The future of Home Health...?!?!

DebB · Aug 28, 1999

Ellen, our agency used to have a fair number of LPN's that would see a variety of skilled visits. With OASIS though, we have found that it is taking more RN's to complete all the OASIS visits. We now have overloaded RN visits and not enough skilled visits for our LPN's.

Mijourney · Jul 28, 2000

Hi,

I am resurrecting this topic, because I feel it is an important one. The issue of the future of home health goes beyond the RN and LPN role. I will write on that issue, however, that lower reimbursement for home health services has made it necessary for companies to use the least expensive worker for the job at hand. Yes, with OASIS this makes it difficult. But, through my participation on this bb, it has been made clear to me that many nurses do not want to see any overall expansions or changes in nursing education or nurse practice acts. Therefore, RNs and LPNs must learn to partner effectively with one another for the sake of the client/family and themselves. Perhaps Ellen, you could draft a proposal on how best to utilize RN and LPNs and present it to administration. In my experiences, administration has never facilitated true cooperation within the nursing ranks.

In a general response to the future of home health, I feel that dedicated home health nurses should advocate on behalf of all current and potential home health recipients irregardless of their backgrounds. Community or population-oriented health activities and initiatives seem to be over-taking individual services, because they are looked upon as more economical, reach a wider audience, and are based on the interdisciplinary model of care as evidenced by more inclusion of other health-oriented professionals. We as home health nurses need to make clear that community-based and home health care should co-exist and can complement each other. The complexities, diversities, and dynamics of life and health justify the use of both entities. Home health advocates should also make clear that everyone should be entitled to home health services not just the ones who can afford to pay for it out of pocket. It may require a label change from home health since I know of home health nurses who have gone on a client's job to provide services. I hope more home health nurses comment on this topic.

Ellen · Jul 29, 2000

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.

Mijourney · Aug 1, 2000

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.

Hi Ellen,

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.

BETA · Apr 25, 2001

In my agency, all of our RNs were paired with a LVN. We call them RN/LVN teams. The LVNs saw the routine daily patients and the RN did the required discharges, care plans etc. We found this to be a lot more cost effective. The team had a daily productivity of 10 patients. Usually the LVN saw 6 and the RN saw 4. Sometimes 7 and 3. That gave the RN time to case manage their patients. They also carried a greater patient load than RN by themselves. We also scheduled them to be off on different days so that their team was covered. On that day the RN would see 5 and on their day on without the RN, the LVN would see 7. The patients were happier too. They very rarely saw anyone but their team.

Mijourney · May 6, 2001

Hi. Since my last response under this topic, I have changed my stance somewhat. BETA, you are correct that it is more cost effective to employ both RNs and LPNs. Much of this I feel is as a result of the effects of managed care. How RNs and LPNs work together depend upon the leadership of the HHA.

Also, I now feel that it is possible for LTC nursing and community or population-based nursing to coexist. It seems that at this time, home health has a positive future in terms of the demands that will be increasingly made for our services by boomers and the generations that follow.

mustangsheba · May 7, 2001

We need to get rid of OASIS. The amount of money spent on this invasion of our privacy is outrageous. An RN can make three visits in the time it takes to do an OASIS visit. Who does this benefit? Just my opinion.

hoolahan, ASN, RN · May 8, 2001

AMEN Mustangsheba!!

My DON is a member of VNAA, and she gets a newsletter faxed to her weekely. It usually arrives on the weekend, when I am working, so I read it. It may make you happy to know that this organization is dedicated to getting rid of OASIS. They even blame the shortage of nurses in HH on the formation of OASIS. They also calculated that on average, it takes 3.2 to hours to complete a new admit, with only 45 minutes, on average spent in the home. (It personally takes me between 60-90 minimum in the home.) Getting rid of OASIS and all excess paperwork was their #2 objective this year, with recruitment as #1.

lpnandloveit1 · May 14, 2001

I m an lpn and I do home care, pediatricl high tech. I have done this for 9 years. I have worked for different agecies in my area and currntly work for an agency that is part of one of the local hospitals. I do not do visits, I do "shifts"(8-12 hr.) I have a VERY good working relationship with my Supervisor. She makes periodic supervisory visits, and I call the office or stop in often. This is a good relationship and I do not feel like I'm free floating.I feel as if any nurse doing any kind of home care should have some type of partner that they can speak to just to make sure you are not missing anything.

ChasRN · May 21, 2001

Regarding OASIS.

The OASIS form functioned for two reasons, neither of them for our, or the patients' benifits. The first was to establish the DRG method of reimbursement currently be used and the second was to make wealthy some campaign contributor in Colorado.

With the establishment of DRGs, there is no further function for the OASIS. The change in reimbursement protocol has happened. This is the ultimate response to "growing home health costs" which resulted from the DRG system of reimbursement to hospitals.

One wonders if the Congress would not be doing a better job if they were paid to stay home.