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Crazy & Compulsive but Compassionate

JennyHHRN's Latest Activity

  1. JennyHHRN

    Custodial or Skilled?

    I hope I don't get banned from asking too many questions! Here's another situation I'm grappling with: Patient has been on service for a year for Foley Cath Maintenance (neurogenic bladder), right sided hemiplegia late effects CVA from 2001. Has visiting physician that orders Physical therapy for home exercise program. Therapy goes in gets patient going with PTA's assisting HEP. Family has paid caregivers (taught them HEP). Patient gets d/c'd from therapy. 1 month post therapy d/c, physician orders therapy again, states patient has declined needs new evaluation and new HEP. We go through the whole thing again and then therapy d/c's. Now it is 3 months since patient was d/c'ed from PT and doctor is ordering it again. Wife begs for therapy, she states once patient is d/c'ed from hh therapy, paid caregiver just can't assist in HEP the way HH staff does and patient gets weaker. She and the physician want to continue this on and off therapy process forever. Is there a limit to how many times therapy can come in and treat the patient? He will always be on HH because of Foley Cath, definitely homebound, can barely get out of w/c, needs assist with any ambulation. I worry that once you teach paid caregivers an HEP it becomes a custodial case. The physician argues that each time he orders PT it is because the patient has experienced a decline in functional status, so therefore patient meets skilled therapy criteria, regardless of how many times he has had therapy in the past. I'm soo torn. ?????
  2. JennyHHRN

    Physical Therapy D/C visits

    Do the Medicare regs state anywhere that the patient must be seen by the PT to be discharged from therapy services? We have a PTA that just transferred from outpatient therapy to home health. She states that in the outpatient clinic PTA's have the ability to decide if the patient was ready for D/C and a last visit with the Physical Therapist is not required. (I'm not talking about OASIS, I know PTA's cannot perform OASIS assessments.) We have always required the PT to do a final visit to confirm pt's readiness for d/c from therapy.
  3. JennyHHRN

    Homebound Or Not?

    I really appreciate all the feedback. It makes me feel better to know I'm not being the Grinch of Home Care. People get really upset when we try to explain that they do not meet criteria.
  4. JennyHHRN

    Calling All HH Supervisors and Managers

    My thoughts exactly. Intake states the d/c planner told her it was a daily dressing. D/C instructions sent home w/pt stated TID. Will explore wound vac option w/physician.
  5. I'm a clinical supervisor for a small hospital-based home health/hospice agency. I find myself having to absorb more and more duties every day and feel frustrated at the lack of resources available. I love this website. I wanted to find out how many of you out there would be willing to share your knowledge or daily frustrations of trying to serve in the ranks of home care middle management. Typical day for me: 6am-hit snooze for the 10th time, contemplate calling in sick 7am-hit the shower, think perhaps I can survive one more day 7:30am-what are my priorities today? How can I get out of wearing pantyhose? 8:00am-I am going to make a difference today, I have a great team, energy to fight the system,and I know there are 5 things I can complete on my "to do" list today, "Ain't No Mountain High Enough" plays in my head :nuke: 9:00am-bogged down in voice mails, e-mails and people holding for me, line of people outside my door wanting to case conference or have laptop fixed 10:00am-last of one of the crowd outside my door is gone and need to attend meeting regarding patient/employee satisfaction, add 10 more things to my "to do" list 11:00am-VP needs stat reports explained, why is volume up or down or stagnate, etc.....what is my action plan? CEO says I need to cut more out of budget somewhere. (only thing left to cut is toilet paper)must send memo: One square per employee. 12:00pm-no time for lunch, blend wt loss shake and slurp at my desk while pulling together acute care hospitalization rates for the month and making return phone calls 1:00pm-irate family of patient on the phone wanting to know why nurse cannot come to just draw blood for the rest of the patient's life, isn't that what they pay taxes for? 1:30pm-head to physician offices to drop off orders and "market":monkeydance: 2:00pm-scheduler notifies me that we have no on-call nurse for the night and not enough staff to cover all incoming admits needing to be done tommorow-fix it now 2:05pm-adm nurse calls from pt home, patient needs wound packed tid, no willing and able caregivers to teach, patient can't do, scheduler says we have no room for all these visits 2:15pm-kindergarten calls, my six year old has a belly-ache:barf01: 2:16pm-husband says his job more important, cannot leave to go pick up child:madface: 2:17pm-grandpa on the way to get belly-aching six year old 2:18pm-feel like a failure as a mom and clinical supervisor:bluecry1: 2:30pm - can't find desk under mountains of paperwork, clear space by creating several big, teetering piles, have mini strokes every 5 minutes knowing that chart reviews not getting done. 3:00pm-Upload Oasis data to state database, spend next hour figuring out why 3 files rejected 4:00pm-Found overworked but loyal nurse to cover on-call 4:15pm-VP calls, can i please present disease management program to physicians in two days (need powerpoint with stats and pathways, etc...) 4:30pm-Physician office calls late referral, wants patient admitted tonight. Peg tube was placed yesterday and patient sent home, no teaching, no tube feeding ordered or dme in home, if we can't do it, threatens to send referral to competitor agency. 4:40pm-call to family to say I'll be home late, don't wait up. 5:00pm-feeling stupid for being so positive this morning, want to quit and sell coconuts on a beach somewhere. "Take this Job and Shove it" plays in my head.
  6. JennyHHRN

    Homebound Or Not?

    Here's the situation: Patient attends water aerobics at least 1-3 times per week. Her son states it is a considerable and taxing effort to get her out of the home. 8 months ago patient had skilled HH physical therapy episode, pt/family was taught transfer techniques and home exercise program. Son wants us to come back into the home for the exact same reason. My concern is that she gets out of the home on a frequent and regular basis. She is participative in an excercise program. The pt/family was instructed on transfers and HEP less than one year ago. Does this scenario meet the Medicare criteria for home health admission?
  7. can one person be the administrator, manager, clinical supervisor and obqi liason? i work for a hospital-based agency that has dissolved the administrator/manager position and requires the clinical supervisors to absorb the manager's duties. does this comply with cms cop's? makes me nervous.
  8. JennyHHRN

    Mediport Flushes And Hh

    The plot thickens. We ran an insurance check and this patient is not Medicare, she's Blue Cross/Blue Shield (husband works full time). But in our state Blue Cross mirrors Medicare policy. We are required to conduct OASIS assessment on all Blue cross patients, that in itself worried me: If we perform the Oasis admit visit but only see her once, would we have to do a non charge d/c visit to complete DC OASIS? That would use up any reimbursement we would get from the 1st visit. We also found out this patient has a broken leg (sustained injury 2 mos ago while out of state), and is nwb., I thought perhaps we might find a skilled reason r/t fracture such as pain mgmt or something like that, but from what the office nurse states, she is not having any issues currently! UUUUUGGGHHHH. I called an infusion company we work with a lot and they said mediport maintenance is not a covered service in the home if the patient is not currently receiving any type of IV therapy through the port. The insurance expects the patient to have port flushed in the physicians office or outpt infusion center. Our town does not have an outpt infusion center. I welcome any and all feedback on this issue.
  9. JennyHHRN

    Mediport Flushes And Hh

    Can a patient be admitted for HH visits just so someone can flush her port once per month? The doctor certifies that she is homebound. The port is not currently in use. They keep it r/t her recent (2mos ago) hx of needing transfusions for anemia. The doctor argues that urinary catheters are covered to be changed once per month by a HH RN so why not flush a cath? I can't find any verbiage in the medicare manuals regarding this.
  10. JennyHHRN

    Any home health manager/Admin/DON/Nurse Super etc

    oh ren! What is it you're doing now? I have been a loyal reader of your posts and you have always helped me so much. I'm so sorry the system chewed you up. I just got done with state survey today, a lovely 5 days of torture. I hope you'll still contribute to the website. You have a gift. :angel2: I can understand BURNOUT, today left me feeling like I just wanted hand over my office keys and say,"Go ahead and pull this off without me, I'm sooo done being the multi-tasking doormat, who only gets credit for the things that go wrong.":angryfire Don't ya just love how those in charge of you give that look of "how could this have happened?,, they do things like this?, this is how our notes print out?, etc...." I just want to scream where have y'all been? Was I talking to the wall when I brought these issues to you every day and was told to focus on other priorities???? okay, now i'm ranting, see this job has turned me into a raving lunatic.
  11. JennyHHRN

    Who pays for the Aide????

    Thanks to both of you. Hey Ren, when I first read your message I thought your M-F stood for a profanity, then I realized you meant MONDAY thru FRIDAY...It was funnier the first read thru.... . -jen
  12. JennyHHRN

    Anticoagulant Therapy and Home Care

    Thanks Guys...I was thinking along those same lines but needed to hear it from others. I swear sometimes I have so many priorities to juggle that it becomes difficult to solve even the simplest of items.:selfbonk:
  13. JennyHHRN

    Who pays for the Aide????

    I've been in home care for over 6 years and I swear, just when I think I have it all sorted out, I start to second guess myself. Then I ask my boss what her take on the matter is and I end up even more confused. Case in point: Whenever we admit a patient for skilled HH services under Medicare we notify their Medicaid Waiver case manager or Care Management (other funding source for private care to the elderly in MI) to place their Aide services on hold. ONLY THE BATH SERVICES! We did this because I was told it is the patient's right to receive personal care under HH benefit. Now if the patient has private care in place for chore services and a bath, it gets really sticky. Only the hour they would get for a bath gets placed on hold and the chore services continue on as normal. When the patient gets D/C'd from HH skilled care, then all aide services go back to being paid for by the other programs. The curve ball came when I remembered being told as an adm nurse to assess if the patient had any paid or non-paid caregivers in the home to assist them with personal care/ADL's. If yes, a paid caregiver or family member has been willingly assisting patient for some time, then an order for a bath aide was not needed. So we get a patient on service for foley cath mgmt. Patient has a privately paid (live-in) 24hr caregiver in the home. Do we now send in bath aides 7 days per week because the patients family wants her bathed daily? See, I'm confused all ready just trying to pose the questions!!! Does anybody have a clear cut operating procedure at your agency?
  14. Okay, I know back in 1997 Medicare said venipuncture is no longer covered as the sole purpose for home care visits. We can continue to draw blood at our visits as long as they have visits for other "skilled reasons". So what do you do with the homebound medicare beneficiary who has been placed on Coumadin and physician wants PT/INR drawn every two weeks. Her Coumadin dosage is dependent upon the lab results. She will be on Coumadin for life. How is it any different than a patient that needs Foley cath management or monthly B-12 injections? And what is the purpose of the following V-Codes: V58.61 Long-term (current) Use of anticoagulants V58.83 Encounter for therapeutic drug monitoring Are they not for Home Health usage???? Are they just FYI codes to put on the 485??? Do you have patients on service like this??? If so, I'm up for any education on the matter.
  15. JennyHHRN

    Oasis Confusion

    Does anyone have advice on this scenario? Nurse visits patient, finds him in respiratory distress and sends him to E.R. Patient dies 6 hours later in CCU. Does the nurse do a transfer oasis assessment (RFA #6 or #7) and discharges the patient? Or does the nurse just complete a death oasis (RFA #8)? I thought this was only for patients who die at home. ???? The nurse argued that since the patient was not admitted for 24hrs to the facility, a transfer oasis would not be allowed. UUUUUUGGGGHHHHH! I'm not sure.:uhoh21:
  16. I'm such a blonde!!!! I'm glad Renerian is observant. I completely overlooked the date. Sorry. Did you accomplish the project? I'm interested.