Home Health Fiasco!

  1. My boss asks me to do an admit. The patient was coming home from the hospital per ambulance and the family requested we be there. Ok. Got the address, waited, no patient, waited some more no patient, waited, ok it's been 45 minutes now. I called my boss and she calls the CM. Calls back, the patient is staying with daughter on the "other" side of town. We forgot to tell you.

    Get to the daughter's home. I had some of the admit filled out by the paperwork faxed to me. i.e. meds, doctor, allergies, orders, labs etc.......They were all wrong!! Called the CM. Oh sorry she says. I ask where are the infusion supplies and meds, I was told they would be here ahead of the patient? Call the infusion company, oh we weren't told, be there in 2 hours!

    Start admission paperwork all over again. Infusion company shows up. The company supplying the ostomy supplies never showed either and patient has two colostomy's which are both leaking at the seal. Call them. Um we were told you were bringing the supplies. Why were you even contacted then, huh? I understand it was made clear to you that HH didn't supplies ostomy items.

    Going over contract with family. 8 visits total. The family says CM told them we were coming every day for 4 hours until patient expires. Um no honey that's not the truth. Did they not mention hospice to you?

    Teaching the family members about the medications, ask to see them, oh family member gone to pick them up. Family member returns, no meds. The pharmacy doesn't have any of them in stock! Patient begiinning to experience alot of pain. No pain med. IDDM - No insulin, no sliding scale to go by anyway! Not in the orders. Call the doctor, sorry forgot.

    Set up IV, wrong tubing, waiting again for supplies. This time they went to the wrong address. OMG. Please somebody do something right. 5 hours later I wrapped up the admit. My boss said, I am so.......sorry and I will pay you accordingly.

    I felt sorry for the family, they only want to care for their dying mother at home. With that said, my worst day so far in home health was still much better than my absolutely best day in med/surg. I'm still loving HH. I hope that never changes!
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  2. 17 Comments

  3. by   NRSKarenRN
    Great job...feeling of being able help that family pull it all together is empowering. They will never realize what all you did, but remember that you CARED.

    Who are these case managers telling patients they will have RN come at 7AM and stay for 4hours ???XXXOOOXXXX???
    They must have a sibiling living in Philly area too spreading mistruth.
    Last edit by NRSKarenRN on Jan 7, '06
  4. by   DutchgirlRN
    Quote from NRSKarenRN
    Great job...feeling off being able help that family pull it all together is empowering. They will never realize what all you did, but remember that you CARED.

    Who are these case managers telling patients they will have RN come at 7AM and stay for 4hours ???XXXOOOXXXX???
    They must have a sibiling living in Philly area too spreading mistruth.
    Thanks Karen. It really was pitiful. I can only tell you it was a hospital for people with no insurance. I hope I never have to deal with them again!
  5. by   CseMgr1
    Quote from NRSKarenRN
    Who are these case managers telling patients they will have RN come at 7AM and stay for 4hours ???XXXOOOXXXX???
    They must have a sibiling living in Philly area too spreading mistruth.
    Unfortunately this is the rule, rather than the exception, with hospital case managers having very little time these days to do discharge planning before their patients' LOS runs out, which involves a great deal of research and coordination of appropriate community services. Just another sign of the times...
  6. by   NRSKarenRN
    karen's discharge planning rule:
    discharge planning begins from the moment person enters a facility:started by er, staff, admission personnel, or floor rn.
    all persons should have a discharge plan started within first 24hrs.

    will add criteria later.... off to homecare intake office
  7. by   suzanne4
    That is how it is supposed to be at every facility, the paperwork started when the admission paperwork is done. And I am at a county facility.

    Sounds more like that case manager is just trying to pass the blame, and sorry, it is not happening. It is their responsibility.
  8. by   DutchgirlRN
    You're correct the case manager should begin planning for discharge when the pt is admitted by talking to all staff concerned including the RN. She was trying to pass the buck. I learned in Nursing School "The discharge begins at the time of admission" !
  9. by   suzanne4
    It still does. :angel2:
  10. by   Traveler
    What an awful day for you and your patient/family. I know that I would have been very frustrated if I had been in your shoes and could feel your frustration in your words. What I also saw though was wonderful and I think it is what is going to make you a wonderful home care nurse.... Your frustration was directed toward the "powers that be", not the family nor the patient. You have great empathy toward the patient and family, and that is what is going to get you through the tougher days (like this was). MAKE SURE they pay you for your extra time. After all, you do your job because you like it, but it's also for the money. I've done lots of extra things in my time in hh and have been promised so much only for many offers to be rescinded. I don't regret anything extra I have done that has helped patients, but make sure they live up to what they promise and don't take advantage of your kind heart.
  11. by   DutchgirlRN
    Thanks Traveler, So far this company has been really good to me and I was told I would get triple pay for this admit. You wanna hear the real kicker? That same evening my director got a call that the family had decided they would switch to hospice! Apparently the doctor had tried to persuade them but no they wanted Mom at home. After everything that happened and finding out that she would be giving pain meds Q 4 , turning Mom Q 2, etc, etc.....I think the daughter finally realized that she couldn't do it. The daughter also runs a full-time day care out of her home. I didn't see how it was going to work. I think Mom is better off with hospice.
  12. by   Traveler
    So the pt was transferred to inpatient hospice? I ask because we routinely transferred pts from our hh side to hospice. Same nurses visiting but different paperwork and focus.
  13. by   DutchgirlRN
    Quote from Traveler
    So the pt was transferred to inpatient hospice? I ask because we routinely transferred pts from our hh side to hospice. Same nurses visiting but different paperwork and focus.
    From what I understand "Alive Hospice" will be taking over her case completely. They (the family) will have a fixed amount of money to spend and they can choose to have nurses or sitters and for how long each will stay and what days they will work. When the money is up, it's up. They also have volunteers who sit with the patients as well as clergy members who help the family and dying patient at no cost. In other words, we got paid $75 for her admit and I'm getting $180 for her admit. My only concern is that the patient is comfortable and that the family feels well cared for. In HH I'm learning new things every day.
  14. by   DutchgirlRN
    Quote from DutchgirlRN
    You wanna hear the real kicker? That same evening my director got a call that the family had decided they would switch to hospice! I think Mom is better off with hospice.
    I had told this daughter that I did not think that her Mom had long to live. She said the doctors had told her they just didn't know, could be months.

    Having seen my share of Stage IV cancer patients I could see that we were talking days and I wanted her to be prepared because she was thinking weeks or even months.

    She called me today. As it turned out her Mom died the next day. She thanked me for letting her know that her Mom was indeed dying because she was able to get the whole family into town to be with Mom when she passed.

    She said the reason she had switched to hospice after I had just done that admission is that after I had left she noticed her Mom's breathing becoming very difficult and she got scared and was afraid to be alone with Mom when she passed so she called hospice for help. They sent over a minister and other volunteers.

    I'm glad it turned out the way it did. The poor woman was pitiful and blessfully passed.

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