Need help quick

[hoolahan]

Hi pals,

I have a new HH client, new to me, 6 years on service. I have been informed that this pt and his father have been very abusive to our home health aides, esp when it comes to this MS pt's daily ROM routine. This aide there now is the last one who has been able to tolerate this pt. Of course no one told me any of this helpful info when I took this case, and the pt and his father have been nothing but nice to me.

Anyway, I have the dubious honor of "having to talk" to this man and his father about a more resonable exercise program. As it is now, the dad stands over the aide while she does ROM and counts out the reps she does, and gives her a hard time if she does 14 instead of 15. This program is one I presume they designed. He had PT available a few years back, but that was stopped when goals were met, the family was very angry, and an offer was made to continue as private pay, but the family declined.

OK, beside the fact that this blows that I come on the scene and now have to police something my agency has allowed for the last 6 years, I need your help.

What exactly is the standard number of rep[s for a routine ROM program that an aide w.ould be responsible for Of course we have no policy on this (Surely you jest!) I did a search and the only site of any value suggested 5-10 reps per activity. This still sounds like a lot to me. Frankly when I have done ROM in the hospital, I only ever did 3 reps per movement. Maybe I am a cheapskate (?)

Anyone know the gold standard here? I should have posted this sooner, the visit is tomorrow. I told my sup's I would "do my best?, but frankly, they created this monster, and I think a supervisory visit is in order here. Whenever I have sup'd the HHA, I have never seen this in action. Patients generally do not want the nurses there taking away from the HHA's time with them, or having an extra set of eyes on them while they are being bathed, so I usually visit at the start or the end of a HHA visit.

Any bright ideas?? How many reps?

[hoolahan, ASN, RN]

MHN, you are seeing the very root of the problem! We have had the MSW out there sevearl times, the most recent being in early January, before I became the CM at the end of January. From my limited attempts to reason with the family, it is clear that they still have not accepted that this man will not be cured. I can only say I have been assured that every nurse who has had this man has tried to educate the family on the progression of the disease, but they cannot accept that.

Outback annie, Hi! Anyone under Medicare for a monthly foley change is eligible for personal care assistance by a HHA with supervision q 2 weeks. We also give a weekly avonex injection. NRSKaren and I were discussing this same thing tonight on the phone, and we have both worked for agencies who were more and some less generous with the interpretation of this hcfa regulation. Maybe your agency does not encourage a HHA be placed when a pt has a foley, but the pt is legally entitled to that as a benefit of Medicare. That is why I am worried about this man, our agency is one of the more generous with this situation in my area, and if they dropped us or we drpped them, I am not sure he would find another agency willing to do what we have done. This particular man has too much money to be eligible for any kind of PCA services program (which is what he really needs), and the family does not want to spend down as the parents are elderly, and want that money saved for this man for when they are gone. Frankly, I do not see how he could possible remain in this home unless he had 24/7 paid live-in, and they know that, that is why they want to save the money for that purpose for when that time comes.

Jenny, I wouldn't give mysef that much credit! LOL! No, I simply inherited this case when the former nurse left. I was unaware of the problems until 2 weeks ago when I reported the aide for leaving early, per the family. After I did, they HHA supervisor/educator, my supervisor, and our director called me in to discuss all the things that had been going on. Needless to say I was shocked, as the family has never been anything but kind to me when I was there. Iwas unable to follow up last week, b/c I had to give the assignment for the inj to a LPN, but the other day, it was again time for the HHA sup, so I was told to address the exercise routine issue.

Hi Ken, I did not listen to the tape, like I said to my sup, how do I know the pt's remarks were not altered? I think it is illegal to tape someone w/o thier consent here too. I was never really afraid I would be fired for that. I just wondered if they would try to force me to inform this family of discharge, if it comes to that. I suggested we have an ethics conference over this one. I did tell my boss that if there were any more problems, I was going to insist she make a joint visit, and she agreed to that.

There is no easy way to solve this problem. I am glad that I have several people working with me toward a resolution. Now that I have seen the true situation, I need some time to think about it. Frankly, I am hoping they can find another agency asap!