Discuss FromSoftware's Sekiro: Shadows Die Twice
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Using this item does not make you lose experience points or sens — contrary to Dark Souls or Bloodborne.
Can you use it in a boss 'room' ?
Yes -- however, it takes quite some time to "get you out". If the boss is agressive, I guess it will be nearly impossible to really use it as the boss will just try and hit you and thus cancelling you journey back to the Dilapidated Temple or last Sculptor's Idol. Can be managed but not in some cases.
No! It take more or less 10~15 seconds to work. Which is nearly impossible to use. It is really stupid considering the death penalty.
Pause the game and quit to escape boss rooms
Can you use it more than once?
Using Homeward Idol removes any of your active balloon buffs, making it a bit of a pain to use on farming runs for fast return to your idol.
Yeah, I learned about the lack of i-frames the hard way trying to bail out of a fight with a Headless. Should probably go see a proctologist
PSA about this thing:

If you use the Homeward Idol at the very beginning of the game (before getting disarmed by Genichiro), you will return to the well you've started with a FULL VITALITY BAR, thus saving pellets and a single Gourd use if you want to beat Genichiro for the first time.