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Any home health manager/Admin/DON/Nurse Super etc

Posted

Specializes in MS Home Health.

I have been in home health since 91. I find the office politics are really getting to me. Having worked for lots of companies, quite a few no longer in business, that the atmosphere has become almost unbearable for a myriad of reasons.

For those with long term management experience in home health, I am finding it very hard to find other managers who really understand the regs/OASIS/ etc and I really am tired of trying to teach people who don't have the knowledge of all that and are put into management roles without that experience etc and your trying to train people over and over and over.

I don't know if any of you long term managers out there are finding your tired of training people over and over and having them leave like their hair is on fire due to the stress and over load.......

For you newer managers, I feel bad as the atmosphere is becoming a totally different animal than it was when I started in home health. Amost 100% of the time I am talking about forms, money, regs.

Karen and hoolahan, I really respect both of your inputs on situations. Do you find yourself in this "mindset". I wonder if getting out of the office and letting all the people with no experience who are put in leadership roles who are not ready, just tough it out and drive the person nuts who hired them.

Sounds synical I know........

'

renerian

renerian, BSN, RN

Specializes in MS Home Health.

Glad to see there are no burned out managers here....

ren

I have been in hh for five years now and finally feel like I am understanding all of the coding, reimbursement, etc. Of course it always changes and it's next to impossible to keep on top of it all. We are having a terrible time finding nurses to work for us- muchless experienced hh nurses. I am tired of taking nurse after nurse out in the field, letting her ride with me, teaching her what I know, making copies of my cheat sheets, taking extra time to help with paperwork, etc. only to have them leave after a short time.

CardioTrans, BSN, RN

Specializes in ICU/CCU/MICU/SICU/CTICU.

Renerian, its not just you. I too started in home care in the early 90's and things have changed drastically since then.

I see many new nurses coming to home care because they think that its soooo much easier than the hospital. Then once they get a taste of home care they leave, because they dont want to have to deal with regs, etc....heard one just in the last 2 wks, say that they were NOT going to do paper work at home, they didnt care who told them they had to. (Keep in mind that the paperwork wasnt done in the home and had to be finished..... like pt admitted one day, and the OASIS not even began until 8 days later) :angryfire Then griping and moaning that she got wrote up...and stated that "paperwork was just stupid"....... just dont even get me started on that one.

I have seen people that has less than 1 yr in home care made into a director, they barely knew how to do the basic paperwork, much less all the guidelines, OASIS, Joint Commission reqs, etc. I have seen directors that could manipulate the crap out of OASIS to avoid Adverse Events, but put them in the field to actually DO an OASIS, and they are lost.

Like Traveler stated, we are having a hard time finding hospital experienced nurses, much less home care experience.

Leaving the office to go back in the field......... would you be less stressed....... have more time for your personally, not have to worry about someone putting your license in jepoardy because of something they did or worse, didnt do?

Now you know why Im leaving the office......... I can go see my patients, do my paperwork, meet my deadlines, and only have to worry about my actions......... and guess what......... make more money in the field, than I did as a supervisor........ :uhoh3: Now tell me whats wrong with that picture?

renerian, BSN, RN

Specializes in MS Home Health.

Cardio and traveler,

Thanks for responding. Yes I thought about that/going back in the field. I agree with a post that says people are put in management roles not knowing. Sad thing is I am making what I made when I started as a home health manager/did visits/cm before that, I am making almost the same salary, as in the mid 90s and I got my masters degree thinking it in part would push that up a bit. No one wants to pay their home health managers a decent salary.......

grrrrrrr

renerian

I have been in home health since 91. I find the office politics are really getting to me. Having worked for lots of companies, quite a few no longer in business, that the atmosphere has become almost unbearable for a myriad of reasons.

For those with long term management experience in home health, I am finding it very hard to find other managers who really understand the regs/OASIS/ etc and I really am tired of trying to teach people who don't have the knowledge of all that and are put into management roles without that experience etc and your trying to train people over and over and over.

I don't know if any of you long term managers out there are finding your tired of training people over and over and having them leave like their hair is on fire due to the stress and over load.......

For you newer managers, I feel bad as the atmosphere is becoming a totally different animal than it was when I started in home health. Amost 100% of the time I am talking about forms, money, regs.

Karen and hoolahan, I really respect both of your inputs on situations. Do you find yourself in this "mindset". I wonder if getting out of the office and letting all the people with no experience who are put in leadership roles who are not ready, just tough it out and drive the person nuts who hired them.

Sounds synical I know........

'

renerian

I have been working mostly in Home Care since 1991 and lot of my work concerns compliance with CoPs, JCAHO, OSHA and the quirks of surveyors in three states.

The VPs ask me for guidance and I frequently field questions from managers and supervisors asking what they have to do to comply. It's a little scary that they rely on me so heavily and there's no other knowledgeable person in the department to discuss it with me.

What I am saying is that no one else seems to takes as much interest in the regulations and yet when the surveyors show up or we have deficiencies to address, I am everybody's friend.

renerian, BSN, RN

Specializes in MS Home Health.

YES I hear you on the "now everyone's friend thing" how true.

renerian

I have been working mostly in Home Care since 1991 and lot of my work concerns compliance with CoPs, JCAHO, OSHA and the quirks of surveyors in three states.

The VPs ask me for guidance and I frequently field questions from managers and supervisors asking what they have to do to comply. It's a little scary that they rely on me so heavily and there's no other knowledgeable person in the department to discuss it with me.

What I am saying is that no one else seems to takes as much interest in the regulations and yet when the surveyors show up or we have deficiencies to address, I am everybody's friend.

I am a R.N., but also a D.O.N. in a home health agency. I know the frustrations of medicare and major staffng issues but I am an excellent teacher, I feel quite knowledgeable and comfortable with medicare rules, regulations, oasis and it does require constant teaching on a daily basis and frequent repetition in order for staff to become proficient. Home health is not easy, I usually tell staff that it requires a good year to start knowing home health. My boss says it really takes about two years to become proficient in home health. We are a one owner company but not a small company in any way, however the owner/administrator attempts to keep all his directors educated in all changes so we in turn can educate staff. Our boss is very supportive of us all, he has alot of patients, backs us up always and I believe that is a good receipe for a good agency. All staff, in turn, are very loyal to our boss and the agency, keeping turnovers to a minimum.

I had a R.N. and L.V.N. wife team sign on with us in order to pick my brain because they felt that they would be taught the essentials because they planned to open up their own agency. I had no problem teaching them and they did move on to open up an agency that is in competition with ours but we are all friends and there is no unethical issues. So to all those out there that are frustrated with office politics, just hang in there, we did become nurses because we have compassion and home health is about education and teaching.

I just started at a Home Health agency where I do not know if she is DON or Intake coordinator but she has been there 6 years and I know more than any of the nursed in the office. And the stuff that goes on. She has signed patients names,patients complain about the nurses not going in weeks but there are notes like any visits aren't missed. Has anybody experienced this...No nurses stay there and the nurse before me complained. We complain to administration b/c all the nurses they hire in this particular office, they really give them a hard time. I think it is b/c they are intimidated by nurses who have a lot of experience. Has anybody had to deal with this. I am scared for my license ..I do not know how long I will stay with this company. I think I made a mistake.

If you are certain that signatures are being forged as well as a number of other illegal actions in your Home Health agency, report it to the florida authorities asap.This will trigger an unannounced survey. Consider that they might have modified some of your doc after the fact as well. You could be at risk, for sure. There are too many first class HHAs in Florida. You do not need or want to be associated with this one.

I di quit I live in louisiana. I handed in my notes and now they are missing and when I called the owner of the company I was told not to worry about the notes they would handle it. I asked her what she meant and she said that she would write a note stated the notes are missing on the patients visits I made. I made copies of the notes and faxed that to her. I do not know what to do,should I report this to Medicare. Alot of things they are doing in that office are illegal and they cover up by lying. I do not want to get my license in trouble. If i call medicare it is my word against there's but i do have copies of the notes.what should I do?

I would suggest that you re-send those notes registered mail and retain the receipt. Granted, it wont prove what the contents of the envelope were, but it's something. It is not illegal for them to place an entry that states: notes missing from X date to X date, but they cannot bill for those visits. I believe it will be in their best interests to file your notes and bill appropriately for them, because without them, they cannot bill.

I have been in home health since 91. I find the office politics are really getting to me. Having worked for lots of companies, quite a few no longer in business, that the atmosphere has become almost unbearable for a myriad of reasons.

For those with long term management experience in home health, I am finding it very hard to find other managers who really understand the regs/OASIS/ etc and I really am tired of trying to teach people who don't have the knowledge of all that and are put into management roles without that experience etc and your trying to train people over and over and over.

I don't know if any of you long term managers out there are finding your tired of training people over and over and having them leave like their hair is on fire due to the stress and over load.......

For you newer managers, I feel bad as the atmosphere is becoming a totally different animal than it was when I started in home health. Amost 100% of the time I am talking about forms, money, regs.

Karen and hoolahan, I really respect both of your inputs on situations. Do you find yourself in this "mindset". I wonder if getting out of the office and letting all the people with no experience who are put in leadership roles who are not ready, just tough it out and drive the person nuts who hired them.

Sounds synical I know........

'

renerian

Nope can relate To everything you just said Plus add My company is being taking over on Monday and I find this same "mindset". I wonder if I should get out of the office before signing that new contract with the new company and let all the people with no experience who are in leadership roles who are not ready, just tough it out and drive them all nuts with the problems . Like all our CNA's have been doing to me this week . No shows ,etc.Have been thinking of going into some kind of medicail marketing . I have worked in home health 10 years 1 year in a leadership role.

Happy

Can anybody tell me what are the rules to be a Don of a privately owned home health that is not accreditied by joint commission. Do you have to work 5 days/ week and be in all the offices under that provider number? Thanks

Can anybody tell me what are the rules to be a Don of a privately owned home health that is not accreditied by joint commission. Do you have to work 5 days/ week and be in all the offices under that provider number? Thanks

The company would set the expectations for the DON. Frequency of visits to sattelite offices will depend on how the office is doing, the strength of the individuals managing the sattelite offices , what the training needs of the office staff are, what the denials or regulatory history of that office are etc. There is no rule,per se. A Director of Nursing for an HHA has 24/7 responsibility for the care delivered under the provider number. Most work weekdays, but are available for consult or to handle unique issues that can occur off-hours.

renerian, BSN, RN

Specializes in MS Home Health.

I did not read the final comments on this thread I posted until now. I guess I posted this thread when my kids were giving me grief at home so I never got back to it.

I am still hanging out in home health looking for another per diem/part time job. I work a full time job evenings so finding one that agrees to be flexible/no on call /weekends,nights or holidays is very hard. Since I already work full time 5 days a week and part time during the day my hours are limited.

Thanks for everyone's reply.

renerian

renerian, BSN, RN

Specializes in MS Home Health.

I am happy to report after 9 months I can finally bump up to more hours at my evening telecommute disease management role and can resign my day job in home health. After nearly 20 years I am just burned out.

renerian

oh ren! What is it you're doing now? I have been a loyal reader of your posts and you have always helped me so much. I'm so sorry the system chewed you up. I just got done with state survey today, a lovely 5 days of torture. I hope you'll still contribute to the website. You have a gift.

I can understand BURNOUT, today left me feeling like I just wanted hand over my office keys and say,"Go ahead and pull this off without me, I'm sooo done being the multi-tasking doormat, who only gets credit for the things that go wrong.":angryfire

Don't ya just love how those in charge of you give that look of "how could this have happened?,, they do things like this?, this is how our notes print out?, etc...." I just want to scream where have y'all been? Was I talking to the wall when I brought these issues to you every day and was told to focus on other priorities???? okay, now i'm ranting, see this job has turned me into a raving lunatic. :bugeyes:

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