is this a form of Home Health that any of you are doing?

  1. I just interviewed for a HH position with a large company. Part of the company takes care of patients with IV's, peds and health issues and the other part of this HH takes care of the mentally and physically handicapped. They train and supply aides to be with the patients 24/7 and some of the patients are in assisted living and need to be checked on quarterly. The job I applied for is for the latter described position. As I understand it, I will do very little nursing care but instead will be supervising the aides and train them to give meds, and assist the patients. Also they are expanding to workmen's comp cases and I will be doing the "nursing part" of that until an LPN is hired. The aide training part of this job will be done "in the home" or "at the site" of care.
    Anyone do anything like this? I'll have patient/aid visits set up for each day.
    OH..one other thing..we also teach the patient. For instance, the patient living in assisted living, we teach to manage their check book, budget..etc.
    Once again..anyone out there doing this sort of HH?
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  2. 6 Comments

  3. by   FTell001
    its me again..with a bit more information. I'm very relieved at this time in my life..to NOT see the inside of a hospital in this area. The patient/nurse ratios are horrendous...the nurses are burnt out..hence my decision to try HH. I've never worked anywhere but in a hospital enviroment so I'm a bit nervous about this.
    I have read the posts here and talked to a lot of HH nurses and most of them I talk to LOVE HH opposed to working in a hospital.
    SOOOOOOO...lol..please tell me this is a "good thing" (as ole Martha Stewart would say)
  4. by   NRSKarenRN
    Hoolihan can best respond to your question.

    It all depends on the amount of aides you are responsible for, if you can find them at the times they are supposed to be in patients homes and aren't "self scheduling" with client, width of territory, who sets schedule: you or office etc.

    It can be great----as it was with the HHA supervisor at my previous job AND NO OASIS paperwork. OR a nightmare if poor business practices occuring.

    You will be responsible that EACH AND EVERY HHA has 12-14 hrs of inservices yearly ( try scheduling that if aides are in homes 12/24 hrs a day).

    All said been in homecare 17 years and still love going to work each day!
    Last edit by NRSKarenRN on Sep 19, '02
  5. by   renerian
    I have been in home health 11 years and not done anything like that........sorry.

    renerian
  6. by   FTell001
    thanks so much to both of you for the responses. I don't think I'll be responsible for the aides certifications..but just their duties related to the patient care they are extending to the clients. Also checking their charting on the meds they give...and making sure the new aides are familiar with the meds they are giving..the feedings..etc..
    I'm nervous..but willing to give this a try. ...
    Thanks Again!
  7. by   hoolahan
    Welcome FT

    I can't give you a short answer to this question. Yes, I did this. My job was to be certain the HHA's had 12 hours of CEU's per year. The accreditation agency determined how many hours could be via handouts, or lecture, etc. I could do 4 handouts and 3 videos. I made up my own Mandatory Jeopardy Game for the manadatory classes, like infection control, pt bill of rights, etc... Then I offered it for a few times a year, at a 4 hr credit. Also, get the firehouse to demo fire carries, how to use extinguisher, stuff like that helps. Adult protective services will usually do a lecture, may be free, may be a fee. That is a big part of the job.

    You begin just like any other job, with an assessment. But your focus is on the pt's personal needs. So, what is their bowel pattern. Do they want a bath or shower? Do they need the aide to shop/drive/write checks, etc.. You develop the care plan based on what the HHA is doing. Any skilled nursing needs you encounter, you refer to a skilled agency. You send in orders to the doc if over the state specified minimum hours. You have to sup once a month to see that the HHA is competent in at least one of four areas.

    This sounds like cake, but it isn't. In my experience, the pt's, and they didn't want to be called pt's, they were called consumers really were unconcerned about the edema in their legs, all they wanted to talk to me about was, please tell the aide not to fold my towels in threes, fold into squares. Please tell her to put the blue socks first in my drawer. etc... They did not have patience for my assessment, nor did they want me "taking their time" from the aide. They didn't want me to watch them be bathed, dressed, and forget toileting. So, it wasn't easy to get to see them in action. The populatioon I was working with though were the developmentally disabled, so they look at themselves differently, not as being "sick." So, in that respect, I felt a burger king manager could have done my job.

    How will the scheduling be done? Do you have to take call? What will you do when a pt who relies on a HHA to be fed three times a day, has their HHA call out sick? It is a big responsibility, and due to the stress and low pay, dedication is hard to find. Weekend callouts are always a nightmare, forget snowstorm shows if the aides use public trans.

    Keep an eye on the schedules. The aides will also have to turn in an activity sheet, like a Note for us. You will need to check that against the care plan to see they are doing everything listed to justify their time there. And check these against their time sheets.

    MY expereince was very bad, BECAUSE, there was some major medicaid fraud going on. I discovered this when I finally got the notes to review. Major discrepanices. A group of very slimy low-down people thought they could take advantage of people who couldn't speak for themselves. I turned them in, as did several other nurses before me I found out, and they were finally shut down.

    I just want to emphasize that NOT all agencies are crooked, and I have some friends doing it, who got me into it in the first place since it was such a "cake" job, and they love it. My experience was vastly different, and I wouldn't take that type of job again if my life depended on it. I'd go back to the hospital first, THAT is how bad it was for me!!

    I sincerely hope your experience is better. Good luck. Check on yahoo.com , there is a nursing educators listserv that was very helpful to me. I also purchased some pre-printed inservice handouts from some resources mentioned on that listserv.

    Also, check your states requirements for HHA. ALWAYS check their credentials before hiring, never assume, ever!!! I had one girl come in and lie to my face, when I said, that's OK, the state BON has an on-line registry I can check your number, she got all squiggly in her chair and changed her tune!! She was no HHA. Also read you state's medicaid manaul, and the accreditation agency's ,manual, may be JACHO, CHAP, or other for a PCA/HHA agencies.

    There is a lot of room for things to fall through the cracks in these types of agencies. The best ones are those who also offer skilled nursing care, and are not simply a PCA/HHA agency.

    Good Luck!!!! I hope I didn't scare you too bad!!
  8. by   FTell001
    OH MY!! thank you for sooooooo much information! Yes..what you expressed sounds like the job I'll be doing. Handicapped clients, assisted living, etc. From what I see, this agency is very complaint with medicaid rules and regs. I've know the owner for years and do agency nursing jobs for them on occasion. Their business has grown and grown with the owners (2 RN's) doing all the field work till just recently deciding to add another RN for field work due to company expansion.
    I will surely get back to you on what I think as soon as I have a chance to work a little "in the field".
    One other question...how do you HH nurses handle your car expenses..and ..how loooooooong does a vehicle last doing all this driving? Isn't that a big expense to you..replacing vehicles?

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