Cherry Aims

Hi. I live in San Diego also. Some of the new grads I know have been willing to drive to El Centro to get their 1 year experience. You might want to try an area like that or try going north to the Temecula area, even Riverside. Have you thought of school nursing?

It is not home health caring for ventilator dependent patients, it’s home care. The state of California paid $29.43 per hour reimbursement for LVN shift care until July of last year. Wages are dependent on reimbursement. Take into account the cost of doing business here in this state: malpractice insurance, payroll taxes, the cost of documentation, instituting the new Conditions of participation etc. I am a clinical supervisor for homecare here in San Diego. My coworkers and I don’t make close to what the case managers do in home health. LVNs left homecare, as have RNs because wages in this field are low. My agency is fighting to attract experienced, competent nurses. Most of the agencies in San Diego, LA, San Francisco have many cases that go unstaffed due to lack of nursing. The issue under discussion is the very poor decision by these two boards limit LVNs scope of practice,across the board, not taking into account persons who live at home dependent on ventilators. The LVN board will hold hearings on this topic in August. I hope everyone shows up to advocate for our patients. Riquelle a decision has not yet been made. The LVN board still has to meet in both Northern and Southern California.

It is not home health caring for ventilator dependent patients, it’s home care. The state of California paid $29.43 per hour reimbursement for LVN shift care until July of last year. Wages are dependent on reimbursement. Take into account the cost of doing business here in this state: malpractice insurance, payroll taxes, the cost of documentation, instituting the new Conditions of participation etc. I am a clinical supervisor for homecare here in San Diego. My coworkers and I don’t make close to what the case managers do in home health. LVNs left homecare, as have RNs because wages in this field are low. My agency is fighting to attract experienced, competent nurses. Most of the agencies in San Diego, LA, San Francisco have many cases that go unstaffed due to lack of nursing. The issue under discussion is the very poor decision by these two boards limit LVNs scope of practice,across the board, not taking into account persons who live at home dependent on ventilators. The LVN board will hold hearings on this topic in August. I hope everyone shows up to advocate for our patients.

By the way this decision was not prompted by the Homecare agencies. Reimbursement drives wages. MediCal, finally, increased reimbursement in July 2018 after many years of stagnation.

What BreatheDeep related is that now matter how skilled the LVN becomes they may never change inner cannula, respond to ventilator alarms, “break the circuit “ to transfer a patient from one device to another, or put a nebulizer treatment in line- it would be out of the scope of practice. I went to the RT board meeting here in San Diego county. The room was packed! People on ventilators and their families discussed their concerns. I don’t think anyone expected the number of people who came. I also don’t think either board took in to account what this decision would mean to those living at home. Again I have to ask what prompted this decision. I have been in the field of homecare for more than 30 years. Many of my patients have been ventilator dependent. LVNs have been providing their care. Now it’s not good enough, safe enough! Why?

Breathe Deep all of the points listed in your response to what LVNs CAN’T do with a ventilator is EVERYTHING THEY MUST DO in Homecare. In many of the homes I visit there is only the patient and their nurse. Vent alarm, occluded teach CALL RT, what a joke with their 24 hour response turn around time. Have the RN do it-I live an hour away from some of my patients AND there is no funding for the amount of RN visits that would be needed. This change in practice will mean our patients can not remain in the home. I find it interesting that you’ve been working on this for a year but your members, the RTs and LVNs I spoke with knew nothing about it.

I think both the LVN board and the Respiratory Therapist board made this decision without input from any of the stakeholders. Where does the RN board stand. How about the physicians who see the clients and sign our Plans of Care. What about those most directly affected: the clients. And since most everything is about the $$$$ how about the payers especially the STATE OF CALIFORNIA!

This ruling is absolutely ridiculous! As a Clinical Supervisor for Home Care, I have seen LVN's caring for ventilator dependent clients for the past 24 years. Most of my clients have not had a RT make a home visit in many months. The RT companies here in San Diego state they have a 24 hour response time. However, tracheostomy ties must be changed daily, suctioning may be hourly, inner cannulas are changed daily, circuits on some clients are changed daily but are at least done weekly, patient's are transferred from the bed to the wheel chair requiring disconnect from bedside vent, nebulizer treatments are both routine and as needed for wheezing and ventilator alarms happen often; what will our clients do? Call the RT? What a joke! Will California pay for RNs in the home? If they do where will those RNs come from? We have clients who live on their own, dependent on their LVNs. This decision may force clients in to facilities, if facilities have available sub-acute MediCal beds. What about the "least restrictive" rule. What is the true reason for this decision? One has to wonder. Please review the ruling. California Association for Health Services (CAHSAH) is holding meetings in a variety of settings to address this issue. Please look at their site and try to attend the meetings and voice your concerns. Let your clients know about this and how it may impact their lives.