Home and Hospital Instruction

Home and Hospital Instruction (sometimes called "homebound instruction") is free public schooling for students who are unable to attend school in person for medical reasons.

The purpose of home and hospital instruction is to allow students to keep up with their classroom curriculum and make educational progress when they are absent.

In every state, students have a right to home and hospital instruction when they are absent for medical reasons. However, details about the laws vary by state. Usually, students can receive 1-2 hours a day of academic instruction, plus any IEP services that are possible to deliver. This article describes the laws in Massachusetts.

Students are eligible for home and hospital instruction if they:

• are ages 3 - 21, have been evaluated by the school district, and have been found eligible for Special Education, AND/OR

• are enrolled in public school in grades Kindergarten - grade 12 (including a regular public school, a charter school, or any other school that the public district is funding), AND

• have 14 or more medically-necessary absences within a school year (these absences can be consecutive, or can be scattered over the school year)

When a student has been evaluated and qualifies for an IEP, then their school principal and Special Education administrator work together to plan and deliver their education program. They must try to deliver the student's program as completely as possible, as long as it does not interfere with a student's medical treatment and recovery.

Students with an IEP have a right to all the services listed on their IEP, plus general classroom instruction. This means that while they are confined at home or in the hospital, students might receive services such as:

• instruction in reading, writing, math, social studies, and science

• occupational therapy (OT)

• speech and language therapy

• physical therapy (PT)

• counseling

• life skills instruction

• vocational training

Schools, families, and medical providers can work together creatively and flexibly to deliver a student's services as completely as possible.

All students have a right to free and appropriate public education, regardless of their health status. When a public-school student with no documented disabilities must be out of school, they can still receive home and hospital instruction as part of general education.

When students do not qualify for Special Education, home and hospital instruction is planned and coordinated by their school principal.

For general education students, home and hospital instruction should help them to keep up with their classroom curriculum. Their instruction usually includes reading, writing, math, social studies, and science.

While home and hospital instruction can never replicate being in class, the principal and family can work together to make sure it educates the student as well as possible.

Students who are homeschooled are eligible for home and hospital instruction if they have been evaluated, and have been found eligible for an IEP. A homeschooled child can receive all the services described in their IEP during their medical absence.

Students who are homeschooled and have not been found eligible for Special Education have two choices so that they can get home and hospital instruction:

1. If the child has a disability that would prevent them from making meaningful progress appropriate to their ability at school, then the family can request a Special Education eligibility evaluation. If the child is found eligible of Special Education, then they have a right to home and hospital instruction whether or not they enroll in public school.

2. If the child would not qualify for Special Education, then the family can enroll the child in public school. As soon as the child is enrolled in public school, they have a right to home and hospital instruction.

Preschool age children (ages 3-5) have a right to home and hospital instruction if:

• they have been evaluated and are eligible for Special Education, and/or

• they live in a state with universal public preschool

Preschoolers who have an IEP have a right to receive all their IEP services during their medical absence, to the degree possible.

Sometimes preschoolers have a disability that limits their learning, but have never been evaluated by their school district. Families can request a Special Education eligibility evaluation from their school district for any child ages 2 years, 9 months or older. If they qualify, their services would start when they turn 3.

If the child has a disability and qualifies for Special Education, then they immediately have the right to home and hospital instruction.

Students enrolled in a public 18-22 program have a right to home and hospital instruction during extended medical absences. As with younger students, they should receive all the services listed on their IEP, to the extent possible.

During medical absences, 18-22 students may receive services such as:

• instruction in functional reading, writing, and math

• job/vocational training

• life skills

• social skills

• counseling

• occupational therapy (OT)

• physical therapy (PT)

• speech and language therapy

The school principal and the Special Education administrator should work together with the family to arrange the student's services.

If a young adult is hospitalized in an adult hospital, their doctors may not know about their right to home and hospital instruction. Families and young adults can educate the medical team about this right, and help the school and clinicians to coordinate the educational program.

Families can follow this process in order to set up home and hospital instruction for their child:

• The student's doctor provides a letter saying that the child must be absent for 14 days or more for medical reasons. This letter must include:

  • the date the required absence starts

  • the medical reason(s) for the absence

  • how long the absence is expected to last

  • what medical needs the team should consider when planning the student's instruction

• The family contacts the school, talks with the principal (and Special Education administrator, if relevant), and requests the home and hospital services.

• The school begins providing the services without delay.

Home and hospital instruction can be provided in many different ways depending in an individual student's circumstances.

Instruction could involve any combination of:

• school district employees teaching the child in-person, at their home or in the hospital

• school district employees teaching the child remotely, over a computer

• the student live-streaming their regular classes

• the school district paying hospital staff to provide the services

• the school district paying another school district's employees to provide the services

• the school district paying a private company to provide the services

Educators should design home and hospital instruction so that it helps a student to keep up with the curriculum, to make progress, and to avoid regression.

Legally, home and hospital instruction must meet these requirements:

• students must be taught the same academic content as in their school

• teachers must meet the same teacher certification requirements as any other teacher in the district, although they do not need to be certified within each subject area

• teachers must be able to effectively provide the required instruction to the students

• teachers must coordinate their teaching and curriculum with the public school district

• Special Education services must either be provided by a certified Special Education teacher, or closely supervised by a certified Special Education teacher

• the instruction must be offered at a time that is feasible for the family

• the school and family should keep track of any IEP services that are missed, so that the school can provide the student with compensatory services after their discharge from the hospital and/or return to school

Schools and families have a lot of flexibility in designing home and hospital instruction programs. Many programs are legal, but may not meet a student's needs as well as they could.

For most students, home and hospital instruction works best when:

• the student uses the actual curriculum materials from their own classroom (books, computers, workbooks, computer software, etc.)

• certified teachers and therapists from the child's own district provide the instruction

• the student receives instruction daily, for at least 1 hour a day (more is required in some states)

• the student has a chance to virtually join their class for part of each school day, and for special events

• when relevant, the student participates remotely in small-group services such as speech and language therapy and academic instruction

• the student and their classmates are able to send physical objects back and forth (art projects, writing work, etc)

• the student is involved in the daily life of their classroom as much as possible

• a certified Special Education teacher with the right sub-specialization provides academic instruction to any student with an IEP (example: an intensive SPED teacher for a student who requires intensive services, a SPED teacher who specializes in specific learning disabilities for a student with dyslexia)

• the student's progress is regularly monitored by the teacher using the same tools the school district uses

• the school district plans an evaluation and IEP reconvene meeting prior to the student's return to school if the child has a documented or suspected disability

• the doctor documents expected absences at the beginning of each school year if a child consistently has 14+ absences a year, or if there is good reason to believe the child will have 14+ absences in an upcoming school year

Some children have absences that last much longer than 14 days.

When a child who qualifies for an IEP is going to be absent for 60 days or more within a school year, the doctor and family should immediately tell the school district. The school's Special Education administrator must schedule an IEP meeting within 10 days.

During the meeting, the IEP team should decide if the child needs additional testing, and if the child's IEP should be updated in order to meet their needs.

Despite their federally-mandated right to home and hospital instruction, many sick students do not receive the education they deserve. Hospital staff, families, and even school staff do not always fully understand the law surrounding home and hospital instruction.

Families of students with heart defects often need to act as their own advocates, and insist that their child receive the educational services they require. If a student's needs are not met, families may seek help from an educational advocate, educational lawyer, their state's Education Department Problem Resolution Office, or their state's Bureau of Special Education. See below for resources that may help.

This content was reviewed by an educator at Boston Children’s Hospital.

These links are provided as resources only. Boston Children's Hospital and the Benderson Family Heart Center don't necessarily endorse all of the information on these sites.

Families local to Boston can contact the Cardiac Neurodevelopmental Program at Boston Children's Hospital for services related to learning and education.