Foot care training

azverte · Nov 4, 2003

Shoes are DME, but you can elect to, instead of full DME povider status, only request Diabetic Shoes supplier status. It is easier. Depending on which state you are in, the federal Medicare will require criteria such as pedorthic (like my state). Maybe not yours. There are many good suppliers. You can deal directly with multiple manufacturers or deal with distributers. I do both. PM me if you need more info. You go! And good luck.

raduda · Nov 6, 2003

Before you spend money and start a shoe business please read this research article at:

http://www.appc1.va.gov/resdev/highlights/pr_05_14_02_questions_diabetic_footwear.cfm

I highly doubt Medicare will continue to pay for Diabetic Shoes & Inserts for much longer with kind of research!

Oh BTW there several qualified nurses doing foot care & trainining for RNs here in the United States. Just search under "Nurses Foot Care" ...

azverte · Nov 7, 2003

Thank you Raduda. I really appreciate through researchers! I was concerned during my planning period that the program could be scrapped but relatively few programs are scrapped once initiated - but nothing is for certain but death and taxes. I have many more articles in peer reviewed journals which site an outcome improvement and cost savings using the Diabetes Shoe Program.

The article you cited is with the VA. I have taken care of ex-VA patients. The VA provides one set of medical grade inserts, instead of the three provided by the Medicare program. Each Veteran I saw was wearing the lowest grade of extra-depth shoes made (and NOT in the patient's measured size!). I asked each Veteran how their feet were measured for their VA provided Diabetes Shoes and each one said, "Um...they asked me my size." Non reported professional measuring.

The you cited article was published 18 months ago and in that time, the program has grown exponentially. Lastly, the article you cited (and I do appreciate it) described that all three groups were provided certain inserts, none of which are the inserts provided in the Medicare's Diabetes Shoe Program which has specific descriptions on medical grading. The medical grade, custom heat moldable (plastizote or similar) inserts will conform to the patient's foot and minimize pressure. The cork ones described in the study will not. So, I wouldn't consider it valid. Still, what I think has NEVER mattered! LOL! It is what the legislature passes and the legislators are hired by voters - so VOTE!

Thank you once again for your research and comments. Every single law, program and thought in the legislature has at least 2 sides. The most compelling one prevails.

Thanks,

Az

PS: It is a sad commentary on quality of care to our veterans!

LoisJean · Nov 10, 2003

Greetings! and all is well, but very, very busy- (which is a good thing and would be an even better thing if I were 20 years younger!)

I have a foot care client who is a Veteran. He has IDDM and can be considered brittle. When my services were requested by his physician, he was in the healing stage of a ulcerated corn. He had a history of ingrowth of both great toes. The Veteran's would not pay for nor reimburse him for the added depth shoes that I suggested he wear and which were ordered by his doctor.

However, when he developed Charcot's Foot, the expense of added depth shoes and brace were completely covered. This puzzled me. There has been somewhat of a stir in the nursing community over the idea of Orthotic Specialities as a career change. It's a very interesting field...might be worth investigating.

And, once again, for Raduda and others interested: LPN's too, can provide foot care. If you question this please PM me.

To give an example of one of our foot care clinics set up 2 x a month at a local Senior Center: I set a fee for service. People sign up. Care is given and payment is made. 10% of my earnings are donated back to the center at each clinic visit. (This center does not request a rental fee from me...so, I donate an amount to them in appreciation.)

I will try to get back onto this board on a regular basis. With a new nurse on board and a huge increase in referrals, I have had to spend almost every waking minute 'on the job', so to speak.

Miss all of you so much...but, I'm still here...still going strong!

Peace,

Lois Jean

angelbear · Nov 10, 2003

I am looking for foot care advise for myself. I hope I am not out of line here. If I am, please forgive me. I have the ugliest toes known to man. I dont know if it is toenail fungus or crows toes(that is what my sister has) at any rate they are very thick and kind of yellow and they kind grow under. I would love to have pretty toe nail like I did when I was a teen. Any advice? Also I have a nasty habit of picking at the skin around my finger nails now I have broken that habit but now the skin is rough and ragged looking any advice on fixing that problem? Thanks for any advice ya all might have and again sorry for hijacking.

raduda · Nov 10, 2003

Yes LPN/LVNs can do foot care - which I did when I was one in the nursing home. However they must do this under the supervision of a RN or doctor according to state laws / Nurse Practice Acts. This means they can not be in an independent business providing this nursing service. If they are - they are liable to be committing tax fraud and malpractice. They risk losing thier nursing license and will not be covered by thier insurance company if anything happens to a client...

raduda · Nov 11, 2003

Cutting and trimming nails in most states is regulated by the medical, nursing, or cosmetology practice acts. I found out when I started my foot care business that when I painted a clients nails in the past I was actually functioning outside the scope of my practice as a nurse! Only licensed cosmetologists can legally do this for others.

Also some years ago in the podiatrists in the state of Michigan brought a law suit against 2 nurses who want to open a foot care clinic. At first the AG stunningly ruled in favor of the DPMs and said nurses could not touch peoples feet from the knees down! However after intervention by the Michigan Nurses Association on these nurses behalf - the AG finally had to overturn his ruling. These nurses lost a lot of money in the process.

Needless to say you must know alot to open a business of this - or any type - no matter how simple you think it may be... And also you must keep up on the law and current events.

I also highly recommend nurses be very involved with thier state nurses associations so they can assist in watchdogging for legislation from outside sources (hospitals, doctors, massage therapists, PTs, +++) that want to control nursing practice.

Remember - we nurses are great revenue generators - lets not let others take our hard earned money - and more importantly - set our standards of care!

Guardian Angels · Nov 11, 2003

This is something that I want to set up in my business. I am an RN

What do you charge and what equipment and supplies do you use?

PM isn't working?

LoisJean · Nov 12, 2003

Angelbear: Take yourself and your toes to a podiatrist. Let him decide the diagnosis and treatment. There are many conditions which mimic the appearance of onycomycosis but a culture of the nail itself is the most accurate and appropriate way to diagnose. Secondly, there comes a time for most of us when pretty feet is no longer the norm. Our feet take terrible punishment over time...let me just say: thank the gods we don't walk on our faces!

Where I come from we have a saying: 'the only ugly foot is the one that isn't there'.

Have a professional check your feet...forget pretty and think "functional".

Just a suggestion.

Peace,

LoisJean

raduda · Nov 12, 2003

edited by The Moderator to remove advertising. :rolleyes:

I hate to do this guys and gals... let's try to be careful :rolleyes: and be respectful of the TOS (terms of service) of this bulletin board.

PM me if you have any questions.

nightngale1998

guest*** · Jan 3, 2004

This is the first time I have posted any message on this forum. I found the forum by doing a search on the interenet on foot care courses and came up with allnurse.com. I am a foot care nurse in private practice in California and have owned my own business for 8 years. There is not much in the way of foot care courses in the US, but Canada has many training programs and might be worth checking out. There is an annual foot care nurse course on the first Monday in October in Winnepeg that I presented at a few months ago that was great. There are 240 foot nurses in the provence of Mannitoba. I do not think there are half that number in the entire United States! The Canadians are far more organized than we are. The WOCN ( Wound, Ostomy, Continence Nurse organization) is in the process of developing a certified foot care program for RN's. I would like to know if the LVN's in the USA have any certified programs because they should be doing this too. There is definetely a major role that LVN's have in foot care. My approach is team work and I am working with and training both LVN's and RN's for my business. I would love to hear from anyone on this subject.

adrienurse, LPN · Jan 3, 2004

I am currently partway through a footcare for nurses course at Red River College in Winnipeg Manitoba Canada. There are very complex aspects for providing footcare and this course involves 44 hours of lecture time and a practicum. It teaches basic footcare, ilnesses and deformaties of the foot and how to advise treatment and when to refer to specialists. I'm learning many valuable things about finding proper footwear and treating ulcers of the foot an leg.

I wouldn't advise anyone to go into the business of providing foot care unless they have taken specialized training.