HOW IN THE HECK DOES HOME HEALTH CARE WORK?

Agnus · Jan 29, 2000

Originally posted by adireen:

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1. Do you call up the patients and tell them, "OK, I have an 8 a.m. opening," and they say "OK," or does the agency line up your appointments?

Ans. Usually you need to call the client. And you work around your schedule and theirs to arrange the visit.

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2. What about if you need directions in going to someone's house? Do you ask the person you're seeing for the directions or does the agency just give you a map and say, "HERE! look it up!"

There will most likely be directions available when you are given the assignment. Getting directions is part of the intake process. It is not a bad idea to call the client to clarify fuzzy directions.

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3. How much time do you need to allow for each patient and what if it runs short/long, and you are early/late in getting to the next one?

Customarily we allow 1 hr per visit. However, this depends on the needs of the client. I would ask your supervisor if you need to allow more time with a client whom you do not know. If this client is new to the company allow at least 2 hours for an initial visit. The initial assessment and paperwork will definitely take this long.

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4. Do you have to call the pt when you are running late/early?

Yes

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5. What happens if you get there and don't know what to do? Say, this is a new procedure for you and you are clueless or worse yet, forget how to do it? Can you call the agency and get help?

Yes

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6. Would they fire you over this?

Not likely. If you misrepresented yourself, maybe. If you handle it badly possibly. Be honest with you employer. Your company is there to support you. If you find this is not the case then you need to go somewhere else.

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7. Also, do you know what each pt of the day's travels will require ahead of time? Do you get a list of their history and what they need done that day?

Sometimes. You should carry everything that you might possibly need for that client with you.

Sometimes this is a new client that you are admitting so you will make these assessments yourself, and be getting the history.

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8. How do you schedule appointments? For example, if I were to be an HHN, I would want to work probably 7:30 a.m. to 5 p.m., and only those hours, probably 3 days per week, while my child is in school, for example . . . are you allowed this type of self-scheduling?

Actually most of the time this will be exactly the type of schedule you will have. Talk to you company.

There is a lot of flexibility in home care in that if you can only work certain times or days you can usually arrange to have only clients that fit your schedule.

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9. is the above-mentioned type of schedule hard to come by in home health?

Relax, the first visit is the scariest. But often you will be allowed to accompany another nurse for a day or two. Once you get past your first one or two clients on you own the fear vanishes. You are not all alone you can call you company for help when you need it. It is rare to send a nurse to a client needing skills she doesn't have. If that ever happens call immediately. No care company wants to put you or themselves in situation of liability.

It is a wonderful field, requiring creativity, flexibility, and tolerance.

W., RN, BSN · Jan 30, 2000

With five years of home care experience, I can tell you how these things work in the agencies in which I have worked and in my state (GA). Of course, these general guidelines are effected often by complications and unexpected changes!

1. First of all, you don't work by appointments. You will create a lot of difficulties for yourself if you do this. Our general rule of thumb is to, through the use of strong organizational skills, organize your day first by a.m. and p.m. visits. These are the visits that are generally going to have to be performed within a pretty tight time frame (your a.m./p.m. insulins, infusions, dressing changes if they're BID). Secondly, when you make your calls to your patients that morning, you can say, "I expect to be there before lunch (or after lunch), is that okay?" These patients are usually homebound and aren't expecting to go anywhere-but sometimes you get difficult ones anyway. That gives you some cushion for you to run early/late. The agency expects you to be pretty independent in planning your day.

2. Directions: If it is an established patient but you're a nurse that hasn't seen them yet--we have direction sheets on the chart or in the handheld computer. If it is a patient that is new, the referral comes with a home phone number. You call and ask directions to the home. A map is useful to have, though, because some of the patients will say, "You take a left at the Old Crossroads Church, they tore that down about ten years ago, you know where that is? Well, then, you take a left by a real big old oak tree-you can't miss it." -- Don't laugh, it really happens! A cell phone is also useful if you can't find the house after all, so you can call the patient back. I must also mention that you need to be efficient in planning your day according to where the patients live-a map can help if you don't know so you can kind of look according to their address. That way you won't be retracing your steps.

3. Usual visit times are 30 min-1 hr, though there have been many times I go over that. Post-hospitals 1 - 1 1/2 hrs and admissions (RNs only) 1-2 hours. Short/long and early/late: don't make appointments as stated earlier.

4. If you are running early/later than you told patient, yes, you do call the patient and let them know. This should not happen often though, and once you get the hang of it, will be easier than it appears.

5. You should have an office nurse that you can call to back you up/get an opinion from in case you need help, which I have at times. The agencies I have worked at have been very good to send a nurse out with you if it is a new procedure for you and check you off - show you how to do it and get you to return demonstrate. I have been in situations, though, where I have asked for help and the nurse would say, "You know how to do that, it's easy." And I would just have to be firm and say, "No, I have never performed this procedure before and need to be checked off on it first." Your nursing supervisor is held liable for the assignments she/he makes.

6. I have never been fired over this. There is an "Assignment Despite Objection" form available from the ANA listing that you can object to the assignment (not refuse)because you are not trained or experienced in area assigned and the safety of the patient is threatened. That way you've CYA in that you have done everything in your power to be properly trained in the assignment before attempting to perform it.

7. You have orders (a POC or 485) and added orders that you take with you. In some agencies, that packet has already been put together for me, along with the directions to the home. Also, an assignment is given to you (ie a.m. insulin, teach wound care, etc.) Also, sometimes you have a note that you need certain supplies before you make the visit. Other times, you get out there and the right supplies aren't out there. You get a standard trunk supply in case of this. Sometimes, you get caught out there without the right supplies in the home or in your trunk. Then, you would just have to call the MD and ask for an order to substitute or either drive back to the office. It is smart to communicate with the previous nurses who have seen the patient (or case mgr who probably knows the pt well) and review the chart for their history. If you are a floater/PRN you get a list of assigned patients and what to do that visit, along with the patient packet. If you are a case manager, you have a lot of control over what patient you want to see on what day and if you have more than you want, which patient you want to give away to the PRN nurses. Patient frequencies may be Q month, 3 X week, every day, BID, and everything in between. A lot different than hospital work.

8. More about scheduling: The agencies I have worked for allow for 5 8-hour days or 4 10-hour days. If you're paid per visit you may work a little under or a little over that and the pay will be the same. It all balances out, though. You are allowed to work out your hours as you wish. I know nurses that start at 6 am and end at 2 pm and those that start at 10 am and end at 6 pm--as long as the patients do not mind. We generally can't expect the patients to be seen before 8 am or after 5 pm if they don't want to (excluding IVs at odd hours). The schedule you typed in looks more like a PRN nurse's schedule, which I have worked a lot. It works out great with children if you only want to work certain days and you get a higher rate too!

9. No, especially if you are PRN. It may be possible as P/T or F/T depending on the agency; you would just have to ask. Usually there is such a high need for nurses in this area that they will use you whenever they can get you!

Hope this helps!

monica f · Feb 1, 2000

I recently started working for a home health agency....beware. First off don't just assume that if an agency has an ad in the paper they acutally have enough work to keep you busy. When I started working I began working with an agency. They gave me all the good points of working in an agency. They promised that they would be able to staff me 40 hours a week. Mt first case was a 3 year old. He was being abused in the home. After working with the case for 3 months I found out just why the agency was hiring so many new people. They were hiring people to work the cases that other nurses had refused to work because of the home conditions. After I spoke with the agency about the conditions in the home several times and expressed my concern I finally asked to be pulled off of the case, because nothing was being done. After I pulled off the case I found out just how few patient the agency really did have. They had been hiring so many new people just to take this particular case over the past 2 years that they could not guarantee you any hours except on the abuse case.

In conclusion, make sure before you start a new job that you know you will have multiple patients. The best way to find out what working conditions are for the nurses is to talk to nurses who are currently with that company. I wish you the best of luck with your career in home health!

adireen · Feb 1, 2000

first case was a 3 year old. He was being abused in the home.

WHY DIDN'T ANYONE CALL THE COPS OR SOCIAL SERVICES TO ADDRESS THIS???? DID THEY JUST SWEEP IT UNDER THE RUG??? HOW AWFUL.

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Irene

monica f · Feb 2, 2000

i did call the social services but you know how that works.....unless the parents gives them enough to question they don't open up the medical records....it's sad

barbd · Feb 3, 2000

OK, I've worked for lot of agencies-I find non for profit are more flexible and nicer in general. They tell you who needs to be seen, what their problems are, where to find their charts, supplies etc. I always called and said-"hi, I'm your nurse today. Can you tell me which part of town you're in? OK, I'll be there between 9 and 10 " or whatever. Most people are flexible because they know you have a long day. Feel free to e mail me with any other questions. I did home care for 10 years because I loved the kind of patient contact you have, however, I'm fed up with Medicare. I now work with people with developmental disabilities and love that, too.

MWS · Feb 6, 2000

regaring 3yr old? So is your agency still working on it? All the nurses who have worked on this case can't they collectively make somebody take notice, the police? SS, the mayor, the governor. I don't mean to attack you personally. Keep notifying people, be in their face.

monica f · Feb 10, 2000

NO as far as I know the agency is not working on the case. Their explanation to me is that "we can't afford to loose anymore cases" so I guess that means that nothing will be done. I did report the incident to social services....I can only hope that they make a home visit and do something about the problems in the home. I also told them where to find the documented incidents....it's up to them now I guess.

DIDI · Feb 11, 2000

Please call your local child protection agency, if you're not sure where to call, try hosp., they have that information. The ER, or peds. unit.Someone will listen if you talk long enough and loud enough.our kids need us!//good luck.

BusinessNurseLinda · Feb 14, 2000

I feel REAL strongly that it's EACH of our responsibility for reporting cases of suspected abuse. In fact, I own my own home based business now, but right before I left home health, I know of a RN and the HHA she worked for that that was in DEEP legal water for NOT reporting a suspected elder abuse. As you know, you don't have to have "proof", and everything is kept confident... Linda

Lois1949 · Jun 14, 2000

The agency for whom I work does all the scheduling for homecare.They will call and let me know what hours are available and let me take my pick,so to speak.There is a case manager to whom I report any change in condition and she will do whatever is necessary to rectify the situation.You have to use your good common sense,also.If you are running late,you call the agency and they will call the client.We are not allowed to call a client directly.Nor are we allowed to give out our phome number to the client. We have daily condition report sheets we have to fill out everyday and return to the agency. The agency will assess the living conditions and the area of the client and decide whether it is safe to take on the case.Should they decide it is not safe,the agency will refuse the client. I have been doing this type of work for years and I wouldn't have it any other way.Instead of getting paid for every mile you travel,your hourly pay is upped.I have traveled as far as 60 miles to a job.I am a single person,so,this is easy for me. I don't think I would do this if I had the responsibility of a family.You would be restricted as to how much work you could handle.