Difference between case management and home health visits?

[guest1143647]

I am new to home health visits. I always did shift work in the home. The jobs are really like night and day, and I am not sure why many people think if you work shift work in the home, that intermittent visits will be a breeze and vice versa. The skill set is totally different, so different in fact that I feel I need intensive training for a lot of skills that I never performed since nursing school 15 years ago. Never did pleural tubes, Picc dressing changes, central lines, etc.  

That said, I starting working for a company that does intermittent skilled visits. I signed a job offer for a full time home health position. As I am going through orientation, one of the nurse managers mentions writing care plans. When I asked her about it, she said the job is really case management. So I told her if that was the case, I would have only signed on to do per diem instead of full time. 

So I guess I am asking you seasoned home health nurses, is care plan writing and case management a part of home health visits?  

This is making me nervous. I only wanted to make visits, not case manage. I really do not understand why they just did not put case management in the job description.

[caliotter3]

Sounds as if somebody is pawning responsibilities off on you and perhaps taking advantage of your inexperience. But then, especially since you are an RN, it makes sense you cover individual cases from front to back. My concern would be getting paid for the mgmt tasks you do outside of the confines of the specific visits. If they intend not to pay you for care planning, etc., no. Don’t let them take advantage of you. And if you don’t want to do it then tell them and look for an opportunity elsewhere.

[Peachpit]

Sounds like there has definitely been some miscommunication between you and your new employer. It's odd during the interview process no one explained to you what the job would entail (wound vacs, wound care, admissions etc) or asked about your recent experience but I'm also curious as to what you thought you would be doing at the visits and if you asked any questions about expectations.

There may be agencies around that have nurses do visits and another nurse case manage but I've never heard of that. In the job offer you signed and the job description you received and most likely signed to does it outline any of this?

Private duty nursing/shift work nursing in the home is different from HH for a variety of reasons. You can read some other threads on here about the differences and why some nurses leave HH for the private duty side.

My only 2 pieces of advice are this: BE HONEST with the employer about a skill you are not comfortable with or have never done and do NOT let them talk you into doing ANYTHING you aren't comfortable with in the home (wound vac, etc) PROTECT YOURSELF.

Second, I would request a "sit down" with your direct supervisor and the director to ask for clarification on your job duties. My guess is they are going to tell you that the offer letter/job description covers it and you should've asked before signing on the dotted line. HH agencies are notorious, at least some of the larger ones where I live, for making a lot of promises that can't/won't keep and the nurse ends up burning out fast.

[guest1143647]

On 3/12/2021 at 11:57 AM, Peachpit said:

There may be agencies around that have nurses do visits and another nurse case manage but I've never heard of that. In the job offer you signed and the job description you received and most likely signed to does it outline any of this?

That is all I ever heard from experienced nurses. Most home health nurses around here say they do not write care plans. They only make visits. 

With this agency,the full timers case manage. The per diem nurses do not. So a nurse can work 40 hours and be per diem because they do not case manage,while another nurse might work 40 hours and be considered full time. The full timers are in a union,while per diems are not.

[Peachpit]

The only nursing union I know of in the south is for federal nurses who work for the VA so that may be why there is a difference with union being involved. But it would be the same here a PRN nurse not having to case manage but a FT nurse having to. Sounds like you and your employer need to have a talk though to clear things up for sure. 

[vampiregirl, BSN, RN]

On 3/11/2021 at 1:41 AM, Runsoncoffee99 said:

So I guess I am asking you seasoned home health nurses, is care plan writing and case management a part of home health visits?  

 

I've worked home health for 2 different companies in the past and care plan writing was part of my job at both companies.

I will say though, the care plans were fairly simple and uncomplicated. Typically they are related to the goals of care (why someone is receiving home health services) and the tasks associated with the care provided. 

I would encourage you to find out exactly what writing care plan entails at your job. 

[NRSKarenRN, BSN, RN]

Home Health care plans are integral to  home health nursing, performed as part of every home health admission visit, readmission, change in care, and recertification. They are more commonly known as  "Home Health Certification and Plan of Treatment (POC)"  or old acronym "845 Plan of Care" =  485 form Medicare required to document plan of treatment --form below, which has all the required elements --can be printed electronically in any format as long as it covers all these areas.  My last handwritten POT was 20 yrs. ago thankfully!

The plan of treatment is based on initial nursing/therapy  admission assessment documentation, home care referral orders and medications client is taking.  Most often is built into today's electronic medical record software that pulls EMR information from OASIS admission assessment, med list, discipline skills requested into form, includes orders per discipline, goals for each discipline and plan for discharge statement/ (usually 1 sentence). Once info is gathered, sent to physician for their signature --Medicare along with many states, does not permit Nurse Practitioner signature for homecare POT orders in order to get paid --- I been working for years contacting legislators to get this changed.

I've written tens of thousands of them over the years as intake/utilization review staff complied information from initial nursing assessment forms to make sure they met the legal requirements for Medicare and insurance payers as missing a few words = loss of $$$$$$ to agency along with Medicare/Medicare certification or even  agency license.

In large organizations, utilization review nurses/ diagnosis coders often review, complete plan of care, send to physician and track POT signed receipt, then billing can occur.

Full time nurses are expected to carry a caseload (25-32 patients; 6 visits per day ) that they manage care clients needs: did PT get in, was aide accepted by patient --supervise every 2 weeks, ordering wound care and incontinence supplies, was meds refilled /being taken correctly, etc   These skills different from private duty home care ---but care plan needed for those clients too every 60 days!

For nurse new to intermittent visits, takes at least 6 months to get sea legs understanding nuances, after 1 year it all clicks.  Very rewarding to be able to get patient be independent in care, help keep loved one out of a nursing home, or allow a graceful passing at home.