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Domiciliary eligibility criteria

Discussion in 'United Kingdom' started by Maureen Hillier, Oct 2, 2009.

  1. Maureen Hillier

    Maureen Hillier Welcome New Poster

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    Does any one use a domiciliary eligibility criteria?
    How do you decide whether a patient is housebound and are there any exceptions?
    Do you provide transport for some patients?:morning:
  2. pommypod

    pommypod Member

    Here we go again..... House bound means exactly that bound to the house , if you can across the threshold and into a taxi/relatives car/awaiting ambulance/ wheel chair you are not house bound. Basically you cannot get out of the house to shop/visit the Gp/coffee mornings/Asda/christmas parties. You are basically termanilly ill and should be shown some respect, the rest can be given a clinic appointment. Please note the definition of house bound does not include my son/daughter works full time/ I cannot afford the taxi fees.

    Why would you provide transport? if they can get out they are NOT HOUSEBOUND, and ripping the NHS off. NO EXCEPTIONS
  3. W J Liggins

    W J Liggins Well-Known Member

    Have to agree with Pommypod here. Many years ago, I was in a management position in an NHS Trust and we decided to call on domicilliary patients without notice. If they were housebound they would be in, and we were prepared to take the chance that in a small number of cases it would be im possible to treat them eg. GP or dentist visiting etc. I was too embarassed to formally write up the results but suffice it to say they included:

    'I'm just taking my friends out in my car' (she was just getting into her highly polished car)
    'I have to walk down to church for my lunch'
    'I'm just leaving on a walking holiday in the Lake District'

    In addition to these pronouncements one male was found up a ladder painting the 1st floor windows of his house, another male was helping his son tarmac his drive, a multitude were gardening and still others were carrying out various forms of DIY.

    The interesting thing was the defensive response in every case when told that they were to attend a clinic in future. It was always 'too difficult' and 'you would never have known if you hadn't seen me'. Astonishing.

    Bill Liggins
  4. Disgruntled pod

    Disgruntled pod Active Member

    I had a young (old) OAP contact me for a home visit. I said that I prefer only to do DOMs for the housebound, that means people that can barely walk. She kept on saying I can walk, but best if you can come here. I felt in a malicious mood, and said yes!

    She had already been to a chiropodist in the town centre but said best if someone could come to her flat it was much more convenient. I pointed out to her that her thickened nails really needed a drill to reduce them well and that was at the surgery. She just smiled and said, "best for you to come here!".

    At the end, she said "how much is that." I said to her "£40 please". She looked at me as if she had seen a ghost. I said to her, "do you think that that is expensive." She said yes. I pointed out how much plumbers charge for a call out fee. I also said that to come to the surgery is much cheaper. I think that she learnt the hard way that there is no such thing as a free lunch!

    The problem is that (although it is the FHPs that are the cheap DOM ones) there are too many too cheap pods taking pity on these poor penniless pensioners. OK some of them have not got a lot of money, but it's amasing how many can get to and afford the dentist!
  5. pgcarter

    pgcarter Well-Known Member

    It's the same all over the world....quite happy to take advantage if you let them.
    regards Phill
  6. ja99

    ja99 Active Member


    LOVE IT!

    No matter where you are, the excuses are all the same!

    Similarly, I once had a request for a House-call, the lady described her location to my secretary (about 35 min drive each way) but 'swore' it was only 5 minutes...quick as a flash my secretary said "...Lady, its 5 mins by phone - not car" and hung up!
  7. cornmerchant

    cornmerchant Well-Known Member

    hi Maureen
    I would like to put my point of view regarding "housebound"and Doms, even though I am not NHS but in private practise.

    Pommypod- not all patients who are housebound are terminally ill- I have many severely immobile patients that do not leave the house , but they are far from ternimally ill!

    I choose -yes choose to do some patients as doms- god forbid I should be classed as a lesser mortal- for several reasons:

    * if very immobile, this type of patient can far overrun their appointment time merely because they take forever and a day to get undressed and then dressed again- I do not have a changing room, hence it is all done in the consulting room! If you see them at home, they are ready when you get there and do not have to spend ages taking off outer wear or underwear!

    * sometimes the elderly and infirm have hygiene problems- much better to see them in their own environment!That way the clinic stays smelling sweet and the environment is not contaminated!

    * if seen in their own environment, often things like slippers can be a giveaway as to why they have a corn under their big toe nail !or why they are always tripping over that loose rug in the lounge!

    *nurses, physios, dentists can all do house calls- so why do I get the impression that Pods who do Doms are looked down upon?

    I work my practise as a mixture of clinic patients and doms- they each get the same treatment- I take my bag to both venues packed just the same.

    Maureen , I do appreciate that the NHs gave to have strict criteria- not your fault, it is the system- in my area I am fairly certain that there are no doms offered by the NHs any more.

  8. ja99

    ja99 Active Member

    Hi CM,

    Are you sure you are looked down upon? I do some Dom's and don't feel that way.

    Secondly, I think Pommypod was simply using 'terminally ill' as a metaphorical exaggeration to make a point - not literally.

    Personally, there are always genuine cases, its just the large percentage of non-genuine cases who make the most noise and almost always slip up and mention the dinner party they went to last night, or the day at the races next week they are going to - its these that 'stick' our collective minds when discussing Doms.

    Last edited: Oct 26, 2009
  9. Tim VS

    Tim VS Active Member

    I am quite happy to do home visits when asked. However I charge for a minimum of an hour's surgery time, since this is usually what it takes once I have driven there, set up treated, packed down etc. This seems fair and reasonable and tends to filter out the ones who just want it for convenience reasons, for example.

  10. charlie70

    charlie70 Active Member

    Private practice: Yes, I would do a home visit if that is what the patient wants, but would charge accordingly to take into account time taken to travel to & from the house and some degree of petrol costs, wear and tear on the car etc.

    NHS: Where good public transport is available, housebound means just that: too infirm or ill to get out of the house and get to clinic. The only excuses I would make are where the patient is the carer for another and they are unable to get someone in to look after their spouse/child/parent for the duration of the appointment. This does happen, especially with dementia: some people simply can cannot be left alone.
    In more rural areas, I think a little flexibility and common sense should prevail. Public transport can be very patchy and taxis can soon mount up to £40 for a return trip. In which case, planning a day of domicilary visits in a small geographical area can mean the more isolated communities still get the care they need.

    I do take a "shades of grey" approach, rather than a black-and-white rigid stick to the rules one.
  11. dgroberts

    dgroberts Active Member

    What are peoples thoughts on the NHS doing away entirely with there dom caseloads but farming it out to private pods under a fee limit agreement or something? NHS could take the stance of offering foot care but you have to come to us, alternatively pay for the service. Doms seem a very inefficient way of working to me and at the moment the NHS is trying to lean things out, a lot.

    Obviously the NHS would have to keep the cases with acute issues (ulcers mainly).

    It would be most productive to have a direct link between NHS -> Private so we could offer a "paid for" but properly regulated service for pt's who shouldn't really be seen in the NHS (there will be hundreds of those up and down the country - clinic and doms).

    Just a thought.

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