Homebound and Hospital Instruction: Federal Rules & State Programs

Federal Regulations Governing Homebound and Hospital Education

In Title 34 of the federal code, Part 300, titled Assistance to States for the Education of Children with Disabilities, federal guidelines specify that state educational institutions are responsible for providing specially designed instruction for students with disabilities. Specifically, Section 300.26 lays out guidelines for the provision of such services, the settings in which they are to be provided, and the specifications for those provisions (34 CFR 300.26). In response, all fifty states now offer programs, including homebound and hospitalized services, for students unable to attend regular classes due to medical conditions. This paper discusses such programs, including the federal guidelines, specific state programs, an overview of services, and an examination of each state's particular requirements for homebound or hospital programs.

To understand the role of federal guidelines in establishing precedent for homebound and hospital educational services, it is necessary to understand the broader framework of special education regulation. Title 34 of the federal code specifically details the requirements for the provision of special education for students with disabilities. According to Section 300.26, special education refers to "specifically designed instruction" provided at no cost to parents that meets the needs of children with disabilities (34 CFR 300.26). The guidelines state this educational component should be offered in "the classroom, in the home, in hospitals and institutions, and in other settings" (34 CFR 300.26).

Additionally, Part (b)(3) of these guidelines states that specially designed instruction is to be adapted to the needs of the child, and is to be designed in a way that "ensures access of the child to the general curriculum, so that he or she can meet the educational standards within the jurisdiction of the public agency that apply to all children" (34 CFR 300.26).

Furthermore, Section 300.551 of Title 34 indicates that states are required to ensure a continuum of alternative placements for children with disabilities that include provisions in the environments listed in Section 300.26 (34 CFR 300.551). Section 300.552 lists specific criteria for such placement. These guidelines dictate that the placement of a child with a disability is determined by a combination of the parents, other individuals knowledgeable about the child, data relevant to the situation, and the available placement options. Further, the placement decision must be revised annually, be based on a program designed for success, be as close as possible to the child's home, and represent the best option for the child (34 CFR 300.552).

In addition to Title 34, Section 504 of the Rehabilitation Act of 1973 protects the rights of those with disabilities by stating that "no otherwise qualified individual with disabilities in the United States…shall, solely by reason of his/her disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance" (20 USC, Section 794). According to the guidelines, a person can be considered disabled under one of three circumstances. First, an individual with a physical or mental impairment that substantially limits one or more major life activities — including learning, hearing, walking, self-care, completion of manual tasks, breathing, and speaking — can be considered disabled. Second, any individual with a record of such an impairment can be considered disabled. Third, anyone believed to have such an impairment can be considered disabled. This third category includes those with a physical or mental impairment that does not limit activity but is treated as a limitation; those whose impairment is only such because of societal attitudes, such as an obese individual; and those with no outward impairment but a clear disadvantage, such as someone with HIV (34 CFR, Section 104.3(j)). In terms of education, Section 504 provides that schools receiving federal funding must provide a free and appropriate education in the least restrictive environment to students with physical or mental disabilities. Combined with Title 34, this means any disabled child must have an Individualized Education Program (IEP) — designed by parents and teachers — that ensures proper placement in the best possible educational environment for the student.

Finally, the Individuals with Disabilities Education Act (IDEA) provides that disabled students between the ages of three and twenty-one have a right to benefit from educational programs. This statute is more limiting than Section 504 in that it specifically defines "disabled" as a child with "mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities" (20 USC, 1401(3)(a)). Further, IDEA requires that the disabling condition result in a specific need for special education.

Section 504, on the other hand, broadened the criteria for special education services. By determining that a disability need only limit a major life activity, Section 504 allowed for services to be provided to children with such conditions as communicable diseases (including AIDS and tuberculosis), temporary disabilities such as short-term illness or injury, severe allergies, and other conditions. Further differences between Section 504 and IDEA are outlined in Appendix A. It was the introduction of these expanded definitions of disability that allowed states to begin providing homebound and hospital educational services.

General Program Overview and State-by-State Requirements

In an effort to comply with these federal regulations, the Board of Education for each state developed a program for children who are temporarily unable to attend a regular school setting. Given the breadth of the federal guidelines, each state has developed its own distinct program, resulting in a wide range of options. This section discusses homebound and hospital education programs in general terms and explains various state-by-state requirements.

In general, homebound and hospital programs are designed to help students who are unable to attend school due to a medical condition maintain their educational goals and continue to progress in spite of their condition. In many cases, students participating in such programs are only temporarily disabled due to injury, short-term illness, or another temporary issue. The instructor adapts the curriculum from the student's normal classroom environment to enable the student to continue learning while managing their condition. These services are not designed to replace regular school attendance, but rather to provide a temporary learning environment when a student is unable to attend regular classes (Michigan Dept of Education, 2003). In this way, homebound and hospital educational settings fulfill the federal requirement for continued and appropriate alternative educational placement.

To qualify for homebound or hospitalized services, a student must be enrolled in a public school. The district in which the student is enrolled is responsible for providing the content of the instruction, any required materials, assignments, instructors, and the determination of the number of instructional hours required each week. Each district is also responsible for determining the minimum number of days a student must be absent from regular classes to qualify for homebound or hospital services. These qualifications can vary greatly between districts within the same state (Michigan Dept of Education, 2003).

In general, the process for obtaining homebound or hospital services is consistent across states. First, the parent or guardian must submit information from a physician, hospital, treatment facility, or other qualified organization specifying the nature of the child's condition, the expected length of absence, and any limitations the condition may place on the child's activities, learning capabilities, or health. In most states, qualifying conditions may be medical, psychological, physical, or addiction-based (Michigan Dept of Education, 2003).

Once school officials have been notified of such a condition, many states require a meeting between staff and the parent or guardian to develop an IEP and to determine whether the student qualifies for special education under Section 504 or IDEA (see Appendix B). First, a determination is made as to whether the student's disability limits a major life activity — qualifying the student for Section 504 services — or whether it adversely affects educational performance, qualifying the student for IDEA services. If eligible under Section 504, the student must be provided with services comparable to those offered to other students with disabilities, including reasonable accommodations, physical and instructional materials, specialized instruction, related aids and services, and a formal accommodation plan. If eligible under IDEA, the district is required to provide specifically designed instruction and related services through an IEP. This plan is adapted to meet the student's educational needs and to create a pathway for the student to attain the highest level of educational achievement possible. Upon completion, the parents and staff agree to and implement the plan (Michigan Dept of Education, 2003).

States vary considerably in the number of absences required before homebound or hospital services will be considered. In some states, students need only be absent for five consecutive school days to be eligible, as in Florida and Kansas. Other states require two weeks of consecutive absences, such as Alabama, New York, and South Carolina. Still others, such as Nevada and North Carolina, require four weeks or more of absence before a student is eligible for home instruction (see Appendix C).

In terms of instructional requirements, states vary greatly. In some states, such as Alaska and Hawaii, homebound or hospital instructors are not required to hold certified teaching certificates and serve solely as tutors. They obtain classroom materials from the student's regular instructor and assist the student in completing assignments. In other states, such as New York and Texas, the individual providing instruction must hold a valid teaching certificate in the state, and some states additionally require special education training certification (see Appendix C).

Required instructional hours per week also vary widely. In most states, at least five hours per week — equivalent to one hour per missed school day — is considered adequate. Other states maintain separate requirements for elementary and secondary students. In Delaware, for example, elementary students are required to receive at least three hours of homebound or hospital instruction per week, while secondary students are required to receive at least five hours. States such as Florida and Illinois require one to two hours per week per subject, while others, such as Missouri and Pennsylvania, determine required hours based on the individual student's educational needs (see Appendix C).

Conclusion

There can be no question that long-term illness or injury can be devastating for a student's educational goals. However, as the federal guidelines specify, this does not mean the child is not eligible for the same educational services as students without such conditions. Every state has implemented a homebound/hospital program for such circumstances, and all families are entitled to receive these services at no charge from their school districts. From the federal government's general guidelines to the specific requirements of each state, homebound and hospital educational programs continue to develop in an effort to maximize every student's educational achievement, regardless of circumstances. By working together, parents, staff, and authorities can ensure that every child receives the education he or she deserves.

Appendix A: Major Differences Between IDEA and Section 504

Who Is Protected

IDEA: Lists 13 categories of qualifying conditions.

Section 504: Much broader. A student is eligible if he or she meets the definition of a qualified person with a disability — that is, has or has had a physical or mental impairment that substantially limits a major life activity, or is regarded as disabled by others.

Duty to Provide a Free Appropriate Education

Both IDEA and Section 504 require the provision of a free and appropriate education to covered students, including individually designed instruction.

IDEA: Requires the district to provide an IEP. "Appropriate education" means a program designed to provide "educational benefit."

Section 504: "Appropriate" means an education comparable to the education provided to non-disabled students.

Special Education vs. Regular Education

IDEA: A student is eligible to receive services only if the multidisciplinary team determines the student has one of the 13 listed disabilities and needs special education.

Section 504: A student is eligible as long as he or she meets the definition of a qualified person with a disability. The student is not required to need special education in order to be protected.

Funding

IDEA: If a student is eligible, the district receives additional funding.

Section 504: No additional funds are provided.

Accessibility

IDEA: Not specifically addressed, although modifications necessary to provide a free appropriate education must be made.

Section 504: Contains detailed regulations regarding building and program accessibility.

Procedural Safeguards

Both require notice to the parent or guardian regarding identification, evaluation, placement, and the provision of a free and appropriate public education.

IDEA: Requires written notice. Notice provisions are comprehensive and specifically spell out minimum content requirements. Written notice is required prior to any change in placement.

Section 504: Does not explicitly require written notice, though it is advisable. Notice is required only before a "significant" change in placement.

Evaluations

IDEA: Consent is required before an initial evaluation is conducted. Reevaluations must be conducted at least every three years. Provides for independent evaluations.

Section 504: Only notice, not consent, is required. Requires periodic reevaluations. A full reevaluation is not required; a review of progress and current evaluation information is required prior to a change in placement. Independent evaluations are not required.

Grievance Procedure

IDEA: Does not require a grievance procedure or a compliance officer.

Section 504: Districts with more than 15 employees must designate an employee responsible for ensuring district compliance with Section 504 and must provide a grievance procedure for parents, students, and employees.

Due Process Hearings

Both require districts to provide impartial hearings for parents or guardians who disagree with the identification, evaluation, placement, or provision of a free and appropriate public education. The rules are virtually identical.

Exhaustion

IDEA: The parent or guardian must pursue the administrative hearing before seeking redress in the courts.

Section 504: No exhaustion requirement.

Enforcement

IDEA: Not enforced by the Office for Civil Rights (OCR). Compliance is monitored by the state Department of Elementary and Secondary Education.

Section 504: Enforced by the Office for Civil Rights.

Source: Missouri Dept of Education, 1993, Student Access, p. 16.

Appendix C: Homebound/Hospital Requirements by State

The following table summarizes the homebound and hospital education requirements for each state, including the number of days of absence required for eligibility, whether a certified teacher is required, and the minimum instructional hours per week. Requirements vary significantly between states. For example, Alabama and South Carolina require approximately two weeks of consecutive absences, while Florida and Kansas require only five consecutive school days. Alaska and Hawaii do not require certified teachers, while New York and Texas mandate valid state teaching certificates. Delaware distinguishes between elementary students (minimum three hours per week) and secondary students (minimum five hours per week), while Florida and Illinois base requirements on hours per subject, and Missouri and Pennsylvania tailor hours to the individual student's needs.

See reference listing for source information by state.