jsilva89

The agency never went out to the house? Red flag! I know agency management has gotten really lax about leaving the office since Covid, as in they never leave and just do everything via phone or zoom, but they should at least be ensuring a safe place for their nurses. Agencies across the board are definitely giving too much leeway to families to just make the rules and do whatever since Covid hit. I'd not only leave the case, but that agency. Sorry, personal safety in my book always comes before lining a staffing agencies pocket. In regards to the parents, Peds units usually have 24 hour visitation, but that being said, there's absolutely no reason one of the parents couldn't meet you at home especially if the kid is currently stable enough to be discharged. Two red flags here. They're potentially refusing to leave the baby with the trained peds staff at a childrens hospital, that flags to me that they could possibly be very difficult to work with OR they don't trust others and will do all the work at home while you just sit there all day. Second flag, they're potentially hiding something at home/lifestyle OR don't even have a permanent home and just want to be discharged and disappear into the night if the baby is super low acuity (sounds crazy but it actually happen at my agency recently). Quick story. About ten years ago the agency I was with called me about a new case. They couldn't give much info, you know except the baby was adorable and the family was great (they use this for everyone btw). The claimed they couldn't give me the address until the night before I went out to work a 12 hours shift. Same story, family was busy, couldn't meet, schedules never matched. I thought no biggie and just went. It was literally a roach infested crack house, no joke. I worked my 12 and never went back. The baby was adorable, but I never relaxed a muscle there once for 12 hours. Now, I want addresses before I ever go out. I'll Google street view before I even go to a meet and greet. Nothing is worse than being dropped in an uncomfortable or potentially dangerous situation. The family AND the house are both imo as equally as important as who the patient is in home care and I need to know what I'll be walking into.

My agency will not allow anyone to go out to any case before a meet and greet. The parents have to "approve" you before you before you can work with them. Agencies are giving parents more and more control like the scheduling issues you brought up. Are families supposed to text and call nurses to make a schedule? No. Will agencies say anything? Absolutely not, less work for them and they can't risk losing the case. All the meet and greets I've been out to are pointless and are nothing but a dog and pony show. I feel your pain.

Does anyone know how exactly insurances agencies determine how patients qualify for skilled nursing private duty? I got hired by an agency that currently has about 40 cases. One trach/vent case, maybe 15 higher acuity cases, and the majority of the rest are just seizure precautions, GT, or just PO feeds or a combo of these. I was surprised how many babysitting type cases there are. The four cases I've gone out to already are so low acuity that a regular baby sitter could've done them. Two with CP both with PO feeds, one-two meds, where working the hoyer was the biggest skill performed. One was a 3 year old with down syndrome, no skills at all, one multivitamin given and mom expected me to play with and entertain him for 12 hours while she went to the beach and got pedicures. A developmentally delayed 14 year old with seizure disorder and no documented seizure in two years years where mom expected me to peel, dice, and mash potatoes all shift to ensure meal prep for two weeks (every time I go to this case, I peel, dice, and mash potatoes) and fold all the laundry since that's "the day nurses job"... She was home all day too watching TV and performed any actual care that needed to be done like meds or daily care. Most of them have had nursing care for years despite everyone knowing there's no actual skilled care. Also, in almost every home the mom is home all day hanging out. So how are they approved for private duty? I know the agency likes to push the notes are what gives or takes away hours from families based on what nurses write, but I've yet to see that be true because there's no way an insurance company sees "peeled and diced potatoes for pt PO feeds", "pt actively walking around, feeding self, toileting, nurse gave PO vitamin", or "all care performed by mom, nurse engaged in play with pt" and still give like 12+ hours of skilled care. So how do insurance companies approve these hours?