How flexibile are you with patients in HH

Published

I started as a PT in home care last August. I came from skilled nursing. It took me awhile to get the hang of doing my schedule. It just seemed logical to me to see patients according to geograpical area which was working fine until I started with a new agency. They seem to go above and above trying to cater to paitents even when the patient is being unreasonable in their demands. I was given several patients that were seen by another PT who was swtiched to a different area. As usual I call people the night before to tell them I would be out. A lot of patients were mad when showed up at the home wondering where the other PT was. I had one patient tell me I dont understand why you are here and where is the other PT? I explained to the paitient that the agency has asked me to see them. Then I get drilled on the times they can and can not be seen. One says she does not get out of bed until 12 noon. Another demanded I only come after her morning tv shows are over with. One says you can only come late afternoon and asked me what are doing during the day you can't come at the time I ask?

This agency has me running all over town to multiple cities where the distances may be quite far from each other. They aren't giving me mile reimbursement either. I see two towns on Monday and Wed and the others on Tues and Thurs and any new ones on Friday as everyone is twice a week. If I was just in your area Mon and Wed for therapy there is no way I am driving back to your area on Tuesday when I could have saw you with the other patients in your area that on Monday. I can only be so accomadating. I am all for rescheduling the visit to another day or time if you have an MD appointment. Why should I go out of my way to see you at another time than the one I said I could come when you are out of the home running errands or eating lunch at Olive Garden. I am also seeing that alot of these patients are not truly home bound. ONe patient told me he needed to cancel all his visits for the week because he was going on vacation to Mexico. If one can go toMexico for leisure how are they homebound?

Up Vote Up Vote ×

The circumstances in your post contributed to why I decided to stop doing visit nursing. Far less inconvenience in extended care.

Up Vote Up Vote ×

The problem is with your new agency.

I accomodate medical needs and I will bend over backwards for some situations, daytime TV schedule isn't one of them, but if you've been up all night with pain secondary to malignancy, I'll see you on my home if your prefer.

We can hardly secure enough PTs despite being a very nice place to work, I'd think you'd have choices.

Up Vote Up Vote ×
Specializes in NICU, PICU, Transport, L&D, Hospice.

Hm

I doubt that agency can afford to lose your skills as a PT, so if I were you I would tell them exactly how their plan is NOT going to work for YOUR PROFESSIONAL needs.

Up Vote Up Vote ×

It is not economic to drive back and forth and a waste of money and time - especially if you are not getting miles reimbursement.

While there are coworkers who accommodate the patients time to extend that makes working hard I do not accommodate this behavior.

In my opinion the pat has to be homebound to receive home care services - meaning the pat is at home unless going to MD appointments and that is prob rare. I agree with you to go in a logical geographical way that saves you time and money. I found that when I leave a message or call and tell the pat when I will be at their home (plus minus half an hour) it usually works.

If you do a great job as a PT - and I assume you do - the pat will accommodate you and take the time you offer just to have you come in. As long as you offer superior customer service otherwise and great PT it should not be a problem.

Up Vote Up Vote ×

Thanks everyone. I am assured that what I am thinking is very logical. I have x amount of patients that need to be each day. I have very wiggle room to cater to everyone time wise. I think I am too nice about this coming from my friend who is a PT. He simply tells the patients I will be at your home at this time and you will need to be up and ready to go lol. I will be nice about it but I will adopting this habit next week. I don't really like patients trying to dictate my schedule for when they choose to be seen. I would love to tell my doctors office I will be there at this time for my appointment and see who far that gets me lol.

Up Vote Up Vote ×
Thanks everyone. I am assured that what I am thinking is very logical. I have x amount of patients that need to be each day. I have very wiggle room to cater to everyone time wise. I think I am too nice about this coming from my friend who is a PT. He simply tells the patients I will be at your home at this time and you will need to be up and ready to go lol. I will be nice about it but I will adopting this habit next week. I don't really like patients trying to dictate my schedule for when they choose to be seen. I would love to tell my doctors office I will be there at this time for my appointment and see who far that gets me lol.

It's not about being nice, or not nice. Don't think of yourself of having to stop being "too nice", look at it as being realistic in order to meet all of your patients' needs and not over extend yourself to the point of not being able to perform the job. It might just be semantics to you, but I think tweaking your perspective might make it more comfortable when asserting your availability.

I have suggested out patient to folks who want to control their therapy schedule. I have also related it as an alternative to inpatient rehab, where there is no control of scheduling and they're confined to a facility. When given those options as perspective, waiting in the comfort in their own home with the convenience of not having to travel to OPPT therapy 3 x week seems a bonus.

I don't say it with any irritation, I simply provide them with alternatives to dealing with home health scheduling if they voice issues with it. And I make sure we are giving adequate notice of days and times of visits. I'm a nurse and our scheduling is even more unpredictable and I can still usually let them know if the next visit will be am or pm so they can have some idea and then I call the evening before to confirm.

Up Vote Up Vote ×
Thanks everyone. I am assured that what I am thinking is very logical. I have x amount of patients that need to be each day. I have very wiggle room to cater to everyone time wise. I think I am too nice about this coming from my friend who is a PT. He simply tells the patients I will be at your home at this time and you will need to be up and ready to go lol. I will be nice about it but I will adopting this habit next week. I don't really like patients trying to dictate my schedule for when they choose to be seen. I would love to tell my doctors office I will be there at this time for my appointment and see who far that gets me lol.

i work as a per diem hh RN. I pick up visits when the regular nurse can't. I get a lot of the "who are you" stuff.

I call the morning of my visit. I frequently get people who want to put me off, or want me to accommodate the schedule of their usual nurse. The problem is, I only work til 2, and if all 4 of my visits want to be seen after noon it just isn't possible. I set up my visits geographically before I call them, and for the most part I won't waiver from it. My morning call goes something like this "I'm Suzy, a nurse with agency C. I am coming out to see you today, I will be there between 10-11". I don't ask for permission, just state the fact. If I get someone who resists, and I don't have the flexibility to change, I tell them, I come when I said or I can't come at all. It is very rare that someone says not at all. My agency encourages accommodating patient requests only if that accommodation works well with staff scheduling.

As as to home bound. If you are serving medicare clients, they are expected to be home whenever you come for a visit. If they are going to Walmart, out to lunch, to the hairdresser, to Mexico, they are not home bound. They are wasting your time, and continuing to see them is against medicare guidelines and could get you in trouble. Discharge to outpatient.

Up Vote Up Vote ×

Yes there are difficult patients with scheduling. Before I make my schedule for the day I look at who I have and what their requests are for scheduling. I then see if I can make that make sense in my schedule. When I start a new patient I ask them if they are an early or late riser and I tell them I do my best to pick a mutually agreeable time for our visits. I do tell them that I may not always be able to come at the perfect time because I drive a lot of miles and I have to make my route make sense otherwise I can't meet the needs of all of my patients. I generally don't have too many problems.

I find that SOCs are the most difficult to schedule early since they are generally very tired and don't want to be seen early. If I'm on call I need to see my first patient at 8am. I will tell them they were put on my schedule at 8 am. It then sounds like I didn't choose that time, I was told by my boss that it had to be then.

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.

I was told the only two reasons a patient can be out and still be considered home bound is physician appointments and barber/hairdresser. Out to lunch, mall, vacation they are not home bound and MUST be discharged per Medicare rules. So the guy going to Mexico needs his discharge completed before he leaves. This is outlined in the intake packet from the agency that the patient is to sign.

The only cases that don't require home bound status are shift care, usually pediatric or young adult as the care is not because they are home bound but to keep the child safe & healthy in the home/family environment. (Usually considered private duty nursing)

Up Vote Up Vote ×

Yes I told the agency I was going to do the discharge from PT and I would pick him back up if the patient still n eeded the service after he returned. They were going on to try to keep him on. I notice that alot but of course agencies don't like to discharge folks. I always remind pts the need to prove on a continous basis to Medicare that they are homebound and I have to document just how homebound they are. If you verbally telling me our appointments need to be rescheduled because you plan to be at the mall or movie theaters then I will have no choice but to discharge you from my services. I would rather play by the rules then get into hot water with a government agency.

Up Vote Up Vote ×
Specializes in Pedi.

You must be firm with your availability. Adults are expected to be homebound to receive services at home if Medicare is the payer so these patients should have no reason to not be available at the time you are. If someone wants to watch a Soap Opera, it's 2015, get DVR.

My patients (children) do not have to be homebound. I will accommodate them if they go to school, as they should be going to school when they are feeling well enough, or when they have other appointments (like EI) that have to be worked around but otherwise, the time I have available is the time they're being seen.

Up Vote Up Vote ×
+ Join the Discussion