Home health has become too much!

[I<3H2O, BSN, RN]

I'm just about at my wits end. I cannot keep staff. Everyone is stressed about the continuously updated list of "you must have this on every chart" that they are ready to give up. Our OASIS reviewers/coders make so many changes to the 485/OASIS that the nurses and therapists have actually stated "why do we even take time to do the assessment because the coders change everything."

Our company was was recently sold to another huge company and if it doesn't get remarkably better soon, I have to leave. They want these 485s to have 10+ safety measures (who has heard of diabetic precautions, incontinent precautions, etc), 4-8 functional limitations (urinary incont as a limitation? Cmon the let a few drops loose when they sneeze!). They make recommendations to add the route to oxygen. How are they going to take it...rectally? Specific dates for goals to be met? What a joke! You damn well better document a FSBS and diabetic foot check on every diabetic pt, every single visit OR ELSE! No matter that the pt denies being diabetic or the fact that 4 medical records say not diabetic but ONE does.

There is so much that MUST be done but you better get X visits done per day and don't have OT. Two hours for a SOC? Sometimes it takes 40minutes to complete an accurate medication reconciliation. :/

are you all all seeing this type of stuff?

[Tigerlily8]

Does anyone know if it is legal in the state of Texas to withhold pay until documentation is complete? Is this a common practice?

[caliotter3]

Does anyone know if it is legal in the state of Texas to withhold pay until documentation is complete? Is this a common practice?

It is a common practice, but not legal at least in my state, per information provided by a representative at the Labor Board. They stated that the work was done when the nursing care was provided to the patient, the resulting paperwork is only a part of how the work was done.

[OldDude]

Does anyone know if it is legal in the state of Texas to withhold pay until documentation is complete? Is this a common practice?

It's according to your employment agreement. If you are paid by the visit then your visit isn't considered complete until you complete the documentation. Otherwise, unless you've signed a contract with that specific terminology about withholding compensation until documentation is complete it is illegal.

[OldDude]

I hear you...I tried home health back when the licensed staff completed everything on paper, turned the paper into a bank of data entry clerks who entered it the next day, printed whatever documentation it was, gave it back to you for proofreading and signature the next day and in the mail for billing the following day, if not the same day. Staff could churn out the visits and generate the billing and still have a life!! Then technology came onto the scene and we were issued "computers." After a couple of months of that I had had enough. All of a sudden patient care had taken a back seat to the "computer" and it's only gotten worse since then. I handed my resignation letter to the the DON and told her to throw the computer in the trash. I haven't worked HH since. My wife however, is a HH PT and worked during the time I did and is still employed in Home Health. Over the last 10 years her annual salary has dropped about $30,000.00 and she puts in about 4 hours every night completing documentation. Like I say...I hear ya.

[NRSKarenRN, BSN, RN]

I am one of the QA nurses staff love to hate. Under Medicare payment is based on FUNCTIONAL deficits listed on the OASIS which needs to match the 485 plan of care. Incontinence IS a functional deficit, can lead to falls and should be listed on every client. I add functional deficit answers to about 90% charts i review.

I highly suggest you attend an OASIS training workshop or at least check out OASIS Answers website for CMS Q+A sections to understand CMS guidance on answering questions. In speaking with my manager, since I attended a Blueprint for OASIS Accuracy workshop, my clients functional scores have improved as reflected at discharge along with agency's functional scores above state average as reported on CMS website.