Need a HH daily agenda

caliotter3 · Nov 15, 2014

There have been posts containing information about both intermittent visits and extended care shifts. You would need to do a little searching to get past the hyperbole and drama. Since you do not want to perform ADLs, suggest you stay away from extended care work.

foggnm · Nov 15, 2014

Actually, I spent about an hour last night and 1/2 hour this morning reading through previous posts. So I wasn't asking out of laziness. And there's a point at which many forum readers will say "this isn't answering my question" and so we ask it.

SunnyRN2010 · Nov 16, 2014

I suppose there must be different types of positions in home care, but I've done it for a little over 2 years and with my position (as well as most other agencies I'm aware of), there must be a nursing skill or educational need that the patient needs in order to qualify for home health under Medicare guidelines. The patient must also be considered home-bound in the sense that it takes a large effort for the pt to leave the house (SOB, needing a walker or w/c, needing someone else to transport, need for supervision, etc). Types of things we do for pts include wound care, IVs, education, medication management/education, labs (blood draws, cultures, UAs, etc), monitoring after medication changes, diabetic teaching/ monitoring, etc. ADLs, bathing, housekeeping, etc are actually outside the scope of practice in my job. We have home health aids that only provide help with ADLs, etc. I'm not sure how private insurance would differ, but I thought all agencies had to follow the same guidelines if they accept Medicare patients.

Private nursing where you care for the same pt all day is probably a different story, but I doubt that would something covered by standard health insurance and I know it isn't covered by medicare. I think that would be private pay, but don't quote me on it!

I hope this info helps!

anh06005, MSN, APRN, NP · Nov 16, 2014

I do intermittent HH nursing and worked a shift today! I'm charge on the weekends (so I adjust the schedule if need be and take call).

I got there about 0640. Looked at the schedule for the weekend and grabbed my eval packets and charts (we still do paper charting). Checked out hospitalized list (if they were discharged we have 48 hours to see them per guidelines) then looked through my charts and eval packets (has hospital stay information) so I know what I've got. Went to eat breakfast in the hospital cafeteria with the other weekend workers about 0800. Back to the office and called the patients who needed follow up from Friday (COPD pt who was little more dyspnic Friday, CHF patient who had gained a little weight). Then called my patients for the day and went to see them.

Patient 1: just got out of the hospital post procedure (node removal). Doing well. No BM x about a week. Doesn't want enema so gonna try PO stuff. Regular visit since she was just observation in the hospital.

Patient 2: eval, pressure ulcer, new meds, sweet guy but very talkative and hard of hearing. Dressed wound, checked meds, discussed HH services

Lunch at home. Worked on paperwork (lots when doing an eval)

Patient 3: IV antibiotics due to sepsis and UTI. Ran over 30 min via PICC. Patient wanted something to hold PICC in place (I didn't have any flex net) so patient sacrificed a tube sock (cut the top off, slip up over the arm. Make sure it's clean of course). Oh and no IV pole so we are using a hanger hung on the curtain rod

Patient 4: post hospital visit (got out of hospital and was inpatient). CHF, horrible heart. Drastic decline from when I saw pt few months ago. Lots of meds adjusted. Pressure ulcer (no direct care needed...stage 1)

I listened to review CD's between patients. Got call from a pt with nausea and vomiting so called MD and got meds called to pharmacy. I have gotten a couple of calls tonight so far too. Patient 10 days post abd surgery with "little bleeding". CG to place gauze and I'll call tomorrow. Then patient 4's spouse called and needed reassurance about pt and his care.

anh06005, MSN, APRN, NP · Nov 16, 2014

Oh and I hardly ever clean people, help to bathroom, etc. We only go out a couple times a week (depending on the issue) and the RN's go to assess the patient, educate on diseases and meds, notify doctors of concerns or changes, etc. If I have a bed bound patient and we are turning to check for ulcers and they need cleaned yeah I'll do it. But that's not very often.

foggnm · Nov 16, 2014

Thanks everyone. These lists were informative. I'm looking forward to the change.

KelRN215, BSN, RN · Nov 16, 2014

I suppose there must be different types of positions in home care, but I've done it for a little over 2 years and with my position (as well as most other agencies I'm aware of), there must be a nursing skill or educational need that the patient needs in order to qualify for home health under Medicare guidelines. The patient must also be considered home-bound in the sense that it takes a large effort for the pt to leave the house (SOB, needing a walker or w/c, needing someone else to transport, need for supervision, etc). Types of things we do for pts include wound care, IVs, education, medication management/education, labs (blood draws, cultures, UAs, etc), monitoring after medication changes, diabetic teaching/ monitoring, etc. ADLs, bathing, housekeeping, etc are actually outside the scope of practice in my job. We have home health aids that only provide help with ADLs, etc. I'm not sure how private insurance would differ, but I thought all agencies had to follow the same guidelines if they accept Medicare patients.
Private nursing where you care for the same pt all day is probably a different story, but I doubt that would something covered by standard health insurance and I know it isn't covered by medicare. I think that would be private pay, but don't quote me on it!
I hope this info helps!

Private insurance companies have their own guidelines- patients with private insurance don't necessarily have to be homebound to qualify for skilled nursing visits. Almost none of my patients (children) would be considered homebound- the majority of them go to school. It's more cost effective for the insurance company to pay for a visiting nurse to draw their intermittent labs and do their CVL care than it is to have them go to the oncology clinic twice/week. Some kids we visit AT school and their insurance pays.

Private duty nursing is not covered by Medicare at all but most people who qualify for that service are so disabled that they qualify for Medicaid on the basis of disability alone. Some private insurance companies will pay but many will not. Medicaid is the primary payor for most of these patients.

ADLs aren't "out of your scope." You are an RN. It is within your scope of practice to assist patients with ADLs. Your job description may change with each employer but your scope of practice (determined by the Nurse Practice Act in your state) most certainly does not. If a patient only needs assistance with ADLs, you are correct they wouldn't qualify for skilled nursing visits but for home health aide services (with appropriate RN supervision) but if the patient has both services in place and you are there when the HHA isn't and Mr. Smith needs help getting to the bathroom, are you really going to tell him no? Certainly you would not stay for an hour and a half to bathe him and you're absolutely not going to do his dishes, pick up after his dog or sweep his floor (none of the above are reimbursable activities for a SN in the home environment) but some help with ADLs may be necessary in the course of a visit.