Illegal home health operation? Please help.

[UpTheLadder12]

I was hired by a family to do pediatric private duty as an LVN, and it was explained to me that I would be paid out of a trust fund, which i believe is a public trust for children who experience complications at birth. I filled out a giant employment packet, and was told that she (the child's mom) would call me when I cleared background checks and all that. She ended up calling me the next day asking if I could come in over the weekend, telling me that she called the trust, and that even though they are still processing my paperwork, they can make exceptions to expedite things when she needs it.

I went in for my first training shift (overnight 12 hour shift) with an LVN who is employed there. Here's the thing: this LVN, as well as one RN and another LVN, are employed through a home health agency. Apparently they started off being payed privately by the trust, and then if the mom "liked them" she turned them over to the agency. There are also other LVNs who are employed by the trust. But ONLY the agency nurses document in the patient's medical record.

During my training, it became clear to me that the only place I was expected to document anything is in a composition book that is for the mom. No official record. And the sheet with the meds on it is not a doctor's order, it's just a printed piece of computer paper that says things like "8 pm- half a tab of ____, 200 mg of _____. So i don't even have access to the official medical record, and everything I am supposed to do is either told to me verbally by the LVNs or the mom, or written on plain paper with no official signatures. The nurse training me said that there were things that the mom wanted her to do that she wouldn't, such as giving him homeopathic drops in his mouth since- they are not prescribed, and he is NPO. Also, the girl training me said that I was making $14.50 an hour, and i said that I was told that i would be making 17. She said that it is 14.50 plus overtime for the last 4 hours, because I'm technically hired as a caregiver and I'm working in a "gray area". I know that that is technically hear-say, but I did the math, and she had the numbers right, and it would be absurd for someone to take the time to make that up and even figure out the math if it wasn't true. It just sounded too fishy to me. And we are ON CAMERA- there are 2-3 in every room.

I was supposed to go in tonight and be the LVN on duty and after calling some friends with home health experience to reassure myself that my gut was right, I called to tell the mom that since I personally had no communication with the patient's record, that I could not give medications and treatments , but that i would be happy to come in as a caregiver and monitor him overnight. Of course she raged at me, saying that I must be mistaken, she's been hiring nurses for years and no one has ever had this problem, I don't know what I'm talking about, etc......But I just can't imagine that I am operating within my scope of practice by giving medications and treatments typed up on computer paper and not doing any documentation. There other things too, like the recipe for the formula that we fed him. The LVN put baby food, baby formula, orange juice, several vitamins and supplements in liquid form, mixed it up and poured it into bottles, and that is what he's fed. Don't we need to see a doctor's order to make and/or feed him that? By the way, the patient is on a G-tube, is non-weight bearing, and requires postural drainage and breathing treatments.

Is this mom going around the system and hiring LVNs "under the table", except for the ones who are hired by the agency and document in the chart? In my opinion, even the ones who are legal are sketchy if they are following the mom's med orders instead of the doctor's.

Oh and on a last note, when the RN came in at the end of my training shift, she was dressed as if she's been clubbing all night, with knee high boots, and leggings that were so see through that I could see her thong- not just the outline of her thong, but the actual underwear.

[Julesmama28]

Not a nurse, but my advice is to run. If you can't document correctly, or even follow an MD's orders than if something goes wrong it's your license on the line!

[onepowerfullady, LPN]

I work in a private duty setting as well through an agency. There are Dr.'s orders in place. My client is a child and is terminal. The mother did most of the training and I told her that if it was not apart of the Mar and apart of Dr.'s orders I could not do it. Anyhow, I would be out first thing smoking... Sounds like some fishy stuff to me! Good luck!

[caliotter3]

In a nutshell, when you work private duty for a client, actual private duty where they pay you, not an agency, you do what the parties, yourself and the client, agree to. But when you work for an agency, then you follow agency policy, care plan (485) in place, proper MARs, proper documentation. Nothing wrong with documenting in her notebook for the private duty job. However, since you are uncomfortable with this entire setup, and I can see why, simply refuse to get involved.

[UpTheLadder12]

in a nutshell, when you work private duty for a client, actual private duty where they pay you, not an agency, you do what the parties, yourself and the client, agree to. but when you work for an agency, then you follow agency policy, care plan (485) in place, proper mars, proper documentation. nothing wrong with documenting in her notebook for the private duty job. however, since you are uncomfortable with this entire setup, and i can see why, simply refuse to get involved.

so, since i was hired private duty, there is no regulation on what i have to chart? also, can i give medications, g-tube feedings, postural drainage, etc. if i have never set eyes on a doctor's order or spoken to the physician, and my only direction comes from the mom and from an lvn who is employed by the agency? i already turned down further employment, and i was supposed to work tonight so i only gave about 7 hours notice, and i know she is very upset. i feel bad, and i really hope that i am not wrong about this (and throwing away a good opportunity). but it just doesn't seem like that can be legal to hire a private duty lvn and just put meds in her hand and say "give him this" without some solid documentation for me to follow that comes from his primary doctor.

[merlee]

So there are no med bottles that the pills or liquids come from? The bottles are sufficient 'orders' if you are strictly private duty.

And there may be overlap in agency and private duty personnel.

But if you are unsure, then stay away.

[UpTheLadder12]

Thanks for the response. What about things like using a pulmo vest? And g-tube feedings. Do I need orders for those?

[caliotter3]

If you do not feel comfortable with the parameters as set forth by the mother, then don't accept the job. If she were wise, she would allow you access to the in home chart from the agency. In it, you would find all the information that you need to feel comfortable with what you are doing. But since she doesn't want to provide this information to you, I would not accept the job.

[ibmanda2000, LVN]

I work pedi home health through an agency. Working as an LVN through a home health agency, we can got give the patient ANYTHING without an MD order... this even includes chapstick! I have a child that gets homeopathic Tx also and her formula is a special blend that we mix according to mom. SHe is also NPO, however we cam give her Vitamin B drops sublingual. We have orders for everything. Even giving manual CPT and/or the pulmo vest needs a Dr's order.

I personally would NOT work for anyone privately.... especially without first getting my own insurance.

Good Luck!