Wednesday 2 June 2021

What Does Housebound Mean?


For several months I have been attempting to determine from my G.P. (family-doctor) whether they recommend me having the Covid19-vaccination (taking into account my various health-issues), which type to have if vaccination is clinically appropriate and also to arrange for the jab to be given at home, due to my being mostly bed-bound or bedridden as well as mostly house-bound.

I received a reply, after several reminders over these past months, last week. The practice-manager wrote:

“I have reviewed you medical record and given that you are able to travel abroad for the winter this technically does not make you housebound.” (sic)

The reader may consider that the practice-manager’s perspective is valid. However, there is no legal definition of what constitutes being house-bound (ditto in re “bedridden” or “bed-bound”). Thus, there can be no technical breach of a non-existent definition.

I have replied to the message I received and below is the pertinent section.


Now to the the very thorny issue of what constitutes being “housebound”. As you are no doubt aware, there is no English legal definition. However, there appears to be a working NHS definition (alas I could not track down), upon which the following seem to be based:

“An individual will not be eligible for a home visit if they are able to leave their home environment on their own or with minimal assistance to visit public or social recreational public services (including shopping)” [source]

“A Housebound patient is defined as being an individual who is unable to leave their home environment due to a physical or psychological illness. An individual is not housebound if they are able to leave their home with minimal assistance to visit, for example, Neighbours, Hairdresser, Supermarket, Bingo.” [source]

“A patient is considered housebound if… The patient cannot leave home without considerable and taxing effort.” [source]

I have thus far this year only left my home on three occasions, each time with carer-support: on 12th February for a 3 minute visit a mile away (via car) to my ex-boyfriend who has cancer and who has been in a bubble of one during lock-down periods (equipment: walking-sticks & portable stool) - it took approximately two days for me to recover from the exertion; (via car) to vote in May (equipment: wheelchair) - again, it took approximately two days for me to recover from the exertion; (on foot) to visit my next-door-but-one neighbours for a socially-distanced cold meal on 22nd May (equipment: walking-sticks) - it took approximately five days for me to recover from the exertion. None of these were appointments, as I am currently unable to specify an exact time when I can do anything due to the precarious state of my health. You will note I have not left my home even once per month. In fact, I have managed to leave my bed-cell (bedroom) less than once per week this year. And that is also the same sort of statistic for last year as well.

I am NOT able to leave my home without taking into account:

* carer support - to prevent accident incl. falls (inter alia dyspraxia, BP), to support when narcoleptic ([hospital specialist/consultant]’s term) and general assistance, incl. financial know-how (inter alia dyscalculia, dyslexia);

* wheelchair or walking-sticks [US canes] (e.g. to neighbours) depending on distance;

* pain medication prior to, during and after any journey, time/distance/purpose dependent;

* incontinence-pads, depending on distance/destination/purpose - if I am likely to become anxious, then the pads are needed;

* water-bottle for car-travel as I require frequent urination when nervous, and travel generally makes me anxious;

* rest - I save up energy prior to journeys and rest afterwards to ensure I try to remain within my energy-envelope.

* sunglasses - to prevent photophobic pain.

* ear-plugs/head-phones - to prevent pain due to hyperacusis.

Under no reasonable understanding can my personal situation be deemed to be outside the remit of needing more than “minimal assistance”. When travelling abroad I take one or two carers, depending on need, as I have to be pushed in my wheelchair (partly due to the chair being unsuitable for self-propulsion) and assisted to do almost everything. Remember, here in the UK, I have carers to ensure I eat, take medications, drink and to help with personal hygiene & dressing. I am wheelchair-ed throughout the æroport. I need assistance to use the æroport toilets. I am assisted on to aircraft either manhandled or via Ambulift, depending on the æroport’s facilities. Again this is not “minimal assistance”.

Additionally for the past couple of years or so I have been bedridden [aka bed-bound] just over 95% of the time, up from my previous 85% proneness.

My en suite w.c. is 3 metres from my bed. It typically takes me upwards of 8 seconds to reach it, depending whether I walk (shuffle) or quite literally crawl. The latter I only need to do when defecation becomes necessary (IBS, diarrhœa), as I have a water-bottle for urination.

Additionally, due to my frequent falls, when out of bed and when alone in the house I wear a pendant-alarm so I can call for assistance. Frequent falling is a sign of frailty.

I also have severe difficulties in mounting or descending stairs, so generally go down on my bottom and crawl up on hands and knees. The inability to use stairs is indicative of frailty.

It is my understanding that my gait speed would also indicate frailty. Indeed, using the Edmonton Frail Scale, I come out as having mild to moderate frailty, depending on the time of year/my state of health. And bear in mind, I am not yet even considered agèd!

Furthermore, were I to be taken in an ambulance to Addenbookes or a London hospital, it would take much longer than the journey to Spain, for example. Being able to leave one’s home with assistance does not lead to the conclusion one is not house-bound, but rather the opposite, that one is house-bound without assistance.

So, to sum, I am de facto both housebound and bedridden the vast majority of the time.

Your definition and understanding appears to be lacking in understanding of my personal situation (odd given you are aware that some years I travel to Spain under the advice of both my G.P.s and hospital consultants!) and everyman’s reasonable definitions of the terms “housebound” and “bedridden”.

In the circumstances, I must insist that you develop a thoroughly thought-through policy with clear definitions of what [the medical-practice] considers “housebound” and “bedridden”. It is then imperative that [the medical-practice] goes through its patient-records and appropriately corrects them as well as taking any pro-active actions to remedy any failures to support patients.

[Image description: the writer in his bed-cell]


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