Keeping HH patients for >1 year

[Charitynursenola]

I have just switched HH companies after working in HH for awhile. I have a few questions as I try to figure out if where I came from or where I am now is the norm. I'll comment after with more info on my opinions.

What is the norm for recertifting patients an extended amount of time for monitoring and disease management, including staying around in the home to fill pill boxes weekly or "frequent labs" (not a skill, I'm aware.) I'm talking years since SOC for some patients. Below are a few examples.

1) a patient receiving dialysis 3x weekly who has chf and copd. No hospitalizations x 6 mo.

2) a copder on RA, old cva patient who is stable. New wound for recert, but no hx of wounds or foley.

3) a patient who has advanced dementia but is brought to the senior activity center 5 days a week by her sitter using the senior center bus (not an Alzheimer's program)

Thanks for any input.

[OldDude]

...fraud?... be careful about signing your name to anything

[caliotter3]

If it were me, I think I would just head on down the road to another job.

[Charitynursenola]

I'm struggling here.

I was told that for one patient in particular, who has been on service continually for over 5 years, that "Well She's had a lot of respiratory issues. Every winter she gets a lung infection. She might have several cert periods where she's stable and then something goes wrong."

In my old job, once you're stable for 3 weeks and All teaching is done, we discharge.

Is this what home health is, staying around to prevent further complications? I am open to changing my way of thinking but my gut is telling me otherwise. I think in the perfect world, you would keep a patient long term. I don't think that Medicare guidelines support this currently, correct?

I was also told, after asking why patient would need to have home health after wound heals, "I'm trying to reframe your brain. Every big home health company gets in and gets out. We don't do that."

[oceanblue52]

Some of the more experienced nurses can correct me if I'm wrong, but the only long term patient we ever had for med box fills were Medicaid patients. Medicare requires other "skills" to necessitate re-certs.

[NurseCard, ADN]

Sounds like a company that I used to work for, whose owner ended

up having to fork over millions of dollars after fraud charges. The company

ended up sold to a bigger, well established company, and the old

practice of keeping patients for years and years, went right out the

window.

[Charitynursenola]

Thanks for the input. Resigning immediately.

[KelRN215, BSN, RN]

When I worked in home health, we had several patients who were on service for YEARS but this was pediatrics and not Medicare. The long term with no end in sight patients were mostly ones with incapable parents- 2 kids with rheumatoid arthritis who needed weekly subq injections and parents were incapable of learning to administer come to mind. Both were on service when I started that job over 5 years ago and I'd be willing to bet both are still on service now. I had a blood pressure check patient who I followed for over 2 years but she was an infant when she came on service and had a very rare liver vascular malformation that compressed her renal artery and her Nephrologist felt it necessary to continue to monitor her blood pressures closely because blood pressures > 90% the norm for her age would negatively affect her long term health. Then there were the CPS kids- several, who we had to visit to ensure that their parents were complying with their treatments. All of these kids had Medicaid. The OP's scenarios don't sound like things Medicare would agree with keeping a patient on service for. We also had a patient whose Adult Day Care center wanted skilled nursing visits for- he had become totally disabled d/t a car accident as a teenager. He had Medicare and Medicaid but all services were billed to Medicaid because he was on service for chronic, not acute, issues. There were weird times when he would switch to Medicare- like if he had a wound.

[cmwodaat]

I have been a home health case manager for 4 years, and to me these sound like long term care patients. We do acute care and long term care cases, and filling a mediset and checking vitals is considered a nursing skill for long term care, but not Medicare or other similar insurance companies. Patients with CHF, dementia and other progressive ilnesses sometimes do qualify for long term care or Alltechs. I have patient for whom I have been filling medisets for for years. This would not be acceptable for an acute care Medicare patient. Different thing completely. Check to see what type of insurance they have.

[jdawson22]

I am currently in the same situation with the company I now work for . At my past agency I rarely did re-CERT's .. now that is the majority of my visits . They keep patients on service for years most are therapy only.. I am constantly trying to discharge people that are not home health appropriate and I'm getting told to keep them when I ask why they will say well they've had a lot of hospitalizations this year they need monitoring etc... monitoring for that long is not a skilled need ... unless I'm missing something.. then they will tell me oh well therapy can keep them because it's maintenance ... but I thought maintenance had to be a very specialized plan and in writing and it also has to end not go on for years ? Or am I wrong? Thanks!

[Guest1039141]

Absolutely not, if it is Medicare. Other payers do not have as strict guidelines. Familiarize yourself with chapter 7 manual from CMS. It outlines all skilled services.

[florencenightingale, BSN, RN]

I started working for a HH company March of 2017. On my 3rd month on the job, I had my performance evaluation my boss pointed out that I discharge patient too early (they only had one certification period in our company).