Learning Objective #1: Understand the various aspects of meanings of homebound

Learning Objective #2: Explain why the homebound criterion may affect psychiatric patients’ access to home care services

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Homebound status is the key criterion of determining eligibility of receiving United States government funded home healthcare services in Medicare program. Patients' access to psychiatric home health nursing care, therefore, is profoundly affected by Medicare's policy, especially after the Prospective Payment System was implemented in October 2000 to control costs of home healthcare services. However, the definition of homebound used by the Medicare program was established in 1965 and the ambiguity in interpreting homebound status may jeopardize depressed older adults' eligibility of receiving psychiatric home health nursing care. Therefore, the purpose of this study is to renew the concept of homebound. Method: Systematic review of published literature, clinical studies, and U.S. government documents. Keywords used in this study are homebound and housebound. Searched data bases include MEDLINE, CINAHL, PubMed, PsycINFO, and Dissertation Abstracts. Meanings, definitions and characteristics of different homebound populations are compared and synthesized. Results: Concept of homebound has two perspectives: physically/medically homebound and socially homebound. The constructs of homebound status are attachment, inability, needs are not recognized or adequately met, disabilities, and isolation. Risk factors of becoming homebound are disease and injury, chronic health problems, depression, old age, and environmental hazard. Consequences of homebound are adverse influences on personal health and functioning level, depression, and possible neglect or abuse. Conclusion: The relationship between homebound and depression is complicated. A depressed person's eligibility to psychiatric home care can be removed, before fully remitted, because of improvement in social function, which is a positive outcome of psychiatric home care services. A renewed definition of homebound recognizing patients' needs is the key to break the cycle of depression and homebound. Finding of this study can influence health policy to enhance patients' access to psychiatric home care.