Driving me CRAZY!!!!!!!!!!!!!!

  1. In noverber of last year I started working with a new home health agency. Ive just recieved a memo that all patients must have a scheduled appointment everytime I see them. This s now mandatory. I see up to seven to eight pts a day. I never know what I am going to walk into when I walk into a home. Be it high blood pressure and I have to call the doc -or rectal bleeding that has been going on for two or three days and the pt is "waiting for the nurse" before they call the MD. So of course the visit will be longer. Now I always try to see the pt whithin the same time frame of a couple hours if I see them more than once a week and I call before I go to thier homes. I just dont see how I can see them at the same time every day.
    What happens when I get a new pt and have to juggle them? and everyone wants me at thier home at 0900? How can I do this?
    It is also common practice for the office to call me out of the "blue" to go 20 miles out of the area I am in to go see someone else that just "needs a visit" when I have two or three people left in the immediate area I need to see?
    Also it is common practice for the office to call for me and another nurse to do blood draws because the pt's nurse "just doesnt do them"? And I have a "scheduled appointment" with another pt.
    I have one area that does not have a home health aide and give these patients baths as well. I dont mind this but it is very time consuming. Also, is it my job to find the patient a home health aide.? I thought the office did this.
    Im getting confused on my role as a home health nurse. I always get diff answers from colleages.

    PLEASE HELP ME!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!

  2. Visit nurse2002 profile page

    About nurse2002

    Joined: Aug '02; Posts: 166; Likes: 3
    Home HEalth Nurse, Agency on the side


  3. by   hoolahan
    Your post has me HOT, as in angry, as in spitting fire.

    FIRST of all. Regarding the HHA. This is the most absurd and ridiculous problem I have ever heard of. Your poor girl. Let me educate you...

    First, what are the ORDERS for your home health aide? 2 hrs? 1.5 hrs?? IF your agency is NOT providing what is ordered, and they are charging Medicare or Caid for it, that IS FRAUD!!!!!! YOU will be also held accountable if you go along with this any firther, now that you know better!! Ask these pt's top show you their Medicare statements. You better find out what that agency is doing behind your back. You are there for a skilled nursing visit, period!! OK sure if someone is soiled you clean them up, but it is NOT your role to give them a bath!!! That is RIDICULOUS!!! With EIGHT pt's a day??? ABSURD!!! I am betting my bottom dollar you are not spending 2 hrs giving a bath, plus your 30 min in their home or 45 for Caid visit. Not to say you wouldn't IF YOU COULD, but with EIGHT pt's??? No way I will believe that, that is why I say your agency is commiting fraud. I am fairly certain they wouldn't just bill for 30 min of HHA service.

    You need to be very direct about this. Approach your supervisor, and tell him or her that you are concerned that by not providing all of the time that MAY be getting charged, you will be accountable for fraud. Put your foot down and REFUSE to do it any more. If they fire you, you could pursue a whistleblower lawsuit.

    SECOND, who's assinine idea was it to make scheduled appt's?? I have 6 visits max a day, a new counts as 2. I call everytone in the am and give them a 2 hr window of when I will arrive period.

    Yes, it is just a fact of l;ife that from time to time you will be called while in the field, but it should be for a credibvle reason, like foley or G-tube out, NOT just for a C-P check, that is NUTS!! They do it to you b/c you allow it, period. REFUSE unless it is an emergency, OR call the pt and feel the situation out for yourself. Are these your pt's?? So you know they have another visit? Or maybe someone isn't managing their caseload and missing things, so sup's are covering their arses??

    This whole appt thing is just not do-able, period. And if they called me in the filed to do something silly, I would say "I'm sorry, but I can't work that into my appt schedule."

    EIGHT visits a day?? That is a lot. MOst people do 6 to 7 a day.

    The nurse that "Just doesn't do labs?" Uh, why don't you ask how you can sign up for that program?? Seriously ask your supervisor if that is a benefit that you can look forward to after X # of years w the company. Just see what she says??

    Your supervisor is treating you LIKE DIRT. Your company is putting your nursing license in jeopardy, and probably making you a party to fraud.

    Frankly, if I were you, I'd get the hell out of there as fast as you can w/o even making any waves. Encg the pt's to report the agency to the State Dept of Health (they are by law supposed to be given those numbers upon admission), or to "discuss" their bills w Medicare or Caid.

    Dahling, you can only be a doormat if you allow it.

    Good luck, and let us know what happens. I hope if I sound harsh, you realize I am not criticizing you, just have been there done that, and I smell a rat, and I think your agency is shady!!
  4. by   nurse2002
    Thank you very much for your reply. No, It wasnt harsh at all. I really needed to hear that. I knew I was being taken advantage of but i did not know to what extent. I appreciate youur input VERY much................ Thanks again
  5. by   nurse2002
    Originally posted by nurse2002
    Thank you very much for your reply. No, It wasnt harsh at all. I really needed to hear that. I knew I was being taken advantage of but i did not know to what extent. I appreciate your input VERY much................ Thanks again

    I also need to say that I dont always have eight visits a day but last week and the week before I did. This wek it is mostly 6 visits. Wen I do a nursing visitand hha visit I am there for one hour. I do the hha and skilled in that one hour. I have no idea how it is billed. Guess I need to find aother job. Thanks!
  6. by   hoolahan
    Good of you to add that, but still, I bet your agency is billing for more. Maybe they are really just trying to provide the pt w the service, but not having enough HHA's is the agency's problem, not yours or the pt's. They agreed to have this service available, and they have to meet the need. Maybe if they paid these people a decent wage, they wouldn't all be leaving to work as medical assistants in doc's offices making 12-14 per hour!!

    WE have the same problems w HHA shortage, believe me, all agencies do, but I have never been asked to bath a pt, as a sub. Have I ever done it? Sure, plenty of times, when I am showing a family how to care for a bed boud pt for the first time, I get out the basin and we bathe them together, change the sheets, tunr and position, but not as a routine. Or maybe when someone has just come home after shoulder arthroscopy w arm in sling and asks me to help them wash up a bit. My agency knows better than to even ask us to do that as a sunstitue basis for the aides!!

    To play devil's advocate, I would never want to be a manager in these days of minimal staffing either.
  7. by   karbyr
    hmmmmmmmmmmmmm.......................just got fired from an agency for refusing to play this game............what is the medicare law about lengths of visits?????????they encouraged us to be in there no more than 20-25 minutes "if at all possible"
  8. by   KP RN
    My daily productivity is 5.7 visits. We do have a policy which requires us to call the pt the evening before our visit to inform them of our appt. time. This has never been a problem. If I get stuck at one patient's house and I get behind, I just call those patients by cell and notify them that I'm running late.
    I would absolutely REFUSE to do HCA visits on a regular basis. Likle Hoolie says, I've done them every now and again, but I certainly wouldn't be giving showers routinely.
    I have a question though. Is this really Medicare fraud?? Seems to me that with PPS, the agency is paid one fee for the entire case. I didn't think agencies were still billing for, say, 12 RN visits, 8 PT visits and 18 home care aide visits???
    It sounds like your agency is taking advantage of you.
    Karbyr, I'm shocked that your agency doesn't want you to be in a pts home for more than 25 minutes!! OMG! How can you possibly do everything you need to do in such a short period of time?? My average visit is probably 45-50 minutes--and that's an easy uncomplicated one!!
    I learn something new every day!!
  9. by   karbyr
    lol, i agree kp..............is impossible to do much more than an aide sup in that amount of time.................on one of my nursing notes the quality assurance manager put a note w/ big letters........."45 minutes for one visit".............course, I had called the md, drew blood, and set her up to obtain a u/a, but apparently took to long doing it...............was actually a relief to get canned
  10. by   KP RN
    Oh my, Karbyr,
    May I assume that you were being paid hourly, as opposed to per visit??
    Glad you got out of there!!
  11. by   hoolahan
    KP, you raise a good point about the PPS thing. But an agency still has to be in compliance w the orders. Now if they do this under Medicaid, it would be fraud.

    Manm do you think they are so devious as to have figured that out about PPS and use it to their advantage like that??

    I was unfortunately involved w an agency who practiced serious medicaid fraud, and ever since that expereince, I am very untrusting. There are a LOT of people out there who do things you just wouldn't believe when it comes to fraud. Shocking. Nothing really surprises me after what I went through.