1 in 5 Medicare patients readmitted within month - Page 3Register Today!
- Apr 5, '09 by nerdtonurse?Don't forget the other side of the fence, tho....we've got folks who know they can come into the hospital for two weeks out of every month, complain of unspecified abdominal/belly pain, get their drug of choice, get yet ANOTHER set of CTs/MRIs, be told AGAIN that there's nothing wrong, so then their "abdominal pain" becomes "chest pain" and they get another 3 days for a complete cardiology assessment, and then the "chest pain" becomes "intractable migraines" and then we do head CTs, carotid dopplers, etc, and that gets them another couple of days, and then the abdominal pain's back. These are not elderly sick folks, these are people in their 30's and 40's who've figured out to work the system. And they are on the callbell every time their PRN pain med's available..."Can I have phenerghan, demerol, and a diet Pepsi?"
We're a smallish hospital, and what burns me up is when we've got people who have positive cardiac enzymes, crappy EKGs, but they're having to sit in the ER because the ICU's full and we've got 5 beds full of the "Demerol and diet Pepsi" folks....
- Apr 5, '09 by nursemarionTo qualify for home health you have to:
1. Have a skilled need- require the services of a nurse or therapist, not custodial care, not just an aide for a bath, but a skilled need. A skilled need means assessment, teaching, or other interventions that require a skilled professional.
2. You must be homebound if you are under Medicare. Homebound does not mean immobile or bedbound. It means you leave the house infrequently or leave the house only with assistance or considerable taxing effort. Someone who goes to Bingo every Tuesday is not homebound. Someone whose daughter takes her out once a month to see her doctor is. Many Medicare patients become short of breath and must rest after walking a short distance. They go out, but it is difficult for them. That is homebound. My mother is 70 and needs a walker and handicapped spaces. She can walk very short distances and though she can get out, she is essentially homebound.
Some insurance does not require homebound status, only medical necessity. Most agencies will send a nurse to evaluate the patient if you are not sure. The same goes for hospice care, an evaluation visit is possible if you are unsure.
We can make visits for a short time, or longer if needed, often only a few visits until the patient has a handle on things. Just don't forget we are out there. Case management is a big part of what we do!Last edit by nursemarion on Apr 5, '09
- Apr 5, '09 by oramarQuote from mama_dIt is laughable. The goverment caused this problem by encouraging early discharges, then complains that people are being readmitted. The main cause of readmission from what I could see was that the person was discharged to early in the first place. Round and round and round we go, where it stops nobody knows.Floor nurses have had this one figured out cold for longer than I've been doing it...as leslie said, "D'oh!"
Medicare/medicaid is all about "get 'em out, get 'em out, get 'em out" and no one there has seemed to figure out yet that all that translates into is "put 'em back, put 'em back, put 'em back!"
Back when I worked days, I cannot begin to tell you the number of times that I argued with CM about whether or not a patient was ready for discharge. Especially with a newly diagnosed renal, CHF, or diabetic patient; there is no way we can squeeze in adequate teaching in a three day stay!
I've been saying for years that we need to have nurse educators for specific disorders on staff at the hospital, whose only job is to go from patient to patient and ensure that adequate education is dispensed to patients, and then to FOLLOW UP on it. Like a phone call at home three days after d/c..."And how have your weights been?" or "How have your fingersticks been?" and the all important "Are you able to afford your medication?"
We have a diabetic educator on staff, who has to cover the whole hospital (census 370-400). You know what she does? Puts stickers on the education sheets for the nurses to check of specific teaching and hands the patients a 60 page booklet. Dietician does the same thing...hands the patients a 30 page booklet. They honestly expect that just giving a 90 page long stack of papers to a sick eighty year old covers them as far as "education" goes, and the floor staff is left to pick up the slack. Makes me want to
I am sick to death of the short term bottom line thinking that goes on...if facilities would be willing to make a little bit more of an investment in our patients and their health at the outset, then we'd be seeing less readmits and better patient satisfaction.
- Apr 6, '09 by croloff303This is a result of mis-managed case management and pressure on MD's to discharge discharge discharge!!!