HHA 485 for client with just an aide, no skilled nurse

[linda106511]

Policy for where I work is every client gets a 485 or home health certification and plan of care. I have worked here a couple of years and in the "orders" section or #21, I have always put ie: medicaid has approved 12 hours per week for home health aide, then describe their duties, I then put a quick head to toe assessment, falls, injuries, hospitalizations, medical status changes, med changes, etc. However, now I am told that this should be primarily about meeting goals, rehab potentials, etc.

Now, 95% of my patients are NOT going to get better. They have home health aides because of debility or otherwise but there is no end-date of services in sight. Also for most of out skilled nursing for example a paraplegic receiving bowel stimulation 3 times per week, it is never going to change. Even our PDN they are not going to get better, unfortunately, just worse. Or there is the extended hours HHA or SN that has had absolutely no changes in medical status.

Anyhow, anyone got any ideas for the 485 or research materials that can direct me. Thanks!!

[Kyasi]

80% of our clients have HHA's only so we write lots of 485's. I'm not sure what specifically you are asking though. Where on the 485 are you having difficulty?

On our frequencies, we write: HHA 2-3h/d, 4-5d/w x9wks for ADL's and IADL's. We don't describe what the HHA's actually do on the 485. That is detailed on our care plan. Also, our head to toe assessments are done Q60days on a recertification form. We don't send this to the doctor but do send a 'Clinical summary' that lets the MD know if there is any change in our plan of care or any issues that have come up between recerts. Don't know if this helps or answers your question. If you can be more specific, I'll try to help more if I can.

Kyasi

[linda106511]

We do a 485 on every client every 56-60 days whether they have a HHA, SN or both. On the orders section, we are told we have to write for example...

Medicaid has approved 20 hours (five 4 hour shifts) per week X 9 weeks. Duties to include personal care (describe duties). Client to be followed up every 56-60 days with a supervisory visit.

Next you would put your 60 summary which includes a head to toe assessment.

Next we need to put if goals were met and rehab potential

Followed up with appointments, med changes, DME changes, if there are supportive families and other services they may receive, open communication maintained with case manager, etc.

It seems like a lot to put on the 485 which are sometimes 3 pages long. I just wish there was a book or guide that one could go by to make sure all the pertinent information is on it so i can get rid of all the unnecessary crap.

The 485 then gets sent to MD for signature. Case conference notes and supervisory visits go into the chart and the MD doesn't see them.

It just seems crazy because we are repeating ourselves on paperwork. We fill out another assessment form but still need to put it on an assessment form.

My major problem is that we are being told by auditors that in the "orders" section we are to put if goals were met or not and why and their rehab potential. Most of our patients are the same month after month, year after year, with no chance of improvement. Sometimes it looks like the 485s are cut and pasted. It drives me crazy!!

[Kyasi]

Interesting how different agencies do things, or maybe it's different state to state.

My agency is Medicaid only. On a simple HHA case, our 485 is 1 page long. We list current DME's, all medications with any changes by marking them (N) new, (DC) discontinued, or © changed. We don't put anything about appointments or family support. We do a coordination of care but it is just a 1 or 2 liner. "ABC Home Care provides ATTN and HMK per Medicaid. They are responsible for these services."

It's interesting to me the different ways others do frequencies. We always give a range. We have to fill out and send 'missed visit' forms to the MD if we don't staff as stated. So to cut down on the amount of forms we have to fill out and send, we always put a range. "HHA 1-2h/d, 2-3d/w x 9wks." Even though our intention is to staff 2 hr, 3x/w, if we have a call off that we can't fill or someone has an emergency and can't staff for the entire 2 hours once during the week, we don't have to fill out a 'missed visit' form.

This is the form we use. http://www.med-quest.us/PDFs/Appendix05/E1-E2485HomeHealthCertiandPlanofCarev.4.pdf

There is a lot of info about filling 485's out if you google it. I was surprised to see that. Since things change so frequently in health care, a book on this subject would be outdated pretty quickly.

Kyasi