Home health nurses and documentation problems - please help me understand.

[nursetobeoneday]

Hello everyone who works for home health!

Please make me understand the following (based on my experience as an admin for a home health):

-Sometimes is takes a month or even two months to get home health documentation from a field nurse

-The documentation is missing critical info or poorly chosen interventions resulting in office staff having to redo lot of the paperwork

I understand that home health nurses are swamped with paperwork. Yet, it makes NO SENSE to put off paperwork for a month or two when it will be even more time consuming to try to figure out what was done during home visit. It would appear that the most effective and fastest way to do this isduring pt visit or right after while all info is still fresh. This would likely reduce many errors in documentation.

- Submitting late paperwork is very unprofessional, irresponsible, and potentially dangerous. I thought that nurses, in general, are very professional and responsible. Am I wrong to assume such a thing?

I am really just looking for a way to get nurses to submit paperwork on time. What can I do or say to make that happen? It does not seem that paying extra money will do the trick since they do not care to get paid for a few months anyways ....

Finally, I was told this is how things are in homehealth and have always been so (chronically late paperwork & poor documentation). I refuse to believe that this is how it should be. There really must be an alternative because since when should we accept mediocrity and half done jobs?

Thanks for any help you can offer!

Best to all

[caliotter3]

Interesting question for the labor board. My agencies have all withheld the paycheck until they get the documentation. Don't know if any of them have done anything besides complain about late paperwork though. Have never heard of anything of consequence happening, except one time one of the agencies gave the nurses a warning about inappropriate documentation. They got blown off as usual. I went into the office one afternoon and saw a nurse sitting there with a stack of her notes working away at it. Nobody said a word, sour looks and nasty glances with daggers in them were going around the room and I left quickly. Strange thing, I had previously, in good faith, warned that very same nurse and she basically told me to go to you know where.

[nursel56]

That does sound extremely sketchy. I honestly did not know the field nurses had the authority to make the decisions about the frequency or skill level of the visits.

The reason we use the 485 and "document for reimbursement" is to make sure we are justifying the need for skilled nursing care. In my state they are only too happy to reduce a homecare patient's hours if the documentation doesn't reflect what is actually happening.

Sounds like a disaster waiting to happen!!

[nursetobeoneday]

Can we complain to the registered nursing board since not providing paperwork or returning calls to report on the case potentially puts the patient at risk (office does not know what is going on with patient).

Or at least, would this behavior be against regulations?

Thanks for any guidance.

[carwin]

If you can get administration on board, ideally you shouldn't process a log that has missing or improper documentation. ALSO, that nurse should not be given more cases until they properly document on the ones they have. I have found that to be most sucessful. BUT, you can't have administration caving in because you need a case opened or someone says that they just have to have their money. You have to be able to review notes so that they can be processed in time for payroll.

If a surveyor walks through the door and asks for a chart that has weeks of paperwork missing, they will want to know how do you handle clinicians who don't turn in paperwork. This is a form of neglect because you have no proof visits were made. You don't want to be in the position to explain missing paperwork. I had a nurse who opened 5 cases and never turned in the paperwork. We made various attempts to comtact, texting, voice mails and certified letters. We reported him to the state board of nursing.

Clinicians will say they will report you to the labor board for non-payment. You will be able to say to them that they didn't turn in appropriate paperwork and show them the policy. BUT IF ADMIN DOES NOT FOLLOW THROUGH YOU CAN HANG IT UP, HENCE MY ORIGINAL POST. REMEMBER TO ENFORCE THIS ACROSS THE BOARD SO NO ONE CAN GET YOU ON PLAYING FAVORITES. Sorry homecare nursing is not the "easy" nursing specialty so if staying organized is an issue, don't do it.

[RubyRN,CHPN]

A hallmark of an exceptional home health nurse is not only excellent clinical skills and critical thinking; it requires organization, ability to work autonomously, meet deadlines, self starter, prioritize, and be dependable. Sorry, this is not a job for slackers or a field where you go to hide or be put out to pasture. Seems like there are a multitude of good nurses looking for employment right now that are probably more than willing to be in compliance. to In order to do ones job nurses need the tools. Tools include a plan of care that accurately reflects the pt's. current needs and orders to cover the visits. Missing these tools puts pt. at risk because the pt. doesn't get the care the MD ordered and they are entitled to and any nurse at risk that attempts to see the pt. knowing these things are missing for obvious reasons. Protecting clinicians who don't turn in charting is a form of enablement, like others say falls back on you at survey. Submitting payment to insurance without proper documentation for visits and skilled care is fraud.

[caliotter3]

I find it unnerving when the family member enters the room and finds me working on my documentation instead of hovering over the patient. Even when I explain about the paperwork, I have been told that someone expects me to be doing something for the patient during the time I am there and "paperwork be damned" (my phrase to explain the attitude), "do that on your time" (actual words one time). Never a word of support from supervisors.

[carwin]

Tell the family that so that you don't get patients confused, the entire visit consists of patient time and paper time. Make a point of calling the doctor for orders or calling the office in front of the patient so that they see your are working on their behalf.

[nursel56]

Can we complain to the registered nursing board since not providing paperwork or returning calls to report on the case potentially puts the patient at risk (office does not know what is going on with patient).

Or at least, would this behavior be against regulations?

Thanks for any guidance.

You could, but then they'll all probably quit. It would be less stressful for all concerned to inform them of your intention to do things by the book- and replace those who choose not to adapt- sometimes all it takes for some people to change is the full realization that you are absolutely serious about their compliance.

[ErinS, BSN, RN]

I work in hospice, and this was an issue within our staff. We got a new manager though who has what she calls the bus philosophy. You do it her way or you get on a different bus. We document on the computer, but they require visits to be charted within 24 hours. The first nurse who did not do this and did not respond to requests to have charting done was allowed to resign. So the question is: do you want staff that are that resistant to change when the change is to promote pt safety? I thought our new manager did EXACTLY the right thing when that nurse was allowed to move on their way.

[caliotter3]

You could, but then they'll all probably quit. It would be less stressful for all concerned to inform them of your intention to do things by the book- and replace those who choose not to adapt- sometimes all it takes for some people to change is the full realization that you are absolutely serious about their compliance.

If all employers took this kind of approach, those who follow the rules would have less of a problem doing so. This policy would be also excellent for those who insist on committing fraud by falsifying their hours. It is so bad in some agencies that the clients insist that new nurses join in the practice because "their nurses" do it and "it's ok" by them. The agency should immediately fire people that do this. But most of the time the agency supervisors choose to look in the other direction and not address the problem, so you know they aren't going to do anything about day to day late documentation.

[nursel56]

I know--- and at times the situation starts to resemble a racket. Like if you want to keep your job, you'll play the way we do or not at all. So far, I've been lucky- not in the position to have to compromise or be shown the door. We had one nurse who tried it (only present for 2 or 3 hours of the 8) but this client was honest, and she stopped the practice. I wonder if they realize that what they are doing is actual theft- either from the taxpayers funding Medical/Medicare, their insurance companies, or the nurses who actually work for the hours they are paid for.

[caliotter3]

Nurses who commit insurance fraud and theft from their employers tend to have that sense of "entitlement" aura about them.