RN supervisory visit Frequency?

[new2hospiceRN]

Does anyone know the reg on how often an RN has to supervise an LVN and HHA in Texas according to Medicare Hospice Benifit guidelines?

[rachelnrn]

(a) Standard: Supervision. A registered

nurse must visit the home site at least

every two weeks when aide services are

being provided, and the visit must include

an assessment of the aide services.

This does not mean a joint visit, you can ask the pt/family how the cares are going. If there is a complaint, the aide must be pulled from that pt until a joint visit can be made to assess their skills

[curiousauntie]

I believe that an on site supervisory visit WITH the home health aide must be done every 60 days, and assessment of the aide services must be done every 2 weeks. I personally do an "assessment visit" of the aide every visit, which for my company is at least once a week, and try to do supervisory visits every 2 to 3 weeks.

[okielpn75, ASN, RN]

So is it required that an RN do an assessment of the patient or just fill out a supervisory form for the HHA? And does that sup visit require an on site visit or can it be done via phone?

[tewdles, RN]

Most RNs will couple the sup visit with an assessment, just to be efficient...you have to see them at least once every 14 days anyway. Our aide supervisory forms are electronic and are actually a part of the routine assessment. The COPs no longer require a direct supervisory visit unless there is a concern, so it can be accomplished by a phone call but that is not preferred for most agencies.

[curiousauntie]

Our clinical note/assessment form has a section for supervision of the CHHA. We note if the supervision of the CHHA is with the CHHA is present or not present. This is why I do one with each visit.

I have had patients/families that are very pleased with an aide and for some reason after a time are no longer as pleased. Sometimes it is due to a change in the visit time of the aide, or for some other reason the relationship between the aide and the patient/family has changed.

As for RN visit frequencies, the Medicare guidelines say every 2 weeks, but my company says weekly. And the frequency goes up as the patient declines. If your RNs are truly not putting eyes on the patients for weeks at a time, how are they documenting decline for the team meetings or certifying eligibility? Not to mention the whole Medicare fraud thing...that will bankrupt the company and the individual nurse!

[okielpn75, ASN, RN]

Our clinical note/assessment form has a section for supervision of the CHHA. We note if the supervision of the CHHA is with the CHHA is present or not present. This is why I do one with each visit.

I have had patients/families that are very pleased with an aide and for some reason after a time are no longer as pleased. Sometimes it is due to a change in the visit time of the aide, or for some other reason the relationship between the aide and the patient/family has changed.

As for RN visit frequencies, the Medicare guidelines say every 2 weeks, but my company says weekly. And the frequency goes up as the patient declines. If your RNs are truly not putting eyes on the patients for weeks at a time, how are they documenting decline for the team meetings or certifying eligibility? Not to mention the whole Medicare fraud thing...that will bankrupt the company and the individual nurse!

The LPN's complete the IDG forms and show decline on our visit notes. The face to face MD visits that have been initiated have eliminated a lot of the recert paperwork for the RN's. When my RN case manager for a patient has just supposedly seen the patient the day before IDG but does not know about an X-ray that was done, lab changes and new med orders I would say that they didn't see them. That is just one example.

[babyluv3]

can anyone tell me where to find a where to find the medicare regulation on RN visits every 14 days?

[Lazarus2127]

Most RNs will couple the sup visit with an assessment, just to be efficient...you have to see them at least once every 14 days anyway. Our aide supervisory forms are electronic and are actually a part of the routine assessment. The COPs no longer require a direct supervisory visit unless there is a concern, so it can be accomplished by a phone call but that is not preferred for most agencies.

tewdles

Hi there I wanted to know where you found in the COPs that Supervisory visits can be done over the phone I have been looking for it and cant find it.

[Lazarus2127]

On caregivers if your a medicare cert. agency can we do phone supervisory visit on them or the client?

[mschelee, MSN, RN]

Can someone post the number of the Medicare reg for required Rn visits and lpn supervisory visits? I recently started a new hospice that thinks one time a Month Rn needs to visit and one time a month for the lpn supervisory..

[irishnoreenRN]

For Medicare compliance an Rn must visit a patient every 16 days . However, as a case manager, one must know how the patient is doing, his or her symptoms and management and effect of treatments. minimally a case manager should visit twice weekly and once weekly in a facility.

Noreen Hendrickson Rn, Case mngr.

[rancin98]

babyluv3, go to http://www.access.gpo.gov/nara/cfr/waisidx_04/42cfr418_04.html for the COP's.

Sec. 418.94 Condition of participation-- Home health aide and homemaker

services.

Home health aide and homemaker services must be available and

adequate in frequency to meet the needs of the patients. A home health

aide is a person who meets the training, attitude and skill requirements

specified in Sec. 484.36 of this chapter.

(a) Standard: Supervision. A registered nurse must visit the home

site at least every two weeks when aide services are being provided, and

the visit must include an assessment of the aide services.

418.76(h)(2) - A registered nurse must make an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while he or she is performing care.

Hospices are required to update the comprehensive assessment as frequently as the condition of the patient requires, which may be more frequently than every 15 days. The hospice must ensure that each update is completed no later than 15 days from the previous one. Hospices are not required to complete, in full, those documents that they identified as comprising their comprehensive assessment every 15 days, although hospices are free to do so if they so choose.

They are required to identify and document if there were no changes in the patient/family condition or needs. There should be evidence that the IDG identifies through its ongoing assessments when a change is needed to the plan of care and evidence that the patient/family receives the care and services necessitated by the

I can't find the COP for LVN supervision, however LVN's are to have a supervisory visit every 30 days. HHA's, LVN's and RN's are required to have a joint onsite supervisory visit annually. Sec. 418.94 Condition of participation-- Home health aide and homemaker

services.