nightmare HHA to work for (long vent)

[hopesgramcracker]

hello everyone, i have been an lpn for a little over one year now and have been with a very small hha since feb of this year. when i started i was not trained like i was promised, they gave me a couple of hours with a qa person to go over skilled nursing notes and the don/administrator/marketer/clinical manager was to ride with me to visits or have the one and only other rn we have ride with me for training. so starting in june the office staff had started asking me to make changes in notes (not missed check offs or info). they put sticky notes everywhere throughout the notes (past and present notes) to tell me to add something. now when i went back to the person who trained me, he told me that this is new and all the notes have to have this, ok no problem. well every couple of weeks new info was needed and i find myself doing what i call "skilled note marathons" with new info that needs to be added...going back to day one of the initial visit for any pt. well this is frustrating to me because this is unpaid office time; i get paid by the visit and have already been paid for all of these visits. at one point they would try and make come in asap and would tell me i would not get my next check unless i come in and "fix my notes" immediately. i went to the don and asked why does this keep getting changed every other week as to what she wants on these notes, she responded by saying oh they are just getting caught up on the notes and things needed to be added. my response is "this is june and i started in february why wasn't i told this when i started?" i am not an idiot if i was told to do it in february it would have been done all along. i also told her that the person who trained me told me to do things one way and she tells us it's not good enough. well as the weeks went on i am getting more and more frustrated because more keeps getting changed. the don has me sign supervisory visit forms that she never performed with me and she has me take abn, recert and discharge oasis forms for my pts to sign and she never sees them for this. i know this is not right but is this illegal? she also has pts that are not homebound recertified. when i turn in my weekly list of who is up for recert or discharges she will see the people who should be discharged and will recertify them anyways even though i have conferenced with pt and ot and we are in agreement that there is nothing further we can do for them. sorry this is so long but i am really frustrated. oh by the way we only had three clinics we were working with and come to find out the head doctor for two of them was indicted for medicare fraud so now we really only have about 8 pts left that are being discharged next month and she is trying to get them another doctor to take them as long as we can service them through the home care. this is so unethical in my opinion but i guess it's not illegal. i am actively looking for another job but i don't want a patchy resume, but i really like my nursing license so i am going to leave. i told the qa person last week that i would be in on monday to work on notes but the don left me a message on monday that she was taking me off of direct deposit to "ensure my notes were completed". no on communicates with each other in that office, the qa person failed to tell her i was going in on monday and she assumed that i wasn't coming in and yet again another knee jerk reaction. is this typical for hha's?

[hopesgramcracker]

Well after speaking to the other field nurse (RN) I was told that we use the ABN form to serve a dual purpose; as an ABN and EDN (and she stated this was not an accurate form). Ok so it must not be presented blank:nono:, but is a two week prior to discharge notification acceptable or must it be within the 48 hour window, and can the LPN present this form? They always have me bring back the recert or discharge OASIS and ABN forms undated, I am told to not let the pts date them the office will date them. (I know I am asking alot of technical questions I just want to be knowledgable as to what the procedural legalities are of these forms).

I resigned on Friday and I will be actively looking for another job starting this week. I have also applied for unemployment until I find a job, I know she is going to fight it but I did state to unemployment that I am asked to falsify documents and was denied my paycheck until past paid nursing notes are "fixed" or "added to". Thank you for all your input I truly appreciate it :loveya:.

[hopesgramcracker]

Thank you KateRN1 for the manual it is definately informative, I also went to the CMS website and reviewed the updated HHABN form which now I know the agency is using an outdated general ABN form (2008 version). I noticed that the HHABN form has a mandatory use date by April 1st, 2011.

[paddler]

Hopes,

I am shaking my head reading all the stress you have been through with this situation. Kudos to you for being forthright, thinking for yourself and for investing so much effort to understand the situation you're in. You seem to be an exemplary LPN for being willing to learn so much about the situation, and follow up on the notes updates they've required of you. I wish the LPNs what worked with me put in half as much effort as you!! Best wishes for your new job search.

[KateRN1]

Two weeks prior to discharge is fine, but it must be presented to the patient at least 48 hours prior to discharge. Any employee of the agency can have the discharge notice signed.

I really think that this is a scary place for you to work and you show a lot of intelligence for asking the kinds of questions you're asking. I think you will do well at a more compliant agency.

Think of this as a learning experience. You learned a whole lot about what *not* to do.

Best of luck in your job hunt.

[kaliRN]

Nothing to add, but wanted to wish you the best OP. I love to see initiative and integrity under difficult circumstances.