Help me brainstorm!

KelRN215, BSN, RN · Jan 30, 2013

My home health patient is a quad has lost his home health benefits through his employer because he is not technically home bound. They have stopped providing his supplies as well. He has to be straight cathed every 4 hours. He has some catheter supplies but it will not last him very long. He cannot afford to buy them (who can, really?) I had the idea of using the same size suction catheter. Has anyone tried this? They are sterile and include sterile gloves. Our office happens to have cases and cases they would donate to him. The only problem I foresee it the risk of trauma from the tip of the catheter. It is not as smooth as a urinary catheter. Opinions? Anyone have experience with this? Also, can someone tell me how to do a paragraph break? The enter key doesn't work here

I'm confused. Why would his homebound status affect his ability to obtain private insurance through his employer?

Does he qualify for Medicaid or Medicare? Patients must be homebound to receive home nursing through Medicare but his supplies should be covered regardless of his homebound status.

Nurseamanda00 · Jan 31, 2013

His insurance did not drop him completely, just his home health AND his supplies. He does not qualify for Medicaid or Medicare because he is 32 and works full time. The state gives him $1000 a month to help with expenses but he has to use that for the nursing care. He is looking into other private insurance companies but they are very expensive and most have already stated they would not cover the home health. It is a tough situation and I wish I knew how to help him.

KelRN215, BSN, RN · Jan 31, 2013

Has he fully explored the Medicaid route? I have patients who live in multi-million dollar houses who have secondary Medicaid insurance because, in my state, people with certain diagnoses (in these cases, pediatric cancer) qualify based on their diagnosis and not their income. In my state, most people with the level of disability that you describe qualify as well.

Nurseamanda00 · Jan 31, 2013

I think that is where he gets the $1000 every month. Sadly it is not enough. He also has a bowel program in addition to his 5-6 caths a day. He has been fighting this for 6 months now to no avail. He applied for the Medicaid waiver program but the waiting list is many years long.

classicdame, MSN, EdD · Jan 31, 2013

So sad. It would be nice if the urologist's office could contact the mfg. rep for assistance. I know this is done with drugs.

nurseprnRN, BSN, RN · Jan 31, 2013

The Medicare benefit for self-cathing supplies used to give people four catheters a MONTH, and DUH, there were UTIs and sepsis. So a few years ago the benefit went up to 200 sterile caths per month, enough for 4-6 per day. They make nifty one-use no-touch ones where the cath is completely enclosed in a sterile sheath so you don't need gloves, even, comes with a little prep wiperoo, the caths are prelubed, and they catch all the urine for spill-free disposal in public restrooms, etc. They've been a godsend for people who want to get out of the house. And since one episode of urosepsis costs about as much as eighteen years of sterile catheters, Medicare finally saw the light.

Yes, I know some places still teach "clean" catheterization. But you know what? That is old, old school. There's no need for that now, and it is not acceptable anymore. Which would you rather if it were your urethra?

No, you can't use 14ga suction catheters unless you have sterile (one-use packets) of lube and sterile gloves, though you could try the 10ga. But first consider contacting one of the vendors either via the urologist or one of the big online suppliers and asking them to help with the financing. They run into this all the time.