tabster224

It is possible that the wounds could be a IAD (incontinence associated dermatitis), I am not saying they aren't stage 2's PU but I did have a patient that when she sat in urine and/or feces she would get these small areas that had serosangeous to bloody drainage. We kept skin protectant (it was like a paste, called sensi-care I think) on her that had zinc oxide in it and it would take care of the areas. No matter how many times we would instruct her about keeping clean, she would claim her family kept her clean, but myself or the other nurse would end up changing soaking wet or feces covered depends almost every visit (she did have bad bladder spasms and had leakage with her catheter, and we also think she was tugging on catheter or rather family was when transferring her, but could never prove it). Anyway, as Kate said it could very well be Stage 2 PU, just another thought of what it could possibly be. Other than the skin protectant we did use Hydrocolloid too. And I agree don't use the small pieces and keep on 5-7 days before removing, sooner removal will cause more open areas. Good luck!

I thought every agency had to have a Medical Director.

I have worked for 3 different agencies. Those 3 agencies have done a transfer to inpatient facility without discharge (Oasis transfer). If they come out of the hospital before the end of episode, then they do resumption of care. If the patient is still in the hospital at the end of the episode, because there was already a Oasis done (the transfer), then we just do a 1 page short discharge (non Oasis). If they come out of the hospital after that discharge and need home health services, it is a all new SOC.

That's is also what I thought. How is it a duplication if the patient is paying for the caregiver. Medicare is only paying once. I guess I just don't understand how it could be considered duplication of services.

I was told at my old job that Medicare guidelines no matter what you have to offer home health aide care. Even if they are in assisted living where the facility gives showers twice a week. I also (in the old job) had patients that had paid caregivers and home health aides through the agency and lived in ALF's that had HHA's. I am not sure if that is correct, but like I said they said no matter what, you have to offer HHA according to Medicare.

I worked for them in Arizona, but not as an MCP, worst home health experience ever. All I can say is the office I worked for (in AZ) has gone through MCP's like crazy in the last 3 years. Last count the office has 2 MCP's and has hired 5 or 6 since and not because they all quit. I have a friend that still works there and was told that when they find something wrong the first to go is the MCP. This is hearsay, but from a very good friend. I think it's office to office though. So if you get in a good office you'd probably be OK. Sounds as though Berube has a good office to work in, mine... not so much. I worked for them on and off for 22 years (Indiana, AZ and San Diego). To make a long story short, they told me what I wanted to hear and didn't deliver what was promised. So live and learn, but I would never work for Gentiva again. JMHO

I honestly think you need at the minimum 1 year med/surg experience before doing home health. Your feelings of you not knowing what is going on in the nursing world is the reason why. Without the hospital or at the very least SNF experience, I think you are doing yourself a huge injustice and opening up yourself to a possible lawsuit. I don't know won't work if you do something wrong. JMHO.

LOL, no I am not. I love my job but I will not wear myself out again for the love of money. The stress isn't worth it. I ended up with shingles last year from the stress of the job (and let me tell you, if you have not ever had shingles, it is the worse pain ever, at least for me it was. I have had a broken bone and given birth, and it is 10 times worse, believe me). I actually get off on much more meaningful things than money. I make enough to pay my bills, have spending money and not worry about it, I want to be around for my grandkids.

Did I read right and you had 4 SOC's and 4 visits on Saturday, 4 visits on Sunday and 8 visits on Monday??? When did you find time to chart? All I can say is WOW!! and I would run fast the other way from that job.

You are very welcome! I think you'd do great case managing!

I have a friend that worked for Nightingales in Arizona and he likes it. Says it is a good company, but he works PRN and was told he had to start doing call. Not sure if that is office to office or just standard for the company.

If you have hospital experience, they will snap you up in a second. Most people that work home care, case manage (esp if you work full time). If you work PRN some agencies don't let you case manage, some do. Good luck!!

If you aren't charging these patients and you aren't billing Medicare, why do you care about the F2F?

Very well said Kate. Unfortunately some cases you have to cut your losses. Getting closed for fraud, the company closes because they can't afford to stay open you lose your job because your patients are not complaint or you (your company) do not recert the patient at the end of the cert period. I understand as the nurse you want to make sure the patient is cared for, but bottom line is no F2F, no money. Home care companies are closing all over the US for those very reasons, hopefully yours won't be one of them.

You are not required to recert a patient at the end of the cert period (or at least I've been told that in several different agencies I've worked). Where do you live? I live in Arizona and AZ and CA I know certain areas have Mobile Doctors that go to the homes and manage patients that will sign the F2F. Also if they are not going to the doctor and the doctor won't come to them and if you can't get F2F signed then your company is not going to get paid for that episode. At least this is my understanding and I've been known to be wrong once or twice.