Feel Good Visits

ksb13 · Sep 27, 2003

Define "feel good visit", does your agency know and approve these visits or are these done by individuals without agency backing? Our agency does the occasional "courtesy visit", usually a one time lab or assessment that MC is not going to reimburse, but it is agency approved, requires a signed MD order and a consent form. We do not generally do courtesy visits after being admitted, we may refer to waiver, MA, or private pay or have MSW see patient to assess for other resoureces. In cases where the MSW has been, no resources are available and the client really needs the care, we do it as an indigent claim. We do ask the patient to file for MA or other resources, but if they do not qualify, we provide the service anyway. On an individual basis, yes, over the years I think every nurse in my agency has made visits to patients on their own time and for personal reasons, but our agency has a clear guideline that in those cases the nurse is acting without agency backing and is individually responsible. Check with your agency and see what the current policy is.

britmess · Sep 27, 2003

The agency is aware of the visits and actually assigns nurses and aides, pays the staff but does not bill M/Care, there is no documentation. I applaud the charitable sentiment behind this but am uncomfortable with the legality.

ksb13 · Sep 27, 2003

I would be VERY uncomfortable with no documentation. When we do indigent care or courtesy visits, the same documentation is required as of any visit. Total assessments are done and all interventions, contacts, follow up plans are documented. I think if the agency is scheduling the visits, then legally they are responsible, but I would check with the powers that be in your agency and see what the written policy is. The agency has the right to provide as much indigent care as they choose, but should follow the same guidelines for care, doc, etc as for any payor source.

britmess · Oct 4, 2003

Thank you. So it is possible to make these non- billable visits but we must document them. Also courtesy visit sounds a lot better than 'feel good'.

renerian, BSN, RN · Oct 4, 2003

Yes you can do a visit and not bill but you need to document it and write no bill on it.

Nice you do that, not many do. renerian

seasonedlpn · Oct 5, 2003

Courtesy visit, or morally obligated visit? I have done many in the past, some free of charge, some for cash. It depends on the circumstances, and the relationship I feel with the patient.

If insurance will no longer pay for visits, and those visits are really needed, such as a bowel program or a minor wound care, I have no qualms about doing them. There is a prior agreement that I am on my own, and should a problem arise, a doctor MUST be notified.

Currently I am seeing two such patients; one is in end stage Multiple Sclerosis, the other a paraplegic living alone.

The M.S. patient is placed in his wheelchair by his wife before she goes to work. He has a Lifeline "pad" to call for help, but his wife can no longer make the trip home at lunch-time to feed him and transfer back to bed. He also needs a bowel program twice a week. Their insurance will no longer pay for his bowel programs, and the out-of-pocket cost would be three times what I make. I now see him 5 days a week, at my regular wage, and they end up paying less. The understanding is that if I should find him in any distress, I call the wife at her job, and she makes any decision. I am comfortable with this arrangement,(for the time being), and they call me their angel.

The paraplegic was a long time patient, as was his mother, before she died. After a few years of caring for people, you feel like family. When his mother had her open heart surgery, the hospital sent her home with a bottle of Phisohex and expected her to do her own scrub! They called me. I went. No charge. Of course it doesn't end there. When their cat was impacted, guess who was on the bathroom floor helping mom give the cat an oil enema? Yep...ME! Theirs was one of the many T.V. sets I helped put back on the stand after our California earthquake, and when Mom needed blood work, I drew it. Sometimes you just have to be willing to stick your neck out to help a person......the trick is knowing when to say no.

Our agency does some free work, but face it, money makes HH go 'round, not good deeds.

My general attitude is this: The agency signs my check, but God is my boss. I don't know what Jesus would do, but I feel I have to do a few good deeds once in a while, who knows, I might need help one day, and I can always remind "The Boss" that what goes around should come around. "Cast your bread upon the waters and it will come back a hundred (or is it a thousand) fold. I believe it.....I practice it!

We can't (and don't) always follow the Book, but a legal obligation is often quite different from a moral obligation. I hold the moral obligation to be the first priority, the agency doesn't have to know every move I make, they only sign my checks.

I like the words of Billy Graham when he said,"I work for God; the hours are lousy, the work is hard, the pay is awful.......but the retirement benefits are out of this world!"

I now step down from my soap box, thank you for hearing me out.

Oh God, Thy sea is so great, and my boat is so small.

renerian, BSN, RN · Oct 5, 2003

Everyone be aware though that if you see a patient on your own accord /and or you do not tell the company you are there or there is no reason to be there, during company hours and something happens, ie) and you are slapped with a lawsuit they most likely will not cover you against a a claim. Just a thought from the management side of things. Just a thought as well if you go somewhere to see a patient and do not reflect it in your documentation you have just now omitted part of your day from the record. So if something were to happen and this said patient called the agency and said mary smith was here this afternoon and now my watch is missing, you have turned in a daily visit record or however you record your patients/mileage time and such, without that clients name on it with is not the truth. You could be fired? Just a thought. Just being a manager here. I understand people going and checking up just reflect it on your paperwork or do it in your own time knowing if it is your off time you are not covered under the agency insurance. I have gone and stopped to see patients but on my own time, not as an agency rep (wear street clothes), I carry my own insurance and I make sure the client knows I am here as a friend not a nurse. I do not give advice/instruction during this visit as then I may be working without orders. It is a fine line we walk.

renerian

britmess · Nov 2, 2003

What is your opinion on aide visits? We often continue them after a pt. is discharged and there is no nurse visit. There is no documentation.

renerian, BSN, RN · Nov 2, 2003

Are you talking a certified or private duty client? Legally if you see someone on company time for a visit you need to make a note to CYA.

renerian

britmess · Nov 2, 2003

These are visits to Medicare patients who had previously been certified for a 60 day episode. There was no valid medical reason

to continue skilled nursing care therefore they were discharged. However, they still needed assistance for ADL's. How can we leave these people unattended yet still stay legally 'safe'?

renerian, BSN, RN · Nov 2, 2003

What you do to CYA is offer private duty. If you do not offer it give a list of ones that do and offer to call a referral. If they refuse you document that and you are covered.

renerian