Originally posted by Ellen:
Mijourney, could you please elaborate more on your 2nd paragraph above? Are you referring to use of out-patient type facilities in conjunction with Home Health?
I would love to write a proposal for LPNs..however in my organization I am but a lowly field nurse and these decisions are made by people we may see yearly. I have made suggestions in the past and some have come to pass. But, just like the new PPS starting in Oct., we are being dictated to because noone bothered to ask us how we thought the new processes might work.
You know when I think about your comment about being a lowly field nurse, I think about the fact that business executives, lawyers, administrators, and physicians would not be able to experience wealth if it weren't for us "lowly" field workers. Don't sell yourself short in the influence department. We need nurses like you to make an attempt to stand up for what you believe and to try to encourage changes, even in a small way. Keep at it. Your post indicates that you have made some inroads.
In reference to community or population-based programs, I find that as the number of aged and disabled individuals increase, more emphasis is placed on physicially grouping these individuals together as with prisoners. I believe that the aging of boomers will make my opinion more evident. For instance, many states have strong nursing home lobbies. This has become more prevalent recently because of the cutbacks in home health services. We know that many families under pressure to survive are forced to place their loved ones in a nursing home because their insurance won't pay for custodial care in the home. I see a growing number of individuals in their right mind being admitted to NH, because they require mostly custodial care. I feel, like many, that the cutbacks in Medicare and Medicaid went overboard. Now, I'm not so sure anyone wants to really reverse the trend of grouping, because it is convenient to place someone out of the way of progress. I think that NHs are needed, and I definitely feel that the frontline workers are underpaid, by and large. But, I don't agree with tucking people who are in their right mind or who have a lot of family support out of the way. I think if all that home health services did was to aid in preventing a person's spirit from being broken, then I think the effort would be worth paying for. LTC and HH should be able to coexist equitably, and we should be able to use these services more effectively then we have been or are using them today. I am in reality. But, I still like to wish from time to time. Hopes this helps clarify some of my comments.