Narcoleptic Nurse

i am in texas as well so i understand your concern. there are a lot of less than ideal agencies. i have run into that a lot. i would say the first step is to check them out on the cms site www.medicare.gov/hhcompare/home.asp if they are not lining up with national averages on the benchmarks, and not a new agency, it can be a clue that they are not sticking to the guidelines. if you mention the word fraud in casual conversation and the owner comes screaming at you, run! if you find out 5 people left in the last month, not a good sign. find out when and if you get benefits, don't assume anything, many agencies don't even pay for l and i here. check about mileage reimbursement, taking it off your taxes doesn't pay your gas bills now. and find out how large of a territory is covered by the agency. find out whether they are automated for charting at point of care and if you can transmit from home to save trips to the office. find out what the usual visits per day is for the agency, some like lots of non benefitted part timers and some stack the regulars with as many visits as they can squeeze on them. you don't want to starve or go crazy. i wish you luck!

My goodness, the point of software charting is to make your life easier with less redundancy. What system do you use? A good system will allow you chart once and never have to reenter demographics, meds etc. Your system must also be a nightmare for QA and compliancy issues. EM me and I can talk to you more about our system.

I went from graveyard on a chemical dependency unit to home health 17 years ago and never looked back. I was amazed what it felt like to not be tired all the time after 12 years of night shift. I liked the freedom and I loved the one on one with patients. It was great to be able to actually do the teaching they needed and see how it really changed some lives. I worked mostly in hospital based agencies so had pretty strict guidelines about overtime and didn't let them push it on me as I was a single mom. Some places tried and and some places really pushed the limits of credible home health. I made a rule early on to preserve my integrity and sanity over any job and I left a few for those reasons. I worked in both paper based and computer based agencies and I far preferred a good POC system over tons of papers. I think the time with patients being themselves was the best. A few won't appreciate you but most will and some will see you as their best friend. Just remember the number one rule and never give them your home or cell number. Good luck!

Thanks for your answers, I left with no regrets and have been welcomed back to my old job for now. I have been approached to sell home health software and am getting some more time in on my web business. I appreciate the support and answers I find on this site.

Thanks for responding. I know I will not stay here. This is but the tip of the iceberg of questions I have about this place and I was already told not to rock the boat. They show up OK on the state report but the last reported survey was shortly after it was opened. I have been in Home Health 16 years in several states in the Northwest and I have never seen anything like the creative interpretation I am finding here in the South. I am too old and not that stupid about regs to sit here with my mouth shut and accept that what I am told is fine because they have never been told different. Especially when I am told not to question. As to the first question about the patient, The son said it had not prevented her decline and he could see no improvement. If it were the one case I might not be alarmed, but there is a definite pattern here. My only personal concern is how many more places are like that. I am suddenly getting a job hopping pattern on my resume. My first boss here was also into creative financing, taking my part of the insurance payment out of my check and not making payments, cost me a bundle when they denied a big claim. For the first time in years I am thinking about looking in a new direction.

I recently started a new job as a case manager. As I am finally getting to look back into records I am seeing that this agency has a strong pattern of never discharging anyone they can get a new 485 signed on. So many patients have many (9+) cert periods, I haven't seen that in years. Amazingly they get 10-12 visits from therapy every cert period. never more or less. They all seem to have either muscle weakness or diabetes as primary diagnosis. I really became alarmed when a patient's son told me his late stage alzheimer's mother gets PT just so the agency can make an extra 2 grand. It made no difference in her functional ability. Where I come from and in my many years in home health I have never seen this as being an OK thing. I know what I have to do for my own integrity, I just want to know if this is seen anywhere else. I could give more instances but I don't want to get identified. I got chastised as a rabble rouser my first week when I asked if something I saw would be upcoding and therefore fraud. Anyway I would appreciate some feedback

I am working with August Systems which is built around a sheduling program that helps tremendously with keeping orders and visits in compliance. Check out their website at http://www.august-systems.com/ , if you like what you see, tell them their favorite Houston nurse referred you.

I hanve been a home health nurse for over 15 years now. I have seen new grads get hired in a few instances but not often. you need some solid background, and common sense helps because you are out there alone. Can a psych nurse make the transition? absolutely if you have other nursing skills with wounds and phlebotomy as well. I did 3 years of Chemical dependency nursing before I went to home health and it has been invaluable to understanding the dependency/codependency you find in the real world. Home health is the best for nursing, just don't think it is "easier". The paper work is mind numbing, the travel can be life threatening and homes can leave you with nightmares. You will use everything you ever learned.

LOL, These are great. I have been in Home health for 15 years and caught myself surprised they don't do some of those things in house anymore. And I am old enough to have trouble remembering how things were. Then I glanced through the Largest student loan thread and grinned realllllllly big. I was really blessed and I lived really frugally then but I graduated with a BSN from University of Washington with a loan for $350 and 10 years to pay it back!!! Something to be said about those good old days.

Pearland, Friendswood and Clearlake are all nice communities. Depending on the time you commute it is not bad to downtown if you live close to a main spoke or the Beltway. I am a newbie here too and the thing that was most disconcerting was how huge this city is. Housing is reasonable but the utilities and taxes are hugely different from the Northwest. Use the HAR website and you can get a pretty good feel for how the neiborhoods are.

I thought you were talking about my office at first. I moved to Texas from the Northwest this year and my boss keeps telling me the irregularities are because "this is Texas" I hear that wages are supposed to be good here but after 6 months I make less than I did at my last job and she won't pay milage and the payroll is rarely right and I am ready to move on but scared it might be this way all over. I can afford to work there, I am going broke!