Is it just our agency? How do you deal with this?

Published

Hi!

I work for an agency that takes Medicaid and Charity Care patients, and so we see a lot of unusual cases come through.

While I don't mind providing services to people in need, what is bothering me is:

1.) The number of people being referred to our agency who are not what I consider Home Health-appropriate cases (people who we are going to see for a specific medical condition over a short period of time who are expected to get better and then discharge), but instead are long-term care cases who refuse to go to AFHs or SNFs, or are people who are unsafe and non-compliant on their own and need daily supervision but can't afford caregivers.

2.) The fact that our agency management still wants to admit these folks to our agency, only see them for the payable HERG/HURG score number of visits, then discharge them whether they have been compliant with care or not.

This drives me crazy because this really puts the HH RN in the middle of a no-win situation.

I worry about my liability and my license when it comes to people who are non-compliant and not safe in their homes, and I have to now find a way to safely DC them from the agency without endangering the patient, angering the PCM or the family, and without looking like we have just tossed the patient to the side the minue they have met their payable number of visits.

But if I don't discharge them, I get upset managers.

Does anyone else have to deal with this sort of situation?

What do you do or how do you handle it?

Up Vote Up Vote ×
Specializes in Med/Surg, Perioperative, Home Health.

I'm sorry to hear you refer to patients who don't want to spend the rest of their life at a long term care facility in such a negative way. Playing a role in helping people choose where they live and die is the most rewarding part of my job. This is home health. We help people stay in their homes as long as possible. Yes, some are unsafe anddont always follow doctor's orders, but then we need to work harder to find the reasons why and advocate for the. We are the ones who help them live safely in their homes and ensure they care for themselves.

I understand it can be frustrating, but please try to make the best of it.

Up Vote Up Vote ×

Hi, and thanks for the response.

I guess from the lack of response from others and your response, I am thinking I have miscommunicated what it is I am trying to say.

I am not feeling negative towards any patient or any choices they may make.

Let me try to rephrase my concern...

We are admitting patients to our agency with known long-term needs, but management is only allowing nurses maybe 5 visits based on billable insurance numbers for short-term acute issues, and then pressuring us to discharge these folks when their coverage for these short-term issues is up, whether they are safe to be on their own or not.

Sometimes they are not and need long-term help for issues which their insurance does not cover in terms of home health.

I was wondering if this is standard practice in home health and/or if there is liability involved for nurses who might discharge a patient who then falls or goes into a diabetic coma because they were no longer supervised by nursing in their homes, but are refusing SNFs and have no other reliable support system in place, can't afford to hire an in-home private caregiver, and are not safe.

It puts me in the middle between trying to make management happy and trying to be there for patients, and THAT is what I don't like and am trying to find an answer for.

Up Vote Up Vote ×
Specializes in COS-C, Risk Management.

Get an MSW consult, document your keester off, and discharge. You cannot force people to be compliant but you can document their non-compliance.

Up Vote Up Vote ×
Specializes in psychiatric home care.

burlshoe114

I KNOW EXACTLY WHAT YOU ARE SAYING and know how it feels too and it is SOOOO frustrating

I work for an agency that does similar stuff. I hate having to admit or discharge a pt that is NOT SAFE TO BE AT HOME!!! My understanding is that it is required that pt be safe to receive home care and not be admitted if they are not safe at home.

As kateRN said DOCUMENT DOCUMENT DOCUMENT

One thing that we do when having to d/c a pt in these circumstances is give them info regarding other home health agencies

Up Vote Up Vote ×
Specializes in COS-C, Risk Management.

Don't forget that the patient has the right to choose where they will live and receive care. We cannot force someone to be compliant, we cannot force them to choose a higher level of care, and we cannot force them to make what we consider to be the "right" decisions. And we cannot document that they aren't safe until we've tried to make them safe. This is where your documentation comes into play. The patient needs to be involved in developing their plan of care, they need to have understanding from the admission visit that non-compliance will result in discharge, and then we have a duty to try to help them to the best of our abilities, even if we're 99.9% sure that it won't make a difference.

Make sure that you are notifying the physician, also. Many times the physicians are not aware of the limitations of the patient/caregiver, so that must be carefully documented and followed up on.

Up Vote Up Vote ×

maybe a little pessimistic of me but this kind of bureaucracy seems to be in every everywhere (even in non health care professions).

it's frustrating as hell

Up Vote Up Vote ×
Specializes in Peds/outpatient FP,derm,allergy/private duty.

I'm not sure why these patients who seem to be clearly in need of more comprehensive services than would be adequate for an acute or temporary short term need and then discharge are not qualified under your states Medicaid program for HHA, and/or some amount of skilled nursing visits that are normallly recertified every 60 days with a plan of care that is a summary of everything they will need for that time period and signed by the patient's doctor.

I'm thinking that possibly this may be a difference in one state government to another, the type of admission/discharge for that type of patient seems inadequate almost right out of the gate.

In my state we have a waiver program that pays for people to get whatever combination of HHA/skilled nursing hours they need and it is expressly stated that without that level of care they would be placed in an LTC center or a rehab facilty or whatever was most appropriate.

I believe that having patients on this type of home care is actually more cost-effective than the long-term care facilities due to risks of infection and other factors.

Here in California I am pretty sure there are several areas one can go to for resources such as adult protective services to get the appropriate type of care for these people. I honestly don't see though, how you could be personally liable for what happens, because you aren't making those decisions or writing admitting or discharge orders.

Up Vote Up Vote ×
+ Join the Discussion