Need advice for a friend

[scrabblern, RN]

Hi,

I am a neonatal nurse and this is really out of my scope so I'm asking for help. My friend's husband just turned 65 and he's been disabled with neuro degenerative disease for many years. He is on IV abx now and according to his wife they had to go to ER 3 times for the PIV. She refused PICC on his behalf. She said that medicare would not cover for an RN to come in and restart an IV and that they have to go to ER. This makes no sense to me. I would like how is that possible? I am not sure thst she's aware of all the resources she has.

Thanks!

[PurpleDaisy🌸]

I can only speak from my experience, but at the agencies where I have worked, we do not start IVs. We will do abx infusion via PICC, with the intention of teaching Pt/CG to become independent with the infusion.

[Libby1987]

Medicare would cover a nurse to make a visit to restart an IV if they otherwise meet other criteria for home health care but we also don't manage peripheral lines, has to be at least a PICC. (I suppose mid lines too but we never see those).

Wonder why she she doesn't want him to have a PICC over multiple ER visits and insertions?

[Hoosier_RN, MSN]

Most time, like for ltc placement, must have qualifying 72° hospital stay to be able to get home health. I, too, wonder why no PICC? Less hassle for sure

[Hoosier_RN, MSN]

I can only speak from my experience, but at the agencies where I have worked, we do not start IVs. We will do abx infusion via PICC, with the intention of teaching Pt/CG to become independent with the infusion.

May depend on state or agency. I've done plenty of IV starts in home health, or if unable to get a start, send to ER for a PICC

[PurpleDaisy🌸]

May depend on state or agency. I've done plenty of IV starts in home health, or if unable to get a start, send to ER for a PICC

Hmmm... I guess I am not certain that we are CAN'T do it, but I have never seen it done. At the smaller agency I work at, only one or two nurses would have ever started peripheral IV's prior to working in homecare, and that was YEARS ago. There are some things we literally never see or may see once a year. PICCS however are more like 1-2 every few months.

I Am curious now... Going to look into why I don't see them.

[Jensmom7, BSN, RN]

Most time, like for ltc placement, must have qualifying 72° hospital stay to be able to get home health. I, too, wonder why no PICC? Less hassle for sure

Where is this? When I worked Home Health a lot of our patients were referred from their doctor's office and had not been hospitalized recently.

[middleagednurse]

She should call her insurance company to find out for sure. all insurance plans are not the same.

[Libby1987]

Qualifying stays are not required for home health. There are other criteria but that isn't one of them.

We don't do peripherals not because we can't but because they're too high maintenance and require too many after hours on call visits to replace in addition to the frequent scheduled changes that are difficult to staff and pose reimbursement problems. As well increased complications and inappropriate for infusing our common lengthy antibiotics courses.

With a PICC, usually only one visit/week is necessary.

[Hoosier_RN, MSN]

In IN, 5 years ago. Unless private pay, they had to have qualifying stay. I think 72° , but intake coordinator took care of those details. But all of our Medicares had been hospital stays. Not sure how it is now. 4 years ago, IN, Medicaids only had to have qualifying disability, not even homebound, to receive services. That remains the same (in response to Jensmom7)

[Jensmom7, BSN, RN]

In IN, 5 years ago. Unless private pay, they had to have qualifying stay. I think 72° , but intake coordinator took care of those details. But all of our Medicares had been hospital stays. Not sure how it is now. 4 years ago, IN, Medicaids only had to have qualifying disability, not even homebound, to receive services. That remains the same (in to response to Jensmom7)

Yeah, don't get me started on the not having to be home bound thing for Medicaid patients. Half the visits are missed because they're running the streets and no one knows nothin'.

[scrabblern, RN]

She said she feels uncomfortable with it. I tried to explain pros and cons but she didn't really want to listen. The staff at ER also suggested he needed a PICC.