Home Health & Hospice

Accept a Referral, Then Decide about the Patient

Homecare Insider, May 18, 2009


One topic of debate in home health care deal with referral and admission. When does a referred individual become a patient? Some agencies believe that when they pick up the phone, that referral is automatically a new patient. However, without learning something about this potential patient’s medical condition or need for care, or without checking out the home environment, there can be problems. What if there is no physician willing to participate in the homecare plan? What if the environment is not safe for homecare staff ? What if the patient’s needs for care exceed what the agency is able to provide?


There is a different way to look at referrals. When an agency accepts a referral, it is agreeing to a "look and see," an evaluation of the patient and caregiving situation. This begins with a call to the physician, the referral source, and, whenever possible, the family or patient. The agency may decide at that time not to proceed any further. However, if the agency decides to send a clinician to the home, this would be an evaluation. During that visit, the clinician will determine whether the patient qualifies for coverage and meets the agency’s admission criteria, as well as verify that the agency is able to meet the patient’s needs. After that decision is made, then the referral becomes a patient. If the referral is not suitable for admission, the agency must have a process to handle this. This process would include notification of the physician and referral source, referrals for the individual not accepted for admission, and documentation of the circumstances.

The agency’s policies play an important role in the admission process. If your manual needs a major overhaul, check out the Homecare Policy Manual for Certification and AccreditationClick Here.