Legal to have 2 patients to one nurse in home care?

Blackcat99 · Jul 31, 2013

It seems to me that it is suppose to be one patient to one nurse period. I am sure the agency is making a lot of money on that case.

PerfectlyPlump, ADN, RN · Jul 31, 2013

Twice agencies offered me similar situations, in Texas, but the agency said I could only have one of the children. We didn't discuss legality.

Editorial Team / Admin · Jul 31, 2013

I guess it would depend on state law and agency policy. My grandparents were home care following my grandmother's stroke and grandfather's broken hip. Both of them received care, but there was only ever one nurse assigned at a time. I don't know anything about the payment; I know Medicare paid some because it was cheaper than an LTC for both.

meanmaryjean, DNP, RN · Jul 31, 2013

I had a home care case once with infant twins- I cared for them both and got an extra $3-4 hourly. It was perfectly legal BECAUSE it was private insurance, not Medicaid.

ventmommy · Jul 31, 2013

What is the level of care required? If they are both on vents or even just both trached, I would guess that would not be legal. It certainly would not be safe. If be Kid A was desatting and needed an emergency trach change for a plug how would you handle it if Kid B then decided he was ****** and pulled out his trach?

PerfectlyPlump, ADN, RN · Jul 31, 2013

Unless there are no other cases to be had, I would request an appropriate rate increase in short order from the agency. Time and a half for 2 children might be a fair rate, as long as it was a safe situation, as alluded to by ventmommy.

PerfectlyPlump, ADN, RN · Jul 31, 2013

Unless there are no other cases to be had, I would request an appropriate rate increase in short order from the agency. Time and a half for 2 children might be a fair rate, as long as it was a safe situation, as ventmommy brought out. Maybe.

luvtwilight · Jul 31, 2013

One is a trach and both have Gtubes and require feedings at night. They are in seperate bedrooms and the nurse is expected to sit in the living room and listen for alarms. I am not going to accept this case. I don't feel comfortable having 2 patients both getting feedings that I cannot visualize at all times, what if one of them vomits, especially the trach patient, and aspirates?! Also I didn't get any training, literally walked in the door and PCG couldn't wait to go to bed, I didn't know where any supplies was located and it was dark. I will be calling the agency to let them know I have decided not to accept the case!

SDALPN · Jul 31, 2013

I had a case with 2pts. The way they worked it it was that one kid stayed home all day and the other went to school. One on tpn and the other only gt. I took care of the one all day and charted on him until the other came home. I would then document care for the other child when he came home from school. The agency made it so that we were only caring for one at a time. But they didn't pay extra. I didn't care for the situation because the risk wasn't worth it and the agency was making lots of money off it and I wasn't.

SinikRN101 · Aug 4, 2013

I have only heard of two patients = two nurses. A friend of mine told me about a situation where she was in need of feminine products and went to the corner market and came back and was fired from it as it was abandoning the patient even though one nurse was present for both patients because she worked with another nurse. I would definitely ask to be oriented to these patients by shadowing another nurse. It really helps with anything you might run into as well as locating supplies, routines, preferences, medications etc. I'm not sure I would sit in a living room, maybe go in there to do some charting but ask for a chair in one room or the other, and make several room checks. I know how scary the thought of aspiration is, maybe use that to create more due diligence? Like if they were hospital rooms you couldn't keep an eye on them every second. Remember to elevate the HOB and chart to CYB.