Considering Home Health but not buying their story . . . - page 2

Hi! I am new to this website and it seems like a wonderful place to get advice. I am getting ready to return to work after staying home with my kids for a year and I am nervous about choosing the... Read More

  1. by   SmittyLPN
    HmarieD (and anybody else who may know),
    I am also confused, but then I don't know much about home health, medicare or medicaid. Which why I started this thread to begin with. Is there some other kind of home care other than "home health" that nurses provide? When I spoke to the RN that manages the office where I interviewed she actually made the statement "we're not Home health" so what are they? They take only medicaid patients/clients that are "stable" and here's the exact description of their medical services off their website " Nurse visits offer skilled maintenance and preventive nursing services to clients with stable chronic conditions. Services include filling insulin for diabetics, setting up oral medications, monitoring skin conditions, providing diabetic nail care, and now, new medication management services." Please keep in mind that I am not an RN so I don't expect to be doing hospital type care in the home. But I don't want to end up doing HHA work either, and I am not a babysitter.
    Really it sounds like most of the visits fall into the above description and the rest are medicaid required assessments occurring either monthly or q6months. And I'd totally settle for that description but eveyone keeps telling me not to fall for it. Perhaps I just don't know enough about the medicaid programs that Missouri offers to know what is going on. I did find out that they actually do offer benefits incuding PTO and 401k, so now the only truly "bad" thing is the low pay. Aside from that this job sounds like what I've been looking for since nursing school 7 years ago, just wish I could figure out exactly what I'd be getting into skill-wise :icon_roll.
  2. by   caliotter3
    Some people use the phrase "home health" to refer to intermittent visits of short duration as opposed to "continuous care" or "shift work", which consists of routine nursing care for stable patients in the home setting. Shift work usually consists of a minimum of four hours and that is what the client is billed for, a minimum of four hours. Intermittent visits average 45 minutes to one hour in length. These are the type of visits that occur for a short time after a hospital stay and have a limited time frame, e.g. for 8 weeks following surgery. Shift work goes on forever, as long as the client can't do for themselves. It prevents them from having to exist in a long term care facility. Another term commonly used for shift work is "private duty", although technically private duty refers to when the patient hires and fires their private caregivers and pays out of pocket, i.e. "private pay". HTH
  3. by   SmittyLPN
    Thanks for the explanation, it helps. Although according to your description it sounds like this agency has taken "continuous care" hours and spread them over the course of a month to allow for visits.? Each client has a HHA and the LPN's do 20-60 minute visits. Patients are not usually fresh out of the hospital, but instead are referred by thier PCP. Once the patients are referred to the agency they are a patient "long-term", usually until they can no longer be cared for in the home or pass away. There is no set time frame for completion of care. The goal is apparently to keep these seniors out of a nursing home as long as possible and keep "costs" of care down. I think I am starting to get the idea pf how this works and where it falls into "home-health" and "community outreach", so we'll see . . .
  4. by   caliotter3
    I agree with you that this agency has taken a minimal number of authorized hours and spread them out throughout the month. I once had a client who periodically lost hours because agencies could not get nurses to work the case. It was almost at the point you describe. One more decrease in hours and she would have been without outside care at all.
  5. by   KateRN1
    Smitty, years ago I did Title XX (Medicaid) visits (in MO) and this sounds just like that. Yes, the pay is low because Medicaid reimburses at an amazingly low rate. These are state-funded hours that the patient qualifies for through the Division of Aging (state), not Medicare (federal). Each pt has a certain number of hours that are approved by the Div of Aging and those are divided up by week. Usually these patients are not eligible for Medicare-funded home health, but have chronic conditions and are indigent, so they qualify for Medicaid. The rationale behind this is that it's cheaper for Medicaid to provide in-home services rather than foot the bill for a skilled nursing facility or group home (I had several MR/DD pts).

    You won't be doing Aide work, usually they have a HHA assigned to them as well who does the baths and that sort of thing. You will be doing just what you described above, assessments (documentation for continued need for care for the DoA), foot care, possibly sup visits of the aides. It's kind of like doing home visits for the type of patients that you often wonder why they're in the nursing home, ya know?

    Anyway, I really enjoyed it (mostly) when I did it. It was reasonably easy work and allowed me to go to school at the same time without killing myself. Feel free to PM me for more details.
  6. by   SmittyLPN
    Finally, an explanation that really makes sense! Thank You KateRN1, and no offense to anyone else who replied, I appreciate you too. Now I understand what this agency is all about. Your description, KateRN1, fits perfectly with the answers the agency has been giving me. I'd PM 'ya but I don't have AOL.
    I would really love to just jump right in and give this type if nursing a try, but the hours combined with the lower pay are hard to get past. The position is 20 visits a week but there are no guarantees and if they drop too far below 15 I barely break even with daycare costs. Of course that doesn't include the mileage pay (.48 per mile) but I can't expect extra money from that. (Although it is quite significant with all the country driving and I'd never spend it all on gas.)
    I actually accepted the clinic job and went to general orientation today. The decision was solely based on potential income so I am not too excited about attending nursing orientation next week. Too be honest, all I could think about today was how much I'd rather be doing the other job . I guess that really tells me what I should do, but How do you cope the potential fluctuation of hours? Perhaps I am just over thinking things, after all my income is really just fun money and I did origionally set out to find a part-time job. Funny how an offer of better money changes one's perspective . . .
  7. by   caliotter3
    The previous answer makes sense to someone who hasn't been told how medicaid works, however, it does not account for home health agencies that get reimbursed from the medicaid program, and still pay their nurses a nurse's wage.
  8. by   SmittyLPN
    I am not so concerned at this point with what other home health nurses make. At this point I need to make a personal decision about whether I want to make a lot of money and work long hours or do I want more time with my young children. I know what the "going rate" for home health LPN's is in my area and I also know what my time is worth. I have other things that I want to accomplish every week besides being a nurse so I am trying to weigh the pros and cons of money vs time. I don't feel that taking less pay makes someone any less of a nurse, just depends on your career goals. I've got a pretty good career as a Mom right now and I don't want to screw that up just to make an extra $2.00/hr. Let's put the issue of what I "should be paid" to rest b/c the actual wage is no longer an issue.
  9. by   KateRN1
    You don't need AOL to do a PM on I don't use AOL either. At the top of the message where I replied to you, you'll see a little icon that looks like a pencil and paper (just under the red flag after my user name). Click that to send me a PM.

    Agencies that only do Medicaid don't pay their nurses or aides very well, sadly. Agencies that do Medicare in addition to Medicaid generally manage to generate a little bit of revenue through the Medicare cases and take a loss or break even on the Medicaid. At the time that I did Medicaid visits, most of the nurses used it for a second job and not their primary source of income. Still, I was never at a loss for visits, since so many people qualify for the Medicaid program and it doesn't require the kind of documentation for recert that Medicare does. It really is often a program for life, since you're dealing with people who have chronic healthcare issues that need to be addressed. Some of the patients that I dealt with, for example, were quads who lived at home with family, a MR/DD teenager with CP, and a quad who required a hoyer lift for transfers. Most of my patients were younger, certainly below the Medicare age. Keep in mind that Medicaid is administered by individual states and may be different outside of MO.

    Smitty, if you want to give it a try, ask if they can use you as a slim-PRN, maybe a couple of visits a week or some weekend visits. The agency I was with was always hurting for weekend nurses. That way, you can try it out and see if you like it. Money isn't everything, as you said, and that kind of nursing has always been very rewarding for me--keeping people at home rather than institutionalizing them when they really just need a little bit of help. Either way, good luck!
  10. by   KateRN1
    Oh, forgot to add that 15 years ago, I was routinely bringing home $750-$900/q2w only for mileage, and if I remember, it was reimbursed at $.33 per mile. Something like that. I would drive--in one day, mind you--from Springfield to ten miles past Bruner, to Republic, and then back to Springfield. Other days, I would drive from Springfield to Mt. Vernon, then Humansville, Bolivar, and back to Springfield. I often spent more time in the car than in the homes. But I loved it. So much freedom and autonomy!
  11. by   SmittyLPN
    Thank you for your positive view on this. It is nice to read that someone really seems to have enjoyed this type of nursing and has actual experience doing it in MO. It is hard I think to compare apples to oranges (for lack of a better phrase). Your post reinforce what the other nurses were telling me about how much they loved doing this. You are encouraging my temptation to just go for it.
  12. by   SmittyLPN
    Quote from KateRN1
    I would drive--in one day, mind you--from Springfield to ten miles past Bruner, to Republic, and then back to Springfield. Other days, I would drive from Springfield to Mt. Vernon, then Humansville, Bolivar, and back to Springfield. I often spent more time in the car than in the homes. But I loved it. So much freedom and autonomy!
    This drive sounds like what I would be doing. At least one day a week I would be driving what I call the "country loop", 117 highway miles round trip plus the miles for whatever stops in towns along the way. It's at least 2 hours of drive time but 2 hours in the car is way better than 8 hours confined to an office any day.
    Last edit by SmittyLPN on May 27, '09 : Reason: spelling
  13. by   NRSKarenRN
    My previous employer provided aides for personal care assistance funded by state medicaid monies.
    Supervisory visits were required every 14 days in patients home: 1 visit in person with aide, other visit with just client to confirm no issues pt was too afraid to discuss with aide present.

    Visit included:
    a. Review of care plan in the chart matched careplan on refrigerator--- or did that care plan grow legs and missing again. Did care plan need to be adjusted due to change in pts health status?
    b. Did aides notes match care plan?
    c. Was aide showing up and staying for entire time interval supposed to be in home?
    d. Was aide abusive to patient?
    e. Did patient look well cared for, home reasonably clean and neat, food in refrigerator, current meds in home?
    f. Any decline in patients health or unmet health needs that showed need for skilled visits?
    g. Provide monthly verbal report to office of aging case manager.
    h. Monthly medication prefills needed for some patients -but was considered skilled care under another program.
    i. Provided monthly inservice topic to aides and was able to give them 1 hr credit.

    I sometimes had 10 patients in one senior highrise ---could be in and out of patients home within 15-20 minutes and see all 10 regulars in one day. Other days, patients all lived in outlying territory and may drive 125 miles roundtrip and only see 5 paitents. Calling clients 2 days before visit to make sure would be home + reconfirming expected visit time afternoon before helped to eliminate missed visits.

    I'd found pts in roach infested homes as aide didn;t show up for days and uneaten food from MOW delivery piled up next to couch.... forgetful souls signing blank forms and aide in and out in 30 min but wrote down 2 hrs.... wonderful aides who kept wc/bedbound paitents alive as only person patient saw as family abandoned them and aides did everything to keep them in their home and out of nursing home.

    It was one of the most rewarding positions I had as able to make great impact on individual lives---taught me community resources that I was totally unaware of and added to my bag of tricks today.
    Last edit by NRSKarenRN on May 28, '09