Home health nurse working as a maid?

[mzsuccess]

Hello! I hope everyone is safe during this his time.

My dilemma is I work for a small home health agency. I love the company and the hours, as it allow for me to study for my RN ( currently an Lpn).

Well one of my pt while she’s sweet and her family is OK. The things I experience there is starting to bother me. They have this motto as if your job is in my hands sort of thing. Like you have to do whatever, plus they down talk the other nurses which also upsets me. I tell them to let the manager know their concerns.

But these are some of the scenarios. My pt is 30, has a Trach but does everything else, smoke, drive, walk, can cook.. everything.

Somehow she doesn’t want to do anything. I make her bed and take out the trash for the whole house and will wash dishes occasionally.

She babysits her nephew who’s one. The baby will be up ( while my pt is sleeping) asking for food and drink. ( mind you I can’t eat while there because the baby and my pt begs for my lunch)

She will have her nieces and nephews over and they’ll make a mess, her and her family expects for me to clean up, vacuum and wash dishes.

The baby has a poopy diaper ( they expect for me to take it to the trash) they live in a apartment complex so it’s a walk.

If someone in the family is sick they bring them to me? For me to assess them. I ask them to f/u with their PCP.

Then my pt and her mom will talk about all of their financial issues in front of me.

My pt asked me to buy her $240 pair of shoes

$150 birthday cake.

shes always asking for things and to come to my home.

My pt is a lesbian I have nothing against LBGT.

but she makes comments like “ set me up with a girl like you” or sits to close to me and tries to touch my hand.

when family is over she’ll say things like it’s clothes in the dryer or things like she’s giving commands. Asks me to organize her closet and drawers.

Like I said it’s only two cases right now and both are full. What should I do? Am I being too harsh and over the top ?

[Been there,done that, ASN, RN]

Yep.. you are a maid... or a buddy, or whatever. You are not performing as a nurse. Medicaid is paying your salary and paying the agency big bucks as well. Whatever, during this crisis.. you have a job.

[nursel56]

4 hours ago, mzsuccess said:

Medicaid, like I said now I ask myself why am I there but it’s all I can do as of now to focus on school and being a mom. As soon as this pandemic is over I’m switching cases if one comes open and if not I’m leaving.

The way I interpreted the questions about why you're there it sounds like your patient doesn't have the limitations that would justify skilled nursing vs home health aide, unless they now pay nurses such a pittance the difference would be negligible, except if something goes wrong.

Then it won't matter if you do housework all day the way the law sees it.

Sorry there are so many unscrupulous agencies out there. Hope it all works out for you there.

[mzsuccess]

22 minutes ago, nursel56 said:

The way I interpreted the questions about why you're there it sounds like your patient doesn't have the limitations that would justify skilled nursing vs home health aide, unless they now pay nurses such a pittance the difference would be negligible, except if something goes wrong.

Then it won't matter if you do housework all day the way the law sees it.

Sorry there are so many unscrupulous agencies out there. Hope it all works out for you there.

They have her down for skilled nursing. I guess because we are sitting much of the day it irks the pt and family. But I’m not going to be a maid, sometimes I completely ignore her demands. I also know that I have no grounds with the other nurses on the cases doing whatever the pt ask such of maid duties and an agency backing their request.

[mzsuccess]

4 hours ago, caliotter3 said:

There are nurses who work as companions or home health aides because they are desperate for work. It is entirely possible that your agency pitched your services to the client this way, especially since your manager talks the way you report. Your problem lies with your employer since they won’t support you working as a professional. You need to find other employment or make up your mind to put up with this.

You’re absolutely correct. However, it says skilled nursing and she’s had nurses for 5 years now so I think she gets it. I think this pt tries to take advantage of the nurses a lot and like having ppl to boss around. She feels just because she has a nurse she doesn’t need to do things and the nurses are her arms and legs and it’s not happening to me. Like to ask a nurse to buy you sneakers for over $200 and a birthday cake for $100. I’m there for 12 hours and starving because the patient literally begs for my lunch and her nieces and nephews.

[caliotter3]

The client treats you this way because your employer encourages this behavior by not supporting you or previous nurses. Previous nurses either quietly walked away from this case and/or the employer or they were forced away from the employer after they spoke up for themselves. This is nothing new in extended care home health. Agencies get away with this because nurses will not stand up for themselves and demand respect. As long as there is one nurse who accepts their paycheck for being treated this way, the agency will continue to encourage and enable the client’s behavior.

[KatieMI, BSN, MSN, RN]

8 hours ago, mzsuccess said:

Excuse me? Just because I’m an Lpn you think those lines can easily get blurred. I am a nurse and was hired as a nurse. ?

Once in my life, when I finally went home after over 2 months in ICU I had services of private duty LPNs. I made it very clear that I (with extreme politeness and additional pay) ask them to cook, clean, run basic errands and otherwise help with "non-nursing duties". No one of them refused and they literally saved my sanity at that really awful time.

I also asked them to buy groceries which, by their account, were improperly expensive or they had to idea what to do with them. When it was all over, the whole team thanked me for providing a free culinary arts course of a kind ? And, of course, the fridge content was communal and free for everyone in my house ?

[caliotter3]

Katie I assume there is a marked difference between the way you treated the LPNs who worked with you and the way this client is treating Mzsuccess. Can’t imagine you asking a nurse to give you their lunch or to buy you expensive shoes or a birthday cake. Nursing staff are usually more agreeable to go that extra mile when they are treated with respect and consideration.

[KatieMI, BSN, MSN, RN]

33 minutes ago, caliotter3 said:

Katie I assume there is a marked difference between the way you treated the LPNs who worked with you and the way this client is treating Mzsuccess. Can’t imagine you asking a nurse to give you their lunch or to buy you expensive shoes or a birthday cake. Nursing staff are usually more agreeable to go that extra mile when they are treated with respect and consideration.

No, I just asked them to buy (on my account, of course) organic chicken for $7.99/lb and such. They were shocked initially, then it was repeated "OMG, it smells so deliciously, I ate half of the gravy while cooking it"

[mzsuccess]

3 hours ago, caliotter3 said:

The client treats you this way because your employer encourages this behavior by not supporting you or previous nurses. Previous nurses either quietly walked away from this case and/or the employer or they were forced away from the employer after they spoke up for themselves. This is nothing new in extended care home health. Agencies get away with this because nurses will not stand up for themselves and demand respect. As long as there is one nurse who accepts their paycheck for being treated this way, the agency will continue to encourage and enable the client’s behavior.

You are so right. I’m going to let the agency know after this pandemic is over why has been going on. But if nurses allow it and so forth then yes it’ll continue on. And trust me a lot of them quietly walked away. I know one of her nurses from her previous agencies that she reported “spoiled” her with gifts. Let her come to her home and etc. She left and when my pt calls her she doesn’t even answer.

[mzsuccess]

1 hour ago, KatieMI said:

Once in my life, when I finally went home after over 2 months in ICU I had services of private duty LPNs. I made it very clear that I (with extreme politeness and additional pay) ask them to cook, clean, run basic errands and otherwise help with "non-nursing duties". No one of them refused and they literally saved my sanity at that really awful time.

I also asked them to buy groceries which, by their account, were improperly expensive or they had to idea what to do with them. When it was all over, the whole team thanked me for providing a free culinary arts course of a kind ? And, of course, the fridge content was communal and free for everyone in my house ?

Katie,

You probably couldn’t perform those tasks and in that case I wouldn’t mind. My other pt is a Quad and she does as much as she can. I don’t mind helping her with dinner, tidying up and etc.

But this pt is fully functional to do so. But acts if she can’t and doesn’t want to because we are her hands and feet. She babysits daily, the baby poops she handed me a diaper one day and then wants me to clean up behind her nieces and nephews and take poppy diapers out. Plus she wants me to buy things on my dime. I’m a single Mom I’m not buying expensive shoes and birthday cakes that I wouldn’t buy for my own child for an adult who’s 30. Heck, she’s older than I am.

[KatieMI, BSN, MSN, RN]

8 minutes ago, mzsuccess said:

But this pt is fully functional to do so. But acts if she can’t and doesn’t want to because we are her hands and feet. She babysits daily, the baby poops she handed me a diaper one day and then wants me to clean up behind her nieces and nephews and take poppy diapers out. Plus she wants me to buy things on my dime. I’m a single Mom I’m not buying expensive shoes and birthday cakes that I wouldn’t buy for my own child for an adult who’s 30. Heck, she’s older than I am.

And this is what concerns us in your question.

It is definitely a situation compromicing your professionalism and integrity, both are things no professional nurse can allow to tamper with. Plus, if patient is able-bodied up to and including driving and babysitting others' kids and still uses skilled nursing care, it smells fishy in terms of Medicare/Medicaid fraud.

Get out of the case ASAP, that's it.

(P.S. so you do not panic. Even if the question about Medicare/Medicaid fraud arises and goes into process, you won't be touched as it was not you (and not your manager too) who had privileges to determine if patient needs the services. There won't be any threat to your license however the case ends. But start to write good notes with all details from now on and till you out of the case).

[caliotter3]

29 minutes ago, KatieMI said:

And this is what concerns us in your question. .....

.....it smells fishy in terms of Medicare/Medicaid fraud......

.....But start to write good notes with all details from now on and till you out of the case).

Expect management to criticize your notes if they are very detailed and make clear what is going on. Expect them to tell you to rewrite notes to their 'standard', to make things vague or outright fraudulent. Be prepared to resign immediately because they will terminate you if you don't bend to their wishes. It might just be better to concentrate on school and family by your own decision to avoid the fallout as much as possible. The other nurses didn't take on the status quo, no reason for you to become the martyr here. You have a future to think about.