Hello, I was recently hired by a start up home care agency with a class A license. I was the only employee as we were attempting to get Medicare approval. To do this we needed to take on ten clients that we cared for without billing Medicare, to prove our worthiness to do so. I had a lot of concerns as the owners have little to no knowledge of any health care practices. When I would raise concerns, like, they had provided me with only an empty office, no supplies and only some generic paperwork to use (no care planning tool, I had to write out by hand from my old school books). The more concerns I brought up like: they had not inquired about my recent Mantoux (I was overdue) and having my proper immunizations in place, they became upset and felt this was no something they needed to worry about. I told them in no way should they send an employee that was no screened out to see patients! That started the power struggling and our first client ended with them telling me to change what I was saying to the doctor and to 'not' make a vulnerable adult report. The client had multiple falls with injuries, my assessment in the home lead me to speak with the family who said client was an alcoholic, almost 90 years old, and he is getting in his car after drinking. Considering the horrible implications we all know about with alcohol, the elderly, and driving, I said we must update the doctor, change the care plan to include ETOH, and make a vulnerable adult report to cover our bases. They said no, you will not do any of these things, you will discharge him asap and keep quiet. I said that I could not do that as that was putting my client and the community at risk. They said they didn't want to deal with it! Can you imagine my horror when they ended my employment as I was none too happy to un-professionally omit important information! The client has A fib and was on blood thinners!! His doctor needs to know all of this to protect him! He need a social worker to help him. I called the department of health. What else can I do here? I did call the physician, and also vulnerable adult and he is agreeing to give up the car keys - moving him to assisted living. A job well done by me, but I am terrified these owners will move on and run the most bent of agencies and I want to protect the public from people who would tell their main health administrator to discharge rather than, inform, cover bases and address the issues, then discharge based on this being out of scope. I'm just in shock, really.
Mar 3, '13
Your manager is right. You have to d/c that patient asap. Changing your care plan will not help your patient. Calling doctor? Doctors do not care what their pts are doing at home. In home care you can make a difference in 10% of your cases, such cases as dressing change, picc line care... other 90% of cases when you write a care plan to educate 90 y.o., demented, hard of hearing gram ma on side effects of medication is nothing but pumping money from medicare to privet pockets. Just be happy that a fraction of those money go to your pocket
Mar 3, '13
By the way, what is class A license?
Mar 3, '13
Hi Steve. I am the director of nursing, or was, and he was not my manager. He is a rich kid who collects automatic weapons. I hope you don't come across me in your career. I have 20 years experience in home care, and wow, how could you not know that the physician directs all care? Of course he needs to be called, he prescribes the medications that put this patient at risk while using excess amounts of alcohol. A class A license in my state is a home care license. We do not drop clients based on the emergence of chemical health or mental health issues. That is basic knowledge - we can discharge them, transition to the appropriate provider if we do not have the professionals with that scope of practice. WE DO need to contact vulnerable adult services when a patient is at risk because of their decision making. I'm interested in what kind of nursing you do? When a chemical health issue is assessed, we do add this to our plan of care to make sure we are holistically addressing each patient. Now, with all that said, I have probably more knowledge and understanding than this site has to offer. I've applied to law school, and one day will make sure 'dollars in pockets' are not motivating factors for any professional. Wow, just wow. You really would not call a doctor who manages coumadin therapy for A fib in a patient found to be profusely intoxicated every visit? What state are you in, Mexico?
Last edit by ari3l on Mar 3, '13
Mar 4, '13
Wow - in my state, failure to report Fraud & Abuse is a serious violation of our nurse practice act. We also have a legally defined nurse-patient duty which would compel a nurse to act to protect the safety & wellbeing of any patient entrusted to their care. It would seem that the OP has an overwhelming duty to act, in situation cited.
Steve123 - You apparently have no real knowledge of Home Care. Prior to coming under a focused scrutiny by the Federal Government, Home Care was seen as a 'get rick quick' scheme for the unscrupulous. It is slowly being cleaned up, but there are many people who still try to take advantage because of the money to be made through fraudulent billing an outright falsification of records. This is OUR money (tax dollars). It is the professional responsibility of every licensed clinician to step up to the plate when they have knowledge that this is happening. The OP is a very good example of why Nursing remans the most trusted profession in the US.
BTW OP, Mexico has a socialized health care model in which this type of patient would undoubtedly be receiving appropriate care.
Mar 4, '13
Quote from ari3l
Now, with all that said, I have probably more knowledge and understanding than this site has to offer.
Welcome to Allnurses! Please don't be too put off by one out-of-left-field response to your first post. You'll find there are lots of knowledgeable and sensible nurses here.
If you are (quite reasonably, it sounds like) concerned about the operations of this agency, you are welcome to report them to your state healthcare licensing agency. Most of them will take anonymous reports, and not disclose to the agency who made the complaint (although that doesn't guarantee that the agency owner(s) won't figure out
who made the complaint). Although the agency is called something different in every state, it's usually a division of the state department of health and human services (although that
is sometimes called something different in different states). You should be able to track down the agency with a little quality Google time.
I worked as a surveyor for my state and CMS for several years, although I did not survey home health agencies. Investigating complaints about facilities was a big part of what we did, and we took complaints seriously.
Mar 16, '13
Reporting a facility to BON cost me my job. For whatever reason you report a facility do it anonymously if you have any hesitancy at all.
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