I want to quit home health

[wideyedfreedom, LPN, RN]

Hi, 

Fairly new HH nurse, RN and I do skilled oasis visits. I am extremely frustrated with several patient situations and how to manage them. 

Most of my "tough" situations are patients with difficult home dynamics or lack of caregiver support. 

Patients who really need to be in assisted living but they refuse and want to stay in their home. No family or close support. We set up appointment with MSW, patient is given resources but nothing gets done. PCP is aware and doesn't do anything. We go in for medication management but seem to get nowhere with the patient. To top it off they have a managed care insurance that they agency and the insurance want us to discharge ASAP, but being the primary nurse I do not want to discharge the patient being it is unsafe and patient is not taking medications properly despite 2 months of medication management and education. 

Patients who are AOX2 but are living alone with no family assistance, or the occasional neighbor or friend who "stops by". 

Homes that are extremely dirty or disorganized and pose a safety risk. We create a "safety plan" but unless their home is completely cleaned out, nothing truly gets done. And many of these patients are too sick to do it themselves and if they have no family support who is going to do it? 

At what point is lack of caregiver support enough to call DCF? Calling DCF to be told that unless it is visualized that harm has happened to patient they can't take the case. But when that harm does happen .. won't that make the home health clinicians liable? As we are supposed to be preventing these things from happening. 

Educating on disease processes over and over to have patients readmitted to the hospital for the same thing. Patients with inability to manage disease processes due to dementia, even if mild dementia, but yet they still continue to live home alone. 

Offering private caregiver or home aid services but usually the patients in this situation do not want to pay for it or cannot afford them 

Patients refusing discharge to a SNF following a procedure to come home with surgical wounds that require daily wound care, yet they have no ability to do it themselves and they have no caregiver assistance and we cannot do daily wound care. 

Or even better, the patients only available caregiver needs a caregiver themselves! 

 Just very frustrating, I get into this situations a lot with patients who have absolutely no support and it feels often like a lost cause. My management states to continue to educate, document and notify MD but is that really all we do in these situations? 

I worry about liability often and I am actively looking for a new job. Of course I have many patients that do have support and good outcomes and I actually feel like we do make a difference. But I see so many that are the opposite. Living in FL, all of these patients families live up north!! 

Any insight or advise would be greatly appreciated 

[heron, ASN, RN]

Unfortunately, you've run into a fundamental glitch in our healthcare system. If you're lucky, you'll be able to figure out how to help your clients as best you can OR find work that's better fit for you.

We have a wealth of experience and even more advice/opinions. You're welcome to whatever helps.

Here's mine.

Legally, I think you're kinda stuck. So far, the only thing you can force on a legally competent adult is pregnancy. I personally don't agree with forcing anything on such an adult "for their own good". It sucks to watch someone make destructive choices. Eventually the safety net fails. If you decide to stay where you are, you'll have to come to terms with that. It's about doing the best you can with the resources at hand.

In fact, I think it's pretty much the same in most areas of nursing.