home Health care. “Homebound” means that a health-related concern makes it difficult for you to leave your home to access the care you need.

Patients are considered “confined to the home” or “homebound” if they meet these two criteria:

  1. Patients either need supportive devices such as crutches, canes, wheelchairs, walkers, special transportation, or help from someone else in order to leave their home because of illness or injury, OR have a condition that makes leaving the home medically inadvisable.
  2. There must exist a normal inability to leave home; and leaving home must require a considerable and taxing effort.

Please take a moment to complete this assessment and also review the results with your doctor.

Together, you will be able to determine if you meet the homebound criteria and qualify for home health care.

Do you need the use of an assistive device such as a walker, wheelchair, or cane?

Do you feel confident in your ability to perform daily activities on your own, such as eating, dressing, bathing, etc.?

Do you have difficulty standing and/or walking?

Do you experience pain or discomfort when you try to move around?

Do you experience shortness of breath when you try to walk?

Do you use a home health device such as an oxygen machine?

How often would you say you leave your home:

FrequentlySeldom – Only for religious services, unique events, etc.Never


Based upon your responses above, someone will contact you to discuss your options for home health care.

Please feel free to contact us to talk about your home health needs.