Can someone please help me with "The BIG picture"

KateRN1 · May 3, 2010

Okay, there are two basic kinds of home health care: intermittent visits (usually Medicare) and shift work/private duty/extended care (usually Medicaid).

Intermittent visits: you see several different patients in the course of a day, requires meeting the Medicare criteria for skilled needs, multiple nurses notes, travel required.

*can case manage--you are responsible for the overall care provided for your patient, coordinating with therapists, LPNs, other nurses, home health aides, etc.

*can work PRN and only do revisits or do OASIS visits and hand-off to case-managing nurse

*or you can work for an agency that has an in-office case manager who handles the details of a patient load

*patients are mostly elderly or disabled or both (duh, Medicare)

Private duty: you see one patient for a specified shift in one day, one nurses note, no travel other than to-from patient.

*more like hospital work, but with one basically stable patient, the kind you might otherwise find in a SNF

*often with children with vents, g-tubes, wounds, treatments, etc., but sometimes with adults who've had MVA, SCI, or other injuries

*case management is most often doen by people in the office

There is one other animal that is rarely discussed here because there's not much of it out there, and that's non-Medicare/Medicaid intermittent visit home health care. You will find this with companies such as Brightstar who provide private-pay nursing care and other insurances that are not covered by the regular home health agencies. There are a lot of agencies out there that provide non-skilled care to patients (such as ADL assistance, basic home maker or CNA-type care) who need nurses to do the initial assessment and plan of care and supervise the aides. That's always a possibility, but I wouldn't recommend it for someone who doesn't already have a background in home health care.

Hope that helps!

Kyasi · May 5, 2010

I think Kate summed up what home health is all about. I've been in the field for 24+ yrs. and I've done everything Kate mentioned. Home care can be both challenging and at times boring in that when you do private duty care, you are doing the same kind of care to the same patient, day after day. It is very rewarding though. The last home case I was on for 9 yrs. was caring for a child who was a quad and on a vent. I knew that child like the back of my hand and knew when she was ill before she started showing symptoms. Being able to assist her family through some very difficult times of their life was a blessing to me. I also was the primary nurse for a family member of a very wealthy family in our community and had amazing experiences with them. (I got to travel and attend the '96 Republican convention for 10 days with them and get paid for it) I've done visit nursing (Medicare) for 4 yrs. and am now the Nursing Supervisor of a Home Health Agency. So there is opportunity for growth in Home care.

If I had to pick the one thing that was the most beneficial to me and the reason I wouldn't change a thing about my nursing career, it is this... Flexibility. I was able to keep my number one priority, raising my family, my main focus. I never missed a single field trip, my kids hardly knew I worked because I was able to schedule my work hours around their school hours, I could work part time when I wanted, full time when I wanted. I could take a week off when I needed. In other words, I arranged my work around my life instead of my life around my work. When my kids were younger, I only accepted jobs that had shifts that worked well with my family life. When my youngest child was an infant, I chose to work 4 hr evening shifts and had a home case that was only blocks from my home. I nursed my son to sleep and came home as he was waking up. (7p-11p) Then when my youngest was in kindergarten, I dropped him off for afternoon class, did home visits while he was in school and was home by the time the kids got home. When they were in school all day, I worked all day. When they started college, I started work full time. Now that I have an empty nest, I took on the kind of challenge I always avoided when the kids were young, because I didn't want to take work home with me. Being in charge of a Home Health Agency requires much more of my time and I have to be on call for emergencies 24/7. But the pay is much higher and in the big picture, this will allow me to retire much sooner than I could otherwise. So you can see how my job 'grew' with me.

In my early years, BC, (before children) I thrived on excitement. ER, Post Pump, ICU, CCU, Delivery room... But once I had kids, I found that I didn't have the energy for that excitement. I wanted my energy for my kids. For me the benefits of Home Care far outweighed any negatives.

I realize that some of my opportunities back then may not be available today. I was very fortunate. I am so very grateful for Home Health nursing. It was perfect for me. You have to decide what you really want in life and which kind of nursing can help you achieve those goals. Good luck to you!

Kyasi

annaedRN, RN · May 6, 2010

I have done both extended care and intermittent visits...and agree with what everyone else has said previously. I have been doing visits for the last 3+ yrs and really enjoy the challenge and diversity of each day. You have some flexibility within each day..but more so the freedom is what I enjoy- I can start from home, run errands between visits, get to a MD appt and see patients before/after, let the dog out to pee, meet a friend for lunch, etc. And as long as I get my patients seen - it's "all good". Some days are busier than others of course.

I like the autonomy. I am confident in my skills and am a strong patient advocate- you have to be. We are often the only eyes seeing these people - we have to be secure enough to talk to the docs and get the patients what they need. Usually, the docs expect that we are gonna call them and tell them what we want..and most often that's what they give us - they don't want a wishy-washy nurse calling them

I have noticed that the acuity of patients continue to grow - people are coming home earlier, sicker and with more health needs - both skills and teaching needs. It is imperative to be educated on the new meds, IVs, wound care products, etc...because we are seeing more and more of everything. You need to be proficient in IVs a(mainly central lines), venipuncture, ostomy care, catheters, and lots of wound care. And teaching is key!! You have to look at the whole picture - the patient's health, independence, caregivers ( and their willingness/ability to assist), safety, environment, finances - in order to see if you can assist them to meet their health care needs safely at home. Sometimes we use nursing, home health aides, PT, OT, SLT, +/or MSW to help meet those needs..occasionally it means helping with placement somewhere. Anyhow...hope that helps you a little.. it is definitely a different kind of nursing, not necessarily acute nursing - but real world, everyday, rewarding nursing for sure!!

CFitzRN, ADN · May 7, 2010

There are a lot of agencies out there that provide non-skilled care to patients (such as ADL assistance, basic home maker or CNA-type care) who need nurses to do the initial assessment and plan of care and supervise the aides. That's always a possibility, but I wouldn't recommend it for someone who doesn't already have a background in home health care.
Hope that helps!

You had me until that last part (LOL). You gave excellent advice, but I don't necessarily agree with that last paragraph. I had zero background in home health and have now been the Clinical Supervisor for a hha for the last 8 weeks. It was a TON to learn but I am loving it and catching on very quickly. Sure, there is some training involved but I am an RN and I can do initial assessments (along with re-eval assessments), case management (dealing with clients' physicians and social workers, etc), I can drive to East BFE and back doing sup visits, I can pull strings and get clients who really need to see a physician in as early as possible (helps that I have physicians' offices background) - etc etc etc. If a person is intelligent and has some nursing experience, I think they can do the job of a Clinical Sup or Case Manager with little trouble. I take all the training classes that our PDN nurses do too, so that I know exactly what they are doing in the field (even though I only supervise our CNA cases - it never hurts to learn everything you can).

I am very blessed to have been given this opportunity and highly recommend it for a nurse who loves autonomy and can manage his or her own time effectively and efficiently. It is an awesome job.

CFitzRN, ADN · May 7, 2010

I think Kate summed up what home health is all about. I've been in the field for 24+ yrs. and I've done everything Kate mentioned. Home care can be both challenging and at times boring in that when you do private duty care, you are doing the same kind of care to the same patient, day after day. It is very rewarding though. The last home case I was on for 9 yrs. was caring for a child who was a quad and on a vent. I knew that child like the back of my hand and knew when she was ill before she started showing symptoms. Being able to assist her family through some very difficult times of their life was a blessing to me. I also was the primary nurse for a family member of a very wealthy family in our community and had amazing experiences with them. (I got to travel and attend the '96 Republican convention for 10 days with them and get paid for it) I've done visit nursing (Medicare) for 4 yrs. and am now the Nursing Supervisor of a Home Health Agency. So there is opportunity for growth in Home care.
If I had to pick the one thing that was the most beneficial to me and the reason I wouldn't change a thing about my nursing career, it is this... Flexibility. I was able to keep my number one priority, raising my family, my main focus. I never missed a single field trip, my kids hardly knew I worked because I was able to schedule my work hours around their school hours, I could work part time when I wanted, full time when I wanted. I could take a week off when I needed. In other words, I arranged my work around my life instead of my life around my work. When my kids were younger, I only accepted jobs that had shifts that worked well with my family life. When my youngest child was an infant, I chose to work 4 hr evening shifts and had a home case that was only blocks from my home. I nursed my son to sleep and came home as he was waking up. (7p-11p) Then when my youngest was in kindergarten, I dropped him off for afternoon class, did home visits while he was in school and was home by the time the kids got home. When they were in school all day, I worked all day. When they started college, I started work full time. Now that I have an empty nest, I took on the kind of challenge I always avoided when the kids were young, because I didn't want to take work home with me. Being in charge of a Home Health Agency requires much more of my time and I have to be on call for emergencies 24/7. But the pay is much higher and in the big picture, this will allow me to retire much sooner than I could otherwise. So you can see how my job 'grew' with me.
In my early years, BC, (before children) I thrived on excitement. ER, Post Pump, ICU, CCU, Delivery room... But once I had kids, I found that I didn't have the energy for that excitement. I wanted my energy for my kids. For me the benefits of Home Care far outweighed any negatives.
I realize that some of my opportunities back then may not be available today. I was very fortunate. I am so very grateful for Home Health nursing. It was perfect for me. You have to decide what you really want in life and which kind of nursing can help you achieve those goals. Good luck to you!
Kyasi

You are my hero(ine). :yeah: