Aredhel13

Congrats to you. I think the issue is that you need more experience in med-surg or DOU, someplace where you can get experience assessing a patient head to toe, and planning their care. You need to be able to draw on that experience when you are all alone in the patient's home, developing a plan of treatment, or deciding whether to call 911 or the doctor. You need to develop that sixth sense that tells you "Something is not quite right here" and moves you to action, and that only comes through a variety of nursing experiences. I was a nurse for 20+ years, had worked in ICU/CCU, med/surg, as a supervisor, and when I started in Home Health I was not so sure of myself. Now, 10 years later, I never want to do anything else. Give yourself some time, get some experience, and you will be an even better home health nurse in a year.

In my experience the number of visits for an 8 hour day are 5-6 depending on routine visits or a SOC , recert/resume etc. Pay per visit is the standard, otherwise there is too much potential for abuse and padding the time card. Each visit (say for 5 visits per day) is weighted about 1.5 hours, which includes travel time, paperwork, the actual visit, prep time, etc. Some visits are longer, some shorter. Interesting to see someone mention "filling med boxes". This is not a skilled need and Medicare will not pay for this.

Wondering if anyone else has run into this situation. Our agency census is about 70% insurance patients and 30% Medicare. Not all the insurance patients are Medicare HMO. The insurance companies/IPA's often have home health see a patient who is not strictly "homebound" according to the guidelines, but is better for them and they authorize payments becouse their philosophy is a little different than Medicare. During our last state survey one of the findings was that we were accepting patients who were not homebound, with the rationale being that if we accept any Medicare patients all our patients have to be "homebound" even if Medicare is not paying (this was a younger man on private insurance). Has anyone run into this? If so, let me know. Thanks.

This is a common problem, and sometimes not easy to solve. It shows the importance of a very acurate initial assessment. Whenever possible we try to have the case manager (who is likely the admitting nurse) do the discharge visit.