Hey all (I lost my prior registration info so I had to reregister - I used to be anticoagulationurse BTW)-
But anyway, I've been in HH for a year now. LOVE IT! The learning curve for the OASIS and computer system has been very steep but my work load is now manageable without too many flame out's anymore about the computer etc. One thing I think I am particularly careful about is the HH criteria. 1) I don't want to be an active participant in fraud, 2) I want the company to get paid, 3) It is unethical to ignore the criteria.
I am an RN and do many of the admissions and discharges. Lately there seems to be a rash of referrals that make it through our intake department screening that are simply NOT homebound. This resulted in a week with 3 no-go's and an unplanned discharge for me. My supervisor questioned one of the no go's and the discharge and I was forced to go back the next day and admit one patient. The other 3 they had another nurse admit without questioning me directly.
I have tried to get some explanation for this and have explained my perspective but it seems to be unheard. Today I was told will be a meeting between my supervisor and the HH manager tomorrow. I can only assume the subject of said meeting, it is to educate me about my recent no go's. I am so nervous that I will be expected to turn a blind eye, by being "re-educated" about homebound status. Not sure what would change about my common analysis of homebound status over the last 2 weeks to explain the sudden frequency of my "inappropriate" no-go's. But, I'm sure it's my mistake right?
NO GO #1: Person was gone at church (which I know is OK) but he drove himself there and was there for over 4 hours, and verified by a family member that he drives regularly without apparent difficulty.
NO GO #2: Person has a 15+ year chronic stasis wound with recent infection being treated and family members caring for wound. Dressing change frequency has recently been increased and family requesting HH. Interviewed patient to discover he drives himself everyday to sit a local coffee shop to read and has not missed a day in over a year. He verbally states, "It's no problem for me to leave home."
NO GO #3: Person is a young guadrapalegic (not new) with a chronic pressure wound and a history of non compliance with medical regimen. When asked about homebound status, he explains how he leaves on the city bus which is not a difficulty for him. He says he can get to the wound clinic, hospital or MD office no problem.
Unplanned Discharge: LONG term foley patient with guadrapalegia and all the proper equipment including adapted van and caregivers (been on service for YEARS, but new to me). When asked if they are "getting out and about" (my favorite way to inquire about HB status) pt reports going to an event all day last week and occasionally going shopping as caregivers have time. Says this did not pose a hardship and when asked directly if it is a taxing effort to leave home in general, the response was, "No." in a why do you ask? kind of way. Haven't we been asking every visit for years now??? (Or are we?)
These are the visits being questions by the superiors and not only questioned, REVERSED by other nurses. Do I have reason to feel defensive?
As I understand MCS/Medicare regs, in the past 2 decades the rules for homebound status have changed from 1) if you say you are homebound, then you are homebound, because Medicare didn't really require as much checking (this obviously led to many abuses and lots of very wealthy HH agency owners), to 2) if you ever leave your home, you are non-homebound, meaning if you drive ever you are non-homebound, to 3) the "taxing effort" definition which has no relationship to driving ability and only assesses pt's ability-not-willingness to go out of the home on a regular basis. This definition allows for rare but important family events, doctor's appts, even regular worship services (not 5 times a week, but a sermon on Sunday then home is ok -- as long as the patient is not breezing through this and it is a taxing effort).
One time during an admit assessment I asked an elderly patient and her daughter if it is difficult to leave the home in any way. She screwed up her face and said, "Not at all." and proceeded to describe how they transfer into the car, use a motorized scooter, etc. And then for clarity I described what a taxing effort is. They both said not a problem. I was preparing to break the news that we would not be able to admit then, and I explained that in order to qualify for our services a person must be considered home bound and again described homebound-ness and taxing effort. And I finally asked, "Are you SURE that you are not homebound?" Their reply, "Oh yes, of course she's homebound, yes!" So I admitted her. The reason I did so (even though of course the woman was not homebound based on the first two honest responses) is because this was after the rash of no-go's which prompted the intial thread I wrote above... I didn't want ANOTHER no-go to be scrutinized and get in trouble.
Paddler, that's very good of you to probe to the answer before making a decision. I have found it very helpful to ask "so, how does it go when you have to go to the doctor?" "Are you able to go on to the pharmacy and get your prescriptions?"
Usually my homebound ones say "No way, my daughter has to bring me home and go back out for them" or something like that.
cathrn64
115 Posts
I have worked in homecare for 18 yrs. I have always been told that if the pt can (and do) drive they are NOT homebound!