Does anybody else do admissions or visits at an assisted living facility that is staffed with NURSES?
This has always perplexed me and it makes me feel like I am "bending the rules" just to get a patient on the books when I am strongly encouraged to admit a patient at an ALF. 100% of the time it is for a wound, usually pressure or trauma in origin (which is the ALF's fault!). They have nurses on staff for med pass, treatments etc. But for whatever reason, they convince a doctor to order HH to come in to do the dressing changes? It doesn't sit right with me because I don't see the need for Medicare to pay HH when they are already paying a nurse at the facility. It seems we should not be going to these places at all, and if the wound care is so complex that the staff cannot handle it the patient needs to be living somewhere else for the time being. I wish I was allowed to just refuse the referral!
I document accordingly in my charting. Recording that Jenny, LPN was taught how to care for wound and also write this in the facility notes. I even put in the HH care plan: "HH nurse to teach skilled wound care to ALF nurses each visit until skill is achieved." I was asked later to change it from ALF nurses to ALF staff because "nurses" is a red flag to medicare. Um yeah, that's why I didn't want to do the admission in the first place!!!
Questions:
1) Do you think the ALF is trying to get outside nurses to care for the wound so that there is no real record of the wound on their forms? Thereby avoiding penalties on whatever reports they have to provide to Medicare?
2) Do you think they just order HH because the staff nurses "don't have time" to deal with the wound which they caused due to their negelct?
3) Is this habit reportable? To whom?
4) Should our HH agency even accept these cases from this referral source?
5) Am I held liable even though I attempt to decline the referral and document honestly, but am asked by supervisors to change it?
