One of the most misunderstoond Medicare rules is the one that requires a patient to be "homebound" in order to receive covered medical services at home. We recently received a complaint from a daughter that her mother's Medicare agency expects her mother to be "bedbound" before she is eligible for care at home.

Not quite. Understanding of the homebound rule morphs just about as quickly as the telegraph game we used to play at parties. You remember the game where someone whispers something to a player at the beginning of the circle, and by the time it reaches the other end the statement has become something altogether different.

That's what appears to be happening with the stipulation that Medicare patients be homebound in order to have visiting medical services covered.

What the "homebound" qualifier actually says it that it must require "great and taxing effort" for the patient to leave home. This means that it is extremely difficult to leave for medical treatment, so Medicare will authorize a visiting nurse or therapist to come to the patient's home as necessary if other program requirements are also met.

This certainly doesn't mean that the patient can never leave home for anything except a visit to the doctor. There was some confusion about this several years back. The head of the Centers for Medicare and Medicaid herself clarified their position by saying that patients could leave home for a short walk or outing, for church, to get an occasional haircut, for special family celebrations, to attend day care, and for other special events. The primary standard was that getting out requires "taxing effort," and the patient must not be driving.

The idea, of course, is that if the patient can easily leave home, then the patient can travel to the doctor's or therapist's office, which is considerably less expensive for Medicare.

Make's sense.

Unfortunately for many of our seniors, Medicare does strongly believe that not having transportation doesn't qualify a patient as "homebound."