henayneiCLNC

I am the Staff Supervisor with a small home care agency where we provide personal care (ADL) services and companion services to help client's stay in their homes as long as possible. The majority of our clients are Medicaid. The companion service is private pay.

my admin remembered, bless his soul, and got me a Gevalia Hot Chocolate :) We are a VERY small personal care agency.... 60-70 clients avg; 40-60 aides avg - majority of services paid by Medicaid... nearly 60% of revenue goes to aide payroll :) I was blessed when he handed the cocoa to me and personally said "Thank you"

this is for north carolina only - you must research the statue statutes and nurse practice in your own states.... in north carolina we have 4 skill categories that are able to provide aide services in the home: companion - no hands on services personal care aide - not certified, may or may not have had previous experience - has had very basic skills verified by an rn at the agency with which they are employed - must be done by each employer agency - able to provide iadls and assistance with a limited level of adls nurses aide i - is certified by the state through written and skill exam - able to do many tasks - but very few invasive ones - able to provide extensive level of adls in addition to the iadls nurses aide ii - a level above na i - has gone through additional schooling and testing - able to do all the na i can plus many additional invasive tasks, sterile dressings etc... extensive adls and more skill intensive tasks definitions from 10a ncac 13j: "hands-on care" means any home care service which involves touching the patient in order to implement the patient's plan of care. "limited assistance" means care to a client who requires hands-on care involving guided maneuvering of limbs with eating, toileting, bathing, dressing, personal hygiene, self monitoring of medications or other tasks assigned that require weight bearing assistance half the time or less during the activity and does not meet the definition of extensive assistance in item (9) of this rule. "extensive assistance" means a client is totally dependent or requires weight-bearing support more than half the time while performing part of an activity, such as guiding or maneuvering of limbs, and meets one of the following criteria: (a) requires extensive assistance in more than two activities of daily living (adls), as defined in item (1) of this rule; or (b) needs an in-home aide to perform at least one task at the nurse aide ii level; or © requires extensive assistance in more than one adl and has a medical or cognitive impairment as defined in item (19) of this rule. (if you want to read the whole statute/rule: http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2013%20-%20nc%20medical%20care%20commission/subchapter%20j/subchapter%20j%20rules.html) according to the nc bon: nurse aide i tasks nurse aide ii tasks personal care aide aka non-registered aide tasks (10a ncac 13j .1003 g) (1) assisting with mobility including ambulation, transfers and bed mobility; (2) assisting with bath/shower; (3) assisting with toileting; (4) assisting with dressing; (5) assisting with eating; and (6) assisting with continence needs.

:) this isn't a hospital and according to the Medicaid oversight organization anyone can give an order to us and anyone can take the order ... literally... our staff coordinator or Admin can take an order (neither is licensed) and anyone at the MD office can give it, even the MD's wife who happens to pick up the phone -- I was told this to my face (by a BSN responsible to teach and communicate the rules and regs for the state vis a vis the Medicaid oversight and statute policies) at a training session for this oversight organization last spring. Now granted, our orders are for things like starting Personal Care Services, BSC, etc... we get an occasional order for frequency and perimeters for reporting of V/S.... but not that often. However, I did find an order to refer a client to one of the Medical Home Health Providers in our area for evaluation and it was stuck back in an obscure part of the client's file, I'd never even seen it, it was literally 5 months old AND had never been acted on. When I dropped my teeth and turned green the Admin seriously did not understand what my problem was. From this event has peaked my discomfiture... I can find nothing in our state standards mandating a cap signing MD orders and without something in writing he just doesn't see that "anyone would have anything to say." According to him if it is not in writing no one can hold us (read me) responsible. Efforts to explain that it is my license and livelihood, much less the welfare of our clients and the company at risk only garners the above assertions....

Thanks - I'm looking for this kind of input as I'm working for a small Personal Care Agency that just started up last year. The owner wrote up policies from his business and administrative POV. He is also uncomfortable with anything being "standard" or "necessary" if it is not written down somewhere. Since our orders are not of a strictly "medical" nature and since our state allows anyone in the doctor's office to give us our orders he does not see why I need to see all the orders and sign off on them ... I have tried to find something in our statutes but have failed. Because we are a Personal Care Agency we do not fall under JACHO or other such oversight. We do get State and Medicaid survey, but a significant portion of his business does not fall under any oversight what so ever (pvt pay companion, home maker, even private pay personal care services). I am uncomfortable, as the medical license, not seeing and signing all orders of any kind, but from his POV this costs my time and therefore his money and since this IS a start up the budget is *very* tight (he is not yet getting a pay check, but we are growing). I would be very interested in what the situation is with other folk as well :)

is that a written policy of your employer or written in your state practice statutes or acknowledged (read "unwritten") "standard of practice?"

Who signs off on orders?? I have long been under the (possible) misconception that a nurse:nurse: was required to sign off on orders received, verbal or written, from physician/physician office. It has been my understanding that this is standard nursing practice and was part of the flow to ensure both accurate transmittal, responsibility and implementation of any given order. Is this so where you practice? If so is it in your statutes, organizational policy or is it "standard practice" and unwritten? would you be so kind as to indicate your state of practice in your post?? Thanks tons!:thankya: Please add your :nuke: Henaynei

I haven't worked for them in a few years, since they split and sold part of their business to IntelliStaf. However, the folks I did work with were the same ones I'd work with before as Gentiva bought out Olsten Kimberely and most of the staff was retained.Recently my encounter with Gentiva has been as a referral source to the Personal Care company for which I currently work. That is not much information for you but at least it bumps your thread up a bit b'Shalom Henaynei

which pda did you choose?

I'd like to know this as well

we have a client who actually smoked marijuana in front of one of our aides. we inquired as to what we needed to do through our legal department. we were counselled that is was not necessary to report this to the police and in fact the police would not act on such a report because there is no way to prove such an allegation - it is just a he-said-she-said situation AND not an offense that the police are likely to spend much in the way of effort and manpower when they have much bigger fish to fry, as the saying goes. we were also counselled to explain to the client that this activity is not to occur when the aide is in the home and that if it down the aide has been instructed to leave immediately and notify the office. hope this helps b'Shalom Henaynei

I do quite a bit of this for long term care companies. PM me if I can be of any help :)b'Shalom Henaynei

I was told by ARC that one can't charge for the classes above and beyond the cost of the class (DVD, materials, rentals, etc) to the students. Your employer CAN pay your for your time, but that is the *only* way you can get paid for offering the coures. So, I've been told. Have you learned something different from ARC?

I am in quite the same predicament, been an RN for 23 years and due to severe back injury am unable to do direct patient care or accept a position, such as in nursing administration, where I might be reasonable expected to take up the slack when they are short staffed, and thus place my self, the clients and staff in an untenable position. I've considered and tried to locate QA/QI positions and the like but the internal structure of medical providers in my area seem to not include specific departments or individuals who cover these positions full time. I would be most cheerfully grateful for any suggestions, all of which will be earnestly entertained, as to some ideas or directions that I have overlooked! Sincerely, Henaynei

mountains, mountains and snow!!!