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 ?

[KatieMI, BSN, MSN, RN]

2 hours ago, caliotter3 said:

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.

You just forgot the commonly used BS of "if you refuse the case, you are abandoning your patient and will be terminated and reported to Boards and they will take your license" ?

Terminated - yes, possible (that's why it is better to leave on your own). Abandonment - no way IF you state you are not coming back BEFORE the start of your shift. This is responsibility of management to find substitution in this case, and they can get out of their comfly leather chairs and go change poopy baby diapers themselves if they want the case that much.

[Daisy4RN]

I thought your post sounded familiar so I read your other posts. This is your 2nd post on this subject. I only point this out because it is imperative that you start CYA immediately. I still do not see that this client has a skilled need, so I ask (bc others may look into this later) what are you charting as the "skilled need". I am not asking for a answer but that you seriously consider this so you do not get accused of fraud etc. Also, I feel you are putting yourself in jeopardy bc of the sexual comments being made by the client, especially if you have attempted to set boundaries to no avail. These sound like the type of people who could easily turn the tables on you and accuse you of sexual harassment. If you haven't already I would think about documenting the situation with a letter to management stating (only) the facts and using quotes (made by the client), and obviously keep a copy for yourself. If I was in your shoes I would be out of there yesterday, and not necessarily bc of the "maid" issue but bc of the other risks you are taking.

Please take care!

[BSN-to-MSN, ADN, BSN, RN]

Think of quitting if at all possible.

[subee, MSN, CRNA]

2 hours ago, RN-to- BSN said:

Think of quitting if at all possible.

I would isolate myself from being involved in a Medicaid fraud case. Please report them when you leave.

[mzsuccess]

25 minutes ago, subee said:

I would isolate myself from being involved in a Medicaid fraud case. Please report them when you leave.

I’m just curious, the pt told me she was told by the MD she will need skilled nursing care and cannot he left alone.
This pt also plays on this, I believe to get sympathy from her family. She’ll act as if she’s so sick and etc.

So I’m not sure how she got nursing care but she can do everything on her own. I’m thinking she had it because she had a cuffed Trach and couldn’t talk but now IDK. I feel like a buddy sitting there and a maid. She acts as if walking is too much for her and everything.
She’s been through a lot and IDK what’s going on physically but all her labs are normal. The Drs are saying nothing is wrong with her and talk her off some of her meds because they she’s becoming addicted.

[KatieMI, BSN, MSN, RN]

1 hour ago, mzsuccess said:

I’m just curious, the pt told me she was told by the MD she will need skilled nursing care and cannot he left alone.
This pt also plays on this, I believe to get sympathy from her family. She’ll act as if she’s so sick and etc.

It is a common story. Either her primary care provider is too lazy or "friendly and customer-oriented" and just signs off renewal orders for skilled nursing, or he/she and home care management "work as a team" to keep her on the skilled list and marginally increase revenue. Or she can overplay both of them for whatever reason. It is very common as well and difficult to check - for provider, there is really no way to know if that moaning, hardly moving human being that sits in the office with teary eyes is quite able-bodied and just enjoys feeling herself like the center of the Universe. I saw more than few of them swearing to God that they are so disabled that they need help with feeding and wiping QAM "as they always did that for me in hospital" - and observed in local Walmart in just an hour or so happily throwing tankloads of Budweiser and 10 lbs packs of burgers in heavy duty trucks in which they got into and drove around without any issues. Some of those apparently grievously disabled samples of humanity came to the office right in camo and with guns hoping to get someone watching their houses, kids, pets and truly disabled dependents for free while they hunted off the Michigan deer season ?

It is a worrisome situation but, in any case, YOU HAVE NOTHING TO DO WITH IT. You did not sign her skilled care needs paperwork, you're off the hook. Just get outta there.

[Daisy4RN]

2 hours ago, KatieMI said:

It is a worrisome situation but, in any case, YOU HAVE NOTHING TO DO WITH IT. You did not sign her skilled care needs paperwork, you're off the hook. Just get outta there.

The OP may not have signed the initial paperwork but is charting on the routine visits. If there is no skilled need what is OP charting? I would think that over time this could pose a problem for OP as well as the MD and office.

4 hours ago, mzsuccess said:

I’m just curious, the pt told me she was told by the MD she will need skilled nursing care and cannot he left alone.
This pt also plays on this, I believe to get sympathy from her family. She’ll act as if she’s so sick and etc.

So I’m not sure how she got nursing care but she can do everything on her own. I’m thinking she had it because she had a cuffed Trach and couldn’t talk but now IDK. I feel like a buddy sitting there and a maid. She acts as if walking is too much for her and everything.
She’s been through a lot and IDK what’s going on physically but all her labs are normal. The Drs are saying nothing is wrong with her and talk her off some of her meds because they she’s becoming addicted.

It doesn't matter what the pt tells you, it matters what the MD has ordered. The pt can "act" sick all she wants but that doesn't mean you need to humor her. Again, I would ask you, what skilled need are you providing and are you charting that (please ask yourself these question). If she is able to drive, babysit etc I would definitely question the skilled need. Maybe the trach might do it but not for anything other than in in/out visit, and then usually only if the trach was new or pt unable to care for it, or no family etc. Please tread carefully in this situation for many reasons!!

[mzsuccess]

2 hours ago, Daisy4RN said:

The OP may not have signed the initial paperwork but is charting on the routine visits. If there is no skilled need what is OP charting? I would think that over time this could pose a problem for OP as well as the MD and office.

It doesn't matter what the pt tells you, it matters what the MD has ordered. The pt can "act" sick all she wants but that doesn't mean you need to humor her. Again, I would ask you, what skilled need are you providing and are you charting that (please ask yourself these question). If she is able to drive, babysit etc I would definitely question the skilled need. Maybe the trach might do it but not for anything other than in in/out visit, and then usually only if the trach was new or pt unable to care for it, or no family etc. Please tread carefully in this situation for many reasons!!

2 hours ago, Daisy4RN said:

The OP may not have signed the initial paperwork but is charting on the routine visits. If there is no skilled need what is OP charting? I would think that over time this could pose a problem for OP as well as the MD and office.

It doesn't matter what the pt tells you, it matters what the MD has ordered. The pt can "act" sick all she wants but that doesn't mean you need to humor her. Again, I would ask you, what skilled need are you providing and are you charting that (please ask yourself these question). If she is able to drive, babysit etc I would definitely question the skilled need. Maybe the trach might do it but not for anything other than in in/out visit, and then usually only if the trach was new or pt unable to care for it, or no family etc. Please tread carefully in this situation for many reasons!!

I mentioned what the pt told me because I’m pretty new to this case and wanted to know exactly why she needed skilled nursing because the agency couldn’t be specific ( red flag) my notes are pretty much recording intake and output, Trach cleaning, cleaning up, and monitoring. She’s had skilled nursing for 4 going on 5 years. I don’t even know the MD that initially signed off, from my understanding she has swelling issues and had to have a Trach to maintain a patent airway. She does EVERYTHING else. I actually feel sad for her, because she’s looking for attention and the only way you can show it to her and by giving her material things. She puts on an act in front of her family. I should have know something was up whenever she goes to the hospital her brother and sister would say she’s running to the hospital again for no reason and even her Dad thought she was faking. So now she focus on her “Trach”. Does every pt with a Trach qualify for a skilled nurse?

[mzsuccess]

5 hours ago, KatieMI said:

It is a common story. Either her primary care provider is too lazy or "friendly and customer-oriented" and just signs off renewal orders for skilled nursing, or he/she and home care management "work as a team" to keep her on the skilled list and marginally increase revenue. Or she can overplay both of them for whatever reason. It is very common as well and difficult to check - for provider, there is really no way to know if that moaning, hardly moving human being that sits in the office with teary eyes is quite able-bodied and just enjoys feeling herself like the center of the Universe. I saw more than few of them swearing to God that they are so disabled that they need help with feeding and wiping QAM "as they always did that for me in hospital" - and observed in local Walmart in just an hour or so happily throwing tankloads of Budweiser and 10 lbs packs of burgers in heavy duty trucks in which they got into and drove around without any issues. Some of those apparently grievously disabled samples of humanity came to the office right in camo and with guns hoping to get someone watching their houses, kids, pets and truly disabled dependents for free while they hunted off the Michigan deer season ?

It is a worrisome situation but, in any case, YOU HAVE NOTHING TO DO WITH IT. You did not sign her skilled care needs paperwork, you're off the hook. Just get outta there.

WOW!,

You really opened my eyes I guess insurance fraud isn’t really common.

I heard her say one day to her ex coworker that she gets paid to do nothing and sit on her a** all day.
I was like OMG. I can’t people will actually fraud the system this way. I’m not feeding into the putty anymore.

7 hours ago, subee said:

I would isolate myself from being involved in a Medicaid fraud case. Please report them when you leave.

Oh! I definitely will.

Her and her Mom even said she can work and get a job doing delivery and have the nurse do the deliveries for them! Fraud!

[Daisy4RN]

23 minutes ago, mzsuccess said:

I mentioned what the pt told me because I’m pretty new to this case and wanted to know exactly why she needed skilled nursing because the agency couldn’t be specific ( red flag) my notes are pretty much recording intake and output, Trach cleaning, cleaning up, and monitoring. She’s had skilled nursing for 4 going on 5 years. I don’t even know the MD that initially signed off, from my understanding she has swelling issues and had to have a Trach to maintain a patent airway. She does EVERYTHING else. I actually feel sad for her, because she’s looking for attention and the only way you can show it to her and by giving her material things. She puts on an act in front of her family. I should have know something was up whenever she goes to the hospital her brother and sister would say she’s running to the hospital again for no reason and even her Dad thought she was faking. So now she focus on her “Trach”. Does every pt with a Trach qualify for a skilled nurse?

Well that is a huge red flag ( the fact the agency cant tell what the skilled need is) ! The problem, at least for you, with the fraud is not r/t whatever scheme she is cooking up unless you are participating (like the example you gave of the driving job). The problem (that could come back to you) is re: the (potential) fraud with your agency and thus you as the nurse providing the care. If you are not clear what the skilled need is then how are you able to chart on that? In my experience simply having a trach does not qualify unless there is also something that goes along with that, pt unable to care for the trach, no family, infection, continuous O2/suction etc. I don't know exactly what her condition is but I would look into this further. As Katie stated fraud at some of these agencies is quite common and you don't want to be caught up in something and risk your license, you never know what could happen. Also, please really consider putting a stop to the sexual language and document your responses as such. Ask your agency directly about the skilled need so you can document, if they say it is the trach ask for written documentation (MD order, procedures etc) so at least you have something tangible, as a nurse you are required to follow the MD orders and document in your charting. This sounds like a horrible assignment and I hope you get out soon and in one piece!!

[CommunityRNBSN, BSN, RN]

I’d be really nervous about the patient flirting with you. Be sure you document everything she has said. How many thousand times have you read about a situation where that is going on, and then when the nurse sets boundaries or nicely explains that they are not going to be involved in a relationship, the patient retaliates, claiming that the nurse was sexually pursuing the patient.

[KatieMI, BSN, MSN, RN]

13 hours ago, mzsuccess said:

WOW!!,

You really opened my eyes

Heh, you never heard what a human being can tell you to prove himself having "emotional disability" and thus get a sheet of paper allowing him to take his pet everywhere free of charge. Especially when he suddenly remembers about that sheet of paper at 4 AM before flying across the country at 8 AM (2 hours drive to the airport) and so rushed to the nearest ER, together with the Fluffy and a bunch of hamsters.

The most exiting thing in the World is searching for a runaway hamster in 50-beds busy ER at 6 AM, I'm gonna tell you ?

Also what human being can do if they are want "someone take care of" an elderly relative for free while they will supplement their income with his SSI check. Or how they can seamlessly blend parenting, religion, Gestapo and Holy Inquisition. Or what can be done if you're sitting in closed mental health facility because you were just recently right in between of killing yourself or someone else but know that your destiny is to shook the Vegas.

Nursing will teach you many things, one of them being lack of ability to get surprised any further when it comes to relations between humans.