Who is considered to be homebound?

An individual is considered to be homebound 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 not medically recommended.  While an individual does not have to be bedridden to be considered confined to his home, if the individual has a normal inability to leave home, or if leaving home requires a considerable and taxing effort by the individual, or if an individual only leaves the home due to the need to receive health care treatment, then the individual is considered homebound.

What if the patient is able to leave the home?

If the patient does in fact leave the home, the patient may still be considered homebound 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 disqualify the patient from being in homebound status.

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:

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• 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

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:

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• 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.

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:

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• 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.

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• 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.

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• 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.

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• 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!

Flu (Also called: Grippe, Influenza)

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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:

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• Body or muscle aches

• Chills

• Cough

• Fever

• Headache

• Sore throat

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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.

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.

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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.

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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.

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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

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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:

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• 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.

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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:

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• Has fewer calories

• An even amount of carbohydrates,

• Healthy monounsaturated fats instead of some carbohydrates

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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.

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MEAL PLANNING

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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.

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. 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:

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1- prolonged chest pain
2- prolonged pain
3- prolonged bleeding

Food Allergies:

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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

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.

Home Safety

General:

• Consider a medical alert or a buddy system.

• Keep a fire extinguisher and smoke detector on every floor.

• Use extreme caution when smoking. Never smoke when alone or in bed.

• Always get up slowly after sitting or lying down. Take your time, and make sure you have your balance.

• Wear proper fitting shoes with low heels.

• Use a correctly measured walking aid.

• Remove or tack down all scatter rugs.

• Remove electrical or telephone cords from traffic areas.

• Avoid using slippery wax on floors.

• Wipe up spills promptly.

• Avoid standing on ladders or chairs.

• Have sturdy rails for all stairs inside and outside the house.

• Use only non-glare 100 watt or greater incandescent bulbs (or the fluorescent equivalents).

• Make sure that all stair cases have good lighting with switches at top and bottom.

• Staircase steps should have a non-slip surface.

Bathroom:

• Leave a light on in your bathroom at night.

• Use recommended bath aids, securely installed on the walls of the bath/shower stall and on the sides of the toilet.

• Skid-proof the tub and make sure the bath mat has a non-slip bottom.

• To avoid scalds, turn water heater to 120 degrees Fahrenheit or below.

• Mark cold and hot faucets clearly.

• Use door locks that can be opened from both sides.

• If possible, bathe only when help is available.

Kitchen:

• Keep floors clean and uncluttered.

• Illuminate work areas.

• Mark “on” and “off” positions on appliances clearly and with bright colors.

• Store sharp knives in a rack.

• Use a kettle with an automatic shut off.

• Store heavier objects at waist level.

• Store hazardous items separate from food.

• Avoid wearing long, loose clothing when cooking over the stove.

• Make sure food is rotated regularly. Check expiration dates.

Drug Safety:

• Review your medicines frequently with your doctor or pharmacist and when you take new medication.

• Make sure medicines are clearly labeled.

• Read medicine labels in good light to ensure you have the right medicine and always take the correct dose

• Dispose of any old or used medicines.

• Never borrow prescription drugs from others.

• Check with your doctor or pharmacist before you mix alcohol and your drugs.

• Have medication dispensed in a bubble pack or convenient dispenser.

• Check with your doctor or pharmacist before mixing non-prescription drugs and prescription drugs.