#022 Geriatric Home Safety Evaluation: Can I send this patient home?

Fast Facts and Concepts #022 PDF

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

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)

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

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:

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”.
 

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.

Underlying Science:

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

ACGME Competencies: Systems Based Practice, Patient Care
 

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.

Author Affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.

Geriatric Fast Facts are edited by the faculty of the Geriatric Education Teams (GETS) program funded by the Reynolds Foundation, Kathryn Denson, MD, Steven Denson, MD, & Edmund Duthie, MD from the Division of Geriatrics, Medical College of Wisconsin, and are published by the Geriatric Fast Facts Website at the Medical College of Wisconsin. For more information write Kathryn Denson, MD. More information, as well as the complete set of Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

Copyright/Referencing Information: Users are free to download and distribute Geriatric Fast Facts for educational purposes only. Citation: Kathryn Denson MD, Judi Rehm, Coleen Crowe MD, Bambi Wessel, Fast Fact #22: Geriatric Home Safety Evaluation: Can I send this patient home? January, 2013.

Geriatric Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm

Disclaimer: Geriatric Fast Facts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Geriatric Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.