When should a patient be referred to Home Health (HH) for wound care?

Home Health Referral Criteria for Wound Care

Patients should be referred to Home Health for wound care when wounds fail to show at least 50% reduction in size after 4 weeks of appropriate standard wound management, or when wounds demonstrate signs of instability, infection, or ischemia that require specialized care but not hospitalization. 1

Wound Classification and Referral Timeline

Stable vs. Unstable Wounds

• Stable wound: Healing or not healing but not worsening 1
• Unstable wound: Progressing due to underlying infection or ischemia, or with impairment in size and depth 1

Referral Decision Algorithm

1. Immediate Home Health Referral (within 24-48 hours):

   • Wounds with signs of infection (hyperemia, cellulitis, purulent drainage, edema, pain, fever)
   • Wounds with signs of ischemia (new areas of necrosis, gangrene, rest pain)
   • Wounds showing extension in size or depth
   • Diabetic foot ulcers with complications that don't require hospitalization 1

2. Standard Home Health Referral:

   • Wounds that fail to show ≥50% reduction after 4 weeks of standard care 1, 2
   • Wounds requiring specialized dressings or treatments not manageable by patient/family
   • Patients with limited mobility who cannot access outpatient wound care
   • Patients with multiple comorbidities affecting wound healing 3

Clinical Signs Requiring Home Health Intervention

Infection Indicators

• Hyperemia around the wound
• Cellulitis
• Purulent drainage
• New areas of wet gangrene
• Increased pain
• Fever 1

Ischemia Indicators

• New areas of necrosis or gangrene
• Rest pain
• Hyperemia of the foot 1

Wound Deterioration

• Extension of ulcer size
• Increased depth
• Involvement of deeper tissues (soft tissue/bone)
• Increased exudate
• Maceration of surrounding skin 1, 3

Benefits of Home Health Wound Care

• Provides specialized wound care in the patient's home environment
• Reduces hospital admissions for wound complications
• Enables consistent monitoring of wound healing progress
• Allows for early intervention when wounds deteriorate
• Facilitates patient education on wound care techniques
• Ensures appropriate application of advanced wound therapies when indicated 3

Standard of Care Elements to be Provided by Home Health

1. Offloading of plantar ulcerations
2. Debridement of necrotic, nonviable tissue
3. Management of infection in soft tissue or bone
4. Appropriate dressing selection based on wound characteristics
5. Patient education on wound care and prevention 1

Common Pitfalls to Avoid

• Delayed referral: Waiting too long before initiating Home Health can lead to wound deterioration and increased risk of amputation 1
• Inadequate assessment: Failing to identify signs of infection or ischemia that require more urgent intervention
• Inappropriate dressing selection: Using dressings that don't match wound characteristics
• Neglecting offloading: Especially important for diabetic foot ulcers and pressure injuries
• Overlooking comorbidities: Diabetes, peripheral arterial disease, and nutritional status significantly impact wound healing 3

By following these guidelines, clinicians can ensure timely and appropriate referrals to Home Health for wound care, potentially improving outcomes and reducing complications associated with chronic, non-healing wounds.