mowing the lawn, driving and working

[erroridiot]

i would like some feedback from anyone sent by a medicare home health agency to open cases when the patient is out mowing the lawn, driving or working

if i won't open a case for some of the above reasons, the agencies will just send another nurse to open it

[morte, LPN, LVN]

years ago, went to admit a patient, a widower, who lived alone. when i got there, the garage was open. and he was out in the field picking grapes.......did converse with him a bit, to check mentation.....seemed fine to me, didnt admit......

[msmel321]

I know exactly what you mean...I went to go admit a pt last week and when I arrived the daughter of pt and the pt herself told me what they needed was a sitter for her mother so she would not be alone while she worked and that her mother is not homebound, she goes everywhere with her duaghter....the pt had 4 meds,all of which she could identify ,when she is to take them and why she is taking them...I offered some other resources for sitters and did not admit...the next day I saw that the agency was sending another nurse to admit When i asked why, they told me the patient was called back by the agency after i left and was upset that she misunderstood about homebound and that her mother is homebound afterall.....I had already put in my 2wks notice with the agency and this was the day before my last day!....I don't know if I will find another agency that second guesses its nurses or gets admissions not matter what, but i hope to...I love what home health could and should be....that was 2 days ago and i start looking tomorrow for another job!

[TazziRN, RN]

I'm not an ogre about the homebound thing, but if there's no way I can fudge it, I won't open it. Your agency had better be careful, or it will find itself in trouble with Medicare.

[msmel321]

There was a bit too much CREATIVE INTERPRETATION going on with that company which is why I left....I am only hoping not all HH agencies do this...I am not quite sure where to begin looking.

[wonderbee, BSN, RN]

Nah. If the patient tells me they don't consider themselves homebound and they don't want HH yet the agency sends me out to convince them that they are homebound and they need HH,well I draw the line somewhere. I really hate that part of my job is selling health care like a desperate used car salesman.

[dgd123]

That agency is committing Medicare fraud and hurting the other agencies in the area and setting them up for failure. Sure, they are appeasing the patient and their family but it is wrong. Remember also that a patient can not "agree to be homebound" either. Homebound is functional and you either are functionally homebound or not. There are a couple of exceptions to this such as when patients are a threat to themselves and must go with their caregiver for their safety-Alzheimer's, some psych Dx, etc. Also remember homebound does not mean a person can not leave their home. A person is homebound if they only leave their home "infrequently, of short duration and it is a considerable and taxing effort". Don't you love how vague this is. I still hear nurses telling patients they can only go to church or the barber shop and this is really not the case. Church and barber were examples given in the Medicare regs so many people fixated on this. In fact, you would not be considered homebound if you were able to go to church daily for hours.

Was that agency you worked for a for profit agency??

[renerian, BSN, RN]

I would offer private pay/big smile.

renerian:devil:

[caliotter3]

If I understood renerian's post correctly, that sounds like a good idea. You can't admit them to your agency according to the rules but you sure could give them a hand for private pay. I'll bet that is how many get their private pay patients. He, he.