Skilled LTC facilities that don't want to perform any "skills"?

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    We continually have trouble transfering hospital patients to a few of our local NH's if the patient has any skilled "nursing" need. Of course almost all of the transfers have PT/OT referals, and they welcome that, but IV antibiotic tx?, sterile dressing changes?, tube feedings?, PICC line?, central line dressing changes? No thanks, no thanks, no thanks, no thanks, and again, no thanks!

    Today, one of their patients came as an outpatient for PICC line insertion, and the charge nurse called to say, "I really think he should stay the night to stablize". "Stablize?! He's not, nor has been, unstable! He is being D/C'd right now and we have sent along our routine care of the line, and detailed instructions on his antibx and it's infusion. Call us anytime with questions or in need of any support."

    Do you guys deal with this? Is this the way it is everywhere? Thanks for any insight!
  2. 16 Comments so far...

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    I forgot to mention above that we do use a home care infusion support company that could have gone out to in-service the nurses and be available for support, but the company also requires that you receive the antibx through them, and the NH had NO interest in this. They were also offered the services of a Home Care nurse to come in as a support person, but the response recieved was, "we do have RN's here you know". How could we have helped make this easier? (I was called to return a call to the DON of the NH (at home) to ease the transition to acceptance of the plan of care for this patient, and that went well, but the time consumed by the panic and call saying they didn't want him back seems unneccesary and expensive!)
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    When I worked LTC, we did all of the above things you mentioned, routinely. Also trach care, TPN, etc.

    Just had a "skilled" facility agree to do peritoneal dialysis on a pt, then boot her out after she'd had the surgery.
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    The LTC where I work handle all of those things, but the problem comes in when we only have LPN on staff and need IV push meds or something of that sort that is out of scope of practice for an LPN. I have no problem calling one of the hospital RN when I need to and I find that when I have a question and ask it in a professional manner that I get my question answered. They have came over to help us out when needed also. (our buildings are connected thru a walkway). The only time we have problems with those sort of skilled nursing requirements is when the staffing is low.. I guess as an LPN, with alot of experience, I still am not comfortable with TPN and PICC lines, we get very few of those, plus I dont think that those are in my scope of practice!! Better to get the extra help and be safe than sorry!! Have a great day everyone!!
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    If a facility is licensed to provide Skilled Nursing Services and is receiving Medicare funds, they had BETTER be performing "skills"!
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    I think many long term care places only have nurses on certain hours (RNs) not 24/7. So the nurse managers who work all day have to come in during off hours, on days off to do skilled care. Sometimes the ratio of one nurse to a hall, 25 clients makes it almost impossible to do the care. One time I worked LTC/SNF and was supposed to do skilled care of 50 patients. Was impossible. That could be a factor.

    renerian
  8. 0
    Originally posted by CseMgr1
    If a facility is licensed to provide Skilled Nursing Services and is receiving Medicare funds, they had BETTER be performing "skills"!
    True, but when it comes to skillable things that involve meds or a large volume of or special supplies the facility is not reimbursed under Medicare, is all part of the facility daily rate.
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    You guys are all missing the boat. While skilled nursing is certainly given to residents who reside in Medicare reimbursed facilities, there is no mechanism to get reimbursed for services such as mentioned in this thread. Our state's reimbursement is based on a mix of the resident's conditions and an ancient, rediculous tool to measure the mix (not the MDS). Additionally, in NYS, the code requires RNs only 8 consecutive hours/day. For example, our nursing home gets $158/day for each MA patient. A Medicare resident may bring in more dollars for a very short period, but then we are stuck with the long-term bills from expensive drugs and treatments. The current reimbursement system cannot take care of American's health needs in nursing homes!
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    Exactly as you stated Bernadettes. Before admission to a LTC, they even take into account things like the possibility of the resident having to be transported to the hospital during the month for a procedure, supplies like topicals or special dressings that are not regular stock at the facility. All these items eat up the reimbursement funds.
  11. 0
    And in some places the reimbursement is even lower. Therefore there is little impetus to take on patients that require expensive equipment and treatments.


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