Patient requesting.....

[nursemomof3boys]

Hi everyone,

I am kind of new to home health. My patient is requesting reduction in frequency of visit and early discharge. She was discharged from hospital a week ago, and readmitted four hours later for exacerbation of symptoms. We put her on 3x/week x2, 2x/week x2 and then 1/week. She wants just two more visits and then DC. She thinks she and her family can do everything we do for her by themselves. We have only seen her for a week. She is doing better but I think its too soon to discharge her.

My DON is not much help at this point. Please I would like suggestions on how to handle it. How do you handle requests like these without getting into trouble with the Doctor? I am wondering how to convince her without making her think the company wants to keep seeing for the money. I am on salary so it won't affect my pay if we dc her.

Thanks for your suggestions.

[caliotter3]

I don't have any advice to give you but can tell you that if this were with any of the agencies I've worked for, the answer from the supervisors would most likely be to give the client what she wants. They tend to let the clients run the show without regard to the consequences.

[erroridiot]

Hi everyone,

I am kind of new to home health. My patient is requesting reduction in frequency of visit and early discharge. She was discharged from hospital a week ago, and readmitted four hours later for exacerbation of symptoms. We put her on 3x/week x2, 2x/week x2 and then 1/week. She wants just two more visits and then DC. She thinks she and her family can do everything we do for her by themselves. We have only seen her for a week. She is doing better but I think its too soon to discharge her.

My DON is not much help at this point. Please I would like suggestions on how to handle it. How do you handle requests like these without getting into trouble with the Doctor? I am wondering how to convince her without making her think the company wants to keep seeing for the money. I am on salary so it won't affect my pay if we dc her.

Thanks for your suggestions.

Patient rights:

Notify the physician of the patient request.

Honor the patient request.

[chenoaspirit, ASN, RN]

I agree...give her what she wants. If you dont, you are providing a service she isnt wanting and will not feel welcomed. Call the doc and tell them the plan. They may not want you to d/c her, but Im sure they will be agreeable since it is basically the patient's right to refuse.

[chenoaspirit, ASN, RN]

Oh, another thing....is she private pay/insurance? If so, the money may be an issue. maybe she cant afford the hh visits?

[twinpumpkin]

Patients have the right to refuse treatment. Notify the doctor of the patient's wishes and dc her.

[nursemomof3boys]

Thanks for your responses.

She is a Medicare patient.

[ellakate]

If the patient is requesting discharge because of non-homebound status, discharge.

However, if the patient remains homebound, place the patient on hold until the end of the certification period. It keeps the statistics correct. This gives the patient's family time to get up to speed, so that you can determine if discharge is in the patient's best interest.

[HmarieD]

If the patient is requesting discharge because of non-homebound status, discharge.

However, if the patient remains homebound, place the patient on hold until the end of the certification period. It keeps the statistics correct. This gives the patient's family time to get up to speed, so that you can determine if discharge is in the patient's best interest.

Not sure what you mean by "keeps the statistics correct". What it does do is keep your agency from getting "PEPped" which means you only receive partial payment for an episode of care if the pt is re-admitted to your agency or another agency within the original 60 days of the episode. I'm pretty sure Medicare frowns on the practice of putting pts on hold when the pt has refused further services or there is no longer a skilled need. It's gaming the system.

[ellakate]

What it does do is keep your agency from getting "PEPped" which means you only receive partial payment for an episode of care if the pt is re-admitted to your agency or another agency within the original 60 days of the episode. I'm pretty sure Medicare frowns on the practice of putting pts on hold when the pt has refused further services or there is no longer a skilled need. It's gaming the system.

I am not so articulate, but that is exactly what I meant. And easy to understand.

As an example of compartmentalized knowledge, my administrators never fully explained this to me. I was trained to do as told, which was clearly not a good thing! (So I am not there now, which is about the best that can happen.)

Thanks for this post.

[luvmy2angels]

I agree to honor her request. She has the right to refuse visits and that is probably what she would do if you keep on trying to see her. Just make sure the Dr is aware that it was her request.

[tewdles, RN]

Bottom line, doesn't matter if it is in her best interest...if she is competent to make this decision then you should honor it. Make sure to notify and document carefully and appropriately. You are not in a position to force health care on someone and you do not want to be party to fraud.