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

  1. 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
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  2. 39 Comments

  3. by   BackfromRetirement
    Uh....no, not where i worked. Admissions were due completed the next morning, and daily paperwork was turned in daily.
  4. by   nursel56
    QUOTE=nursetobeoneday;435770. . . .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?
    Ah, the"everybody else is doing it" excuse! I think you have the right to communicate what is expected of them, and set up consequences if those expectations aren't being met. You're stressing, they aren't. They're turning in unacceptable documentation, you aren't. Give them back ownership of their actions. .002 Best wishes!
    Last edit by nursel56 on Jun 14, '10
  5. by   mamamerlee
    When we were on paper, we had 48 hours to get admissions in, and nothing got paid without paperwork. On the computer - 24 hours.

    And who does not want to get paid for months on end? Something is fishy here.

    Is this across the board in your agency? Time to clean house.
  6. by   tewdles
    not familiar with that situation...our documentation was required within 48hrs.
  7. by   wsuRN09
    Our documentation is due every friday or we don't get paid... not to mention the office supposedly will call you everyday until the paperwork is submitted.
  8. by   SunnyAndrsn
    I worked as a home care nurse for a medically fragile child for about a year. This child had RN care--no aides--for approximately 12 hours a day. There was a brand new nurse, straight out of school, and her only professional job was working for this child. Her documentation (lack there of) drove me crazy! I'd find out more about what was going on from the school (as we attended with him) than I would from the nurse. According to her, everything was always fine.

    As an example: "O2 sats stable this shift, except when the probe wasn't working right." Um, ????? No comments on changing the probe, contacting the company that provides the medical equipment, and no comment on how the client actually appeared during the time that the "probe wasn't working right." Left me with some fun CYA the next day.

    I discussed the situation with our agency, specifically citing her need for help with documentation and nothing was ever done :-(
  9. by   RubyRN,CHPN
    I remember at a former employer there were nurses who continuously called in sick at the end of month to complete paperwork because if their paperwork wasn't complete they wouldn't get paid. We were on computer and visit documentation were linked to a computerized time sheets on a day to day basis. When your documentation was complete, you checked a box on the time sheet page. This was your electronic signature. Several memos were made by management regarding timeframes to complete documentation as well as poorly written policies and procedures which were not updated when we went computerized. All were poorly enforced by management. If you pointed out to your supervisor these deficencies, they would find a reason to get on your case as a form of retaliation. As a case manager, I saw it putting so much unnecessary burden on the other nurses/casemanagers who were having to carry extra because of this and our patient care would suffer. Irronically, one of our biggest offenders was a nurse who then was promoted to home health manager! Go figure! I agree with OP in as to just how unsafe and how unprofessional it is. I agree with poster, time to clean house! Luckily, I was given an opportunity to move on to a more professional establishment. This is no longer an issues because if nurses aren't getting their work done, they are quickly weeded out.
  10. by   Lacie
    Our Nurses are required to turn in PW on Mon, Wed,Fri. We also check all our variances before Friday. If pw isnt in or incomplete they dont get paid. If pw doesnt have the proper documentation they have 24 hours to come into the office and make all corrections. Money tends to do the talk when they wont listen to anything else.
  11. by   carwin
    I sit here at work at 6:30 pm trying to write guidelines for completing our nursing notes. I've been DON for the past 2 monts. One of my nurses hung up on me today because she said she was sick of hearing how we must document for reimbursment as well as to show care provided. She said she's been in homecare for 20 years and knows what she is doing. I have nurses wanting to make 16 visits and all the notes say the same thing. They want the aide in for 16 visits and never want to make a sup visit. Who visits at that rate anymore? I question how many are visits are actually being done. Never is the 485 consulted as a guide for planning visits. The notes generally state the vital signs and a sentence or two saying "taught lasix and told patient not to take it at night" "progress to goals-status quo"; plan for next visit-teach and assess. Just because nursing care is occurring on a ratty old couch does not lessen the requirement for quality care and the accurate documentation of such. I don't understand stand why people don't think this documentation won't come back to haunt them personally. Survey-wise, these notes don't stand alone. RACs will have a field day with us. The notes appear to be a visit between two friends. All of our nurses are contingent so the owner doesn't want anyone to quit. I said you are paying for poor documentation and you will pay back if there is an audit. What is going on with our nursing profession-at the very least-chart to keep you license safe. We are in one of the target cities for fraud and they still aren't impressed. HELP!!! I love homecare and just hate to see what it has become.
  12. by   carwin
    Re: Home health nurses and documentation problems - please help me understand.
    I sit here at work at 6:30 pm trying to write guidelines for completing our nursing notes. I've been DON for the past 2 monts. One of my nurses hung up on me today because she said she was sick of hearing how we must document for reimbursment as well as to show care provided. She said she's been in homecare for 20 years and knows what she is doing. I have nurses wanting to make 16 visits and all the notes say the same thing. They want the aide in for 16 visits and never want to make a sup visit. Who visits at that rate anymore? I question how many are visits are actually being done. Never is the 485 consulted as a guide for planning visits. The notes generally state the vital signs and a sentence or two saying "taught lasix and told patient not to take it at night" "progress to goals-status quo"; plan for next visit-teach and assess. Just because nursing care is occurring on a ratty old couch does not lessen the requirement for quality care and the accurate documentation of such. I don't understand stand why people don't think this documentation won't come back to haunt them personally. Survey-wise, these notes don't stand alone. RACs will have a field day with us. The notes appear to be a visit between two friends. All of our nurses are contingent so the owner doesn't want anyone to quit. I said you are paying for poor documentation and you will pay back if there is an audit. What is going on with our nursing profession-at the very least-chart to keep you license safe. We are in one of the target cities for fraud and they still aren't impressed. HELP!!! I love homecare and just hate to see what it has become.
  13. by   nursetobeoneday
    I'm afraid money won't do the talk here. The nurses simply don't care if they get paid weekly or a few months down the line. They know they'll get their compensation one day down the line. The question I have, are we obligated to pay if paperwork is half done and get submitted a month or two late? Or even just pay partially?
  14. by   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.

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