Been asked to do home wound care after patient is discharged

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Hello all. I am an RN and one of my elderly pts that I've been caring for is soon to discharge home after several months of hospitalization. I've gotten to know her and her family very well. She will be discharged home with her also elderly husband and she has a large pressure wound on her buttocks with a wound VAC. I'm the main one that does her dressing changes at the hospital, because it causes her so much pain. This wound is FINALLY getting better, but we constantly battle keeping suction on the machine due to location. The patient is very worried she won't get good care at home or won't be able to fix the VAC when there is a leak. Her family has offered to pay me to come do her wound care at home. Is this ok? We have CNAs that sit for patients after discharge. Normally I wouldn't even give this request any consideration, but I do worry about her wound; and wouldn't want to see her have a set back after finally moving the right direction.... Has anyone done home care for a patient once discharged?

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Specializes in Care Coordination, Care Management.

There ARE home care nurses...but anyway, I would check with HR at your hospital to verify you are allowed to do this, to make sure there is no conflict of interest.

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Specializes in MICU, SICU, CICU.

If she has been hospitalized for several months, her homecare needs may be rather complex. She needs to move on to other support systems and focus on that adjustment and her recovery. She would probably be best served having her medications, supplies, DME and treatments coordinated by a Home Health Nurse rather than a family member.

I think that it is very nice for you to want to help her but her progress should be documented and it is necessary for reimbursement. Maybe you could arrange to visit during the dressing change, just to provide reassurance to the patient and her husband. You really dont want to take on this liability and answer calls at all hours due to air leaks. Have they offered any compensation for being on call?

I hope one of the experienced Homehealth Nurses will chime in with some current Medicare/Medicaid/private insurance policies and billing practices regarding Wound Vacs in the home.

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Specializes in Care Coordination, Care Management.

You bring up very good points, the OP should really bow out here...additionally, there is no Medicare/Medicaid/Insurance reimbursement for someone who is not an independent provider registered with the state.

If she has been hospitalized for several months, her homecare needs may be rather complex. She needs to move on to other support systems and focus on that adjustment and her recovery. She would probably be best served having her medications, supplies, DME and treatments coordinated by a Home Health Nurse rather than a family member.

I think that it is very nice for you to want to help her but her progress should be documented and it is necessary for reimbursement. Maybe you could arrange to visit during the dressing change, just to provide reassurance to the patient and her husband. You really dont want to take on this liability and answer calls at all hours due to air leaks. Have they offered any compensation for being on call?

I hope one of the experienced Homehealth Nurses will chime in with some current Medicare/Medicaid/private insurance policies and billing practices regarding Wound Vacs in the home.

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Yes, a conflict of interest. You could discuss with social work/discharge planner about if you could contact the home health agency and ask to get a per diem position.

However, if you are at work and something goes wrong, then what? You can't leave work to troubleshoot or help. And there does need to be other nurses who can take care of this patient.

I get that many months of caring for someone and it is hard to let go. But I think you may need to.

Best wishes

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Clear, healthy boundaries are the key to a happy life. Let it go and move on (as should the family). This is why God made home health agencies. ;)

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Specializes in Infusion Nursing, Home Health Infusion.

Unless you are set up as a private duty nurse and are aware of all the regulations in your state I would suggest you gracefully bow out!

It sounds as if they have grown to depend upon you and trust you and that is good but do not be sucked into thinking that you are the only nurse that can perform this task and can perform it with minimal pain. I agree you need to let homecare take over. They actually do a lot more than you probably know when they open a case. They do a complete evaluation and assessment of the patient, train caregivers if they are able,evaluate the home for safety, review of all medications, assess the need for skilled nursing care and so much more.

The patient is ready to move to a different level of care now and along with that goes establishing relationships with new professional caregivers and I would reassure them she will be taken care of.

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Specializes in LTC,Hospice/palliative care,acute care.

She sounds like a good candidate for sub acute care....

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Specializes in Pedi.

Consult Case Management. This patient needs to be referred to a Home Health Agency at discharge for her wound care needs.

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Specializes in Postpartum/Lactation/Nursing Education.

I agree with PP who suggest the patient would best be served by Home Health nurses. Allowing her to be assessed and treated by Home Health will allow for physician consultation as well as other services if need be. Also keep in mind the liability involved. While the family currently believes in you, what happens if the sentiment changes? What if there is difficulty with wound healing and they decide it is your fault? Since you are not working in an official capacity how will you prove any care you provided was appropriate? What documentation will you have to back you up? Another thing to consider is what happens if you notice problems with the wound such as poor healing or infection. Since you aren't employed by a Home Health agency all you can do is pass that information on to the family. Sounds like a potential disaster just waiting to happen. Your license is too important to put at risk.

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Specializes in Geriatrics, Home Health.

I'm a home health nurse. Colleagues of mine have called the floor about recently discharged patients before, especially for things like would care.

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The liability is what I was worried about, and conflict of interest with my current employer. I don't want the pt to take steps backward but I know home health will take good care of her. I've never even questioned doing this before, just got to close to this one. I've given her all the #s at the hospital and my email address and told her she can call anyone of us if she has any questions or concerns and could email me directly anytime, and asked her to come visit at the hospital as soon as the wound is healed enough and the VAC comes off. I think she is ok with that. I understand her worries but I'm sure after her first visit from the nurses she will be confident again. She has just become so used to us, and I'm sure it's scary to move on. Thank you all for your advice and point toward the right direction. â˜ºï¸í ½í¸·

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