An individual shall be considered to be home bound if the individual has a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device (such as: crutches, a cane, a wheelchair or a walker); or if the individual has a condition such that leaving his or her home is medically contraindicated.  While an individual does not have to be bedridden to be considered confined to his home, the condition of the individual be such that there exists a normal inability to leave home; that leaving home requires a considerable and taxing effort by the individual, any absence of an individual from the home attributable to the need to receive health care treatment.

What is the patient is able to leave the home?

If the patient does in fact leave the home, the patient may still be considered home bound, if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive medical treatment. Occasional absences from the home for non-medical purposes, e.g., an occasional trip to barber, a walk around the block or a drive, would not necessitate a finding that the patient is not home bound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain health care outside the home.

2- Maintaining a Healthy Diet:

Healthy Eating for a Healthy Weight

A healthy lifestyle involves many choices. Among them, choosing a balanced diet or eating plan. So how do you choose a healthy eating plan? Let’s begin by defining what a healthy eating plan is. According to the Dietary Guidelines for Americans, a healthy eating plan:

• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Includes lean meats, poultry, fish, beans, eggs, and nuts
• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars
• Stays within your daily calorie needs

Eat Healthfully and Enjoy It!

A healthy eating plan that helps you manage your weight includes a variety of foods you may not have considered. If “healthy eating” makes you think about the foods you can’t have, try refocusing on all the new foods you can eat, such as:

• Fresh fruits ? don’t think just apples or bananas. These are great choices, but try some “exotic” fruits, too. How about a mango? Or a juicy pineapple or kiwi fruit! When your favorite fresh fruits aren’t in season, try a frozen, canned, or dried variety of a fresh fruit you enjoy. One caution about canned fruits is that they may contain added sugars or syrups. Be sure and choose canned varieties of fruit packed in water or in their own juice.
• Fresh vegetables ? try something new. You may find that you love grilled vegetables or steamed vegetables with an herb you haven’t tried like rosemary. You can sauté vegetables in a non-stick pan with a small amount of cooking spray. Or try frozen or canned vegetables for a quick side dish — just microwave and serve. When trying canned vegetables, look for vegetables without added salt, butter, or cream sauces. Commit to going to the produce department and trying a new vegetable each week.
• Calcium-rich foods ? you may automatically think of a glass of low-fat or fat-free milk when someone says “eat more dairy products.” But what about low-fat and fat-free yogurts without added sugars? These come in a wide variety of flavors and can be a great dessert substitute for those with a sweet tooth.
• A new twist on an old favorite ? if your favorite recipe calls for frying fish or breaded chicken, try healthier variations using baking or grilling. Maybe even try a recipe that uses dry beans in place of higher-fat meats. Ask around or search the internet and magazines for recipes with fewer calories ? you might be surprised to find you have a new favorite dish!

Do I have to give up my favorite comfort food?

No! Healthy eating is all about balance. You can enjoy your favorite foods even if they are high in calories, fat or added sugars. The key is eating them only once in a while and balance them out with healthier foods and more physical activity.

Some general tips for comfort foods:

• Consume them less often. If you normally eat these foods every day, cut back to once a week or once a month. You’ll be cutting your calories because you’re not having the food as often.
• Eat smaller amounts. If your favorite higher calorie food is an afternoon chocolate bar, have a smaller size or only half a bar. Be careful! This technique works well for some people, but others may find it is too tempting to have their favorite food available, even in smaller amounts.
• Try a lower-calorie version. Use lower-calorie ingredients or prepare it differently. For example, if your macaroni and cheese recipe uses whole milk, butter, and full-fat cheese, try remaking it with non-fat milk, less butter, light cream cheese, fresh spinach and tomatoes. Just remember to not increase your portion size. For more ideas on how to cut back on calories.

3- Immunizations & Swine Flu Information:

Swine Flu:

Swine flu is an infection caused by a virus. It’s named for a virus that pigs can get. People do not normally get swine flu, but human infections can and do happen. The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. and include fever, cough, sore throat, body aches, headache, chills and fatigue.

There are antiviral medicines you can take to prevent or treat swine flu. There is a vaccine available to protect against swine flu. You can help prevent the spread of germs that cause respiratory illnesses like influenza by

• Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Washing your hands often with soap and water, especially after you cough or sneeze. You can also use alcohol-based hand cleaners.
• Avoiding touching your eyes, nose or mouth. Germs spread this way.
• Trying to avoid close contact with sick people.
• Staying home from work or school if you are sick.

Flu

Also called: Grippe, Influenza.

The Flu is a respiratory infection caused by a number of viruses. The viruses pass through the air and enter your body through your nose or mouth. Between 5% and 20% of people in the U.S. get the flu each year. The flu can be serious or even deadly for elderly people, newborn babies and people with certain chronic illnesses. Symptoms of the flu come on suddenly and are worse than those of the common cold. They may include:

• Body or muscle aches
• Chills
• Cough
• Fever
• Headache
• Sore throat

Is it a cold or the flu? Colds rarely cause a fever or headaches. Flu almost never causes an upset stomach. And “stomach flu” isn’t really flu at all, but gastroenteritis. The main way to keep from getting the flu is to get a yearly flu vaccine. If you get the flu, your health care provider may prescribe medicine to help your body fight the infection and lessen symptoms.

4- Diabetic Diet & Monitoring:

Diabetes – tests and checkups

You can live an active lifestyle when you take control of your own diabetes care. Still, everyone with diabetes must have regular health checkups and tests. These appointments will give you a chance to ask your doctor or nurse questions and learn more about diabetes.

See Your Doctor

See your diabetes doctor every 3 to 6 months. During this exam, your doctor should check your blood pressure, your weight, and your feet.You will also need to see your dentist every 6 months.

Eye Exams

An eye doctor (called an ophthalmologist) should check your eyes at least once a year. If you have eye problems because of diabetes, you will probably see your eye doctor more often.

Foot Exams

Your doctor should check the pulses in your feet and your reflexes at least once a year. The doctor should also look for calluses, infections, and sores. If you have had foot ulcers before, you should see your doctor every 3 to 6 months.

Routine Tests

Hemoglobin A1C (HbA1C) . An HbA1C lab test reflects the average amount of sugar in your blood over the past 3 months. It shows how well you are controlling your diabetes. The normal level is less than 6%. Most people with diabetes should have an HbA1C of less than 7%. Higher numbers mean that your diabetes control is not as good.

Cholesterol

A cholesterol test measures how much cholesterol and triglycerides are in your blood. You will have the test on an empty stomach after not eating overnight.

Adults should have this test every year. If you are being treated for high cholesterol, you may have this test more often.

Kidney Tests

Once a year, you will need a urine test that looks for a protein called “albumin.” Because the test looks for small amounts of albumin, it is sometimes called a test for micro-albuminuria. You will have more of this protein in your blood if you have early kidney damage due to diabetes. But, the level of this protein in urine can also be higher for other reasons. Your doctor may also check your level of kidney function with a blood test every year.

TYPE I Diet:
If you have type 1 diabetes, it is important to know how many carbohydrates you eat at a meal. This information helps you determine how much insulin you should take with your meal to maintain blood sugar (glucose) control.The other two major nutrients, protein and fat ,also have an effect on blood glucose levels, though it is not as rapid or great as carbohydrates. A delicate balance of carbohydrate intake, insulin, and physical activity is necessary for the best blood sugar (glucose) levels. Eating carbohydrates increase your blood sugar (glucose) level. Exercise tends to decrease it (although not always). If the three factors are not in balance, you can have wide swings in blood sugar (glucose) levels.If you have type 1 diabetes and take a fixed dose of insulin, the carbohydrate content of your meals and snacks should be consistent from day to day.

MEAL PLANNING

One of the most challenging aspects of managing diabetes is meal planning. Work closely with your doctor and dietitian to design a meal plan that maintains near-normal blood sugar (glucose) levels. The meal plan should give you or your child the proper amount of calories to maintain a healthy body weight.The food you eat increases the amount of glucose in your blood. Insulin decreases blood sugar (glucose). By balancing food and insulin together, you can keep your blood sugar (glucose) within a normal range. Keep these points in mind:

• Your doctor or dietitian should review the types of food you or your child usually eats and build a meal plan from there. Insulin use should be a part of the meal plan. Understand how to time meals for when insulin will start to work in your the body.
• Be consistent. Meals and snacks should be eaten at the same times each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) consistent from day to day.
• Learn how to read food labels to help plan you or your child’s carbohydrate intake.
• Use insulin at the same time each day, as directed by the doctor.

Monitor blood sugar (glucose) levels. The doctor will tell you if you need to adjust insulin doses based on blood sugar (glucose) levels and the amount of food eaten. Having diabetes does not mean you or your child must completely give up any specific food, but it does change the kinds of foods one should eat routinely. Choose foods that keep blood sugar (glucose) levels in good control. Foods should also provide enough calories to maintain a healthy weight.

Type II Diet:

If you have type 2 diabetes, your main focus needs to be on weight control. Most people with this disease are overweight. You can improve blood sugar (glucose) levels by following a meal plan that:

• Has fewer calories
• An even amount of carbohydrates,
• Healthy monounsaturated fats instead of some carbohydrates

Examples of foods high in monounsaturated fats include peanut or almond butter, almonds, and walnuts. You can substitute these foods for carbohydrates, but keep portions small because these foods are high in calories. Learn how to read food labels to help you make better food choices. Often, you can significantly improve control of type 2 diabetes with moderate weight loss (for example, 10 pounds) and increased physical activity (for example, 30 minutes of walking per day. Some people will need to take medicine by mouth or insulin in addition to making lifestyle changes.

MEAL PLANNING

One of the most challenging aspects of managing diabetes is meal planning. Work closely with the doctor and dietitian to design a meal plan that maintains near-normal blood sugar (glucose) levels. The meal plan should give you or your child the proper amount of calories to maintain a healthy body weight. Having diabetes does not mean you or your child must completely give up any specific food, but it does change the kinds of foods your child should eat routinely. Choose foods that help keep glucose levels in good control. Foods should also provide enough calories to maintain a healthy weight. Regular monitoring of blood sugar (glucose) at home will help you learn how different foods effect blood sugar (glucose) level.

5- Infection Control:

Every year, many lives are lost because of the spread of infections in hospitals. Health care workers can take steps to prevent the spread of infectious diseases. These steps are part of infection control. Proper hand washing is the most effective way to prevent the spread of infections in hospitals. If you are a patient, don’t be afraid to remind friends, family and health care providers to wash their hands before getting close to you.

Other steps health care workers can take include:

• Covering coughs and sneezes
• Staying up-to-date with immunizations
• Using gloves, masks and protective clothing
• Making tissues and hand cleaners available
• Following hospital guidelines when dealing with blood or contaminated items

6- When to call 911:

A 911 emergency is a situation in which someone needs immediate help because he or she is injured or in immediate danger. So if you’ve had a car accident and someone is hurt, obviously you’ll call 911. But if your car just broke down and you need a tow truck, you’ll need to call a towing service (or, better still, your parents!). Call 911 if there’s a fire, if someone has had an accident, or if you see a crime being committed. When you call 911, the emergency dispatch operator will probably ask what, where, and who questions such as:

“What is the emergency?” or “What happened?”

“Where are you?” or “Where do you live?”

“Who needs help?” or “Who is with you?”

There are many reason to call for help, the most crucial factors to call for help are:

1- prolonged chest pain

2- prolonged pain

3- prolonged bleeding

7- Benefits of Home Health:

There is nothing like the comfort and security of home when you’re ill or recovering from an illness. Research shows that even for those living with chronic illness or disability, living at home is often the best option for physical and mental well being. Some of the benefits of in-home care include:

• ·Provides individuals needing care with dignity and independence.
• ·May help prevent or postpone hospital or nursing home care.
• ·Allows maximum freedom and comfort for the individual.
• ·Offers individualized care tailored to the needs of the individual and family.
• ·Provides professionally supervised services.
• ·Supports families while keeping them together.

8- Food Allergies:

Food allergy is an abnormal response to a food triggered by your body’s immune system. Allergic reactions to food can sometimes cause serious illness or death. Tree nuts and peanuts are the leading causes of deadly allergic reactions called anaphylaxis.

In adults, the foods that most often trigger allergic reactions include:

• fish and shellfish, such as: shrimp, lobster or crab
• peanuts
• tree nuts, such as: walnuts
• eggs

Problem foods for children are eggs, milk as well as peanuts.

Sometimes a reaction to food is not an allergy. It is often to a reaction quote on quote “food intolerance”. Your immune system does not cause the symptoms of food intolerance; however these symptoms can look and feel like those of a food allergy.

9- Medication Safety:

What should you communicate with your doctor?

• Create a list if vitamins, medicines, and any other medication you are currently taking. Make a copy of the list, and place it in a safe place in an available location for emergencies.
• Provide a list of all the medicines you are taking to your health care provider.
• Always check with your physician before taking any non-prescribed medications.
• Be aware of how many refills your doctor orders.
• Read the label each time you take your medication.
• Use a memory aide such as a calendar or pill box, to help remind you when to take your medication.

List information to discuss with your pharmacist:

• Ask for a large print label on your medication, and a language that you understand.
• Try to use the same pharmacy for all your medication.
• Review with the pharmacists: side effects, what to avoid when taking the medication and food and drug interactions as well.

What are measures to promote safe and accurate administration?

• Read all labels carefully in a well lighted room.
• Follow the 5 RIGHTS:

Right medication

Right dose

Right person

Right route

Right time

• Check all expiration dates.
• Do not store medication near heat or humidity.
• Do not write over label prepared by pharmacists.
• Do not combine different medications in the same prescription bottle.
• Do not share prescribed medications with other people.
• Store medication out of reach of children.
• Report any side effects or problems to your physician.
• Plan ahead to reorder medication ahead of time.
• Take all medications as ordered.
• As the pharmacists ahead of time what to do if doses are missed.

10- What is Guided Imagery:

A technique that involves using the imagination and mental images to promote relaxation, changes in attitude or behavior, and encourages physical healing. Also known as visualization.You can use an instructor, tapes, or scripts to help you through this process.

Guided imagery is based on the concept that your body and mind are connected. Using all of your senses, your body seems to respond as though what you are imagining is real. An example often used is to imagine an orange or a lemon in great detail-the smell, the color, the texture of the peel. Continue to imagine the smell of the lemon, and then see yourself taking a bite of the lemon and feel the juice squirting into your mouth. Many people salivate when they do this. This exercise demonstrates how your body can respond to what you are imagining.You can achieve a relaxed state when you imagine all the details of a safe, comfortable place, such as a beach or a garden. This relaxed state may aid healing, learning, creativity, and performance. It may help you feel more in control of your emotions and thought processes, which may improve your attitude, health, and sense of well-being.

What is guided imagery used for?

Guided imagery has many uses. You can use it to promote relaxation, which can lower blood pressure and reduce other problems related to stress. You can also use it to help reach goals (such as losing weight or quitting smoking), manage pain, and promote healing. Using guided imagery can even help you to prepare for an athletic event or for public speaking.

Is guided imagery safe?

Guided imagery is safe. No known risks are associated with it. Guided imagery is most effective when the person teaching it has training in guided imagery techniques.

11- Home Safety