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.

What I meant to say, and I do apologize, I was in a hurry when I wrote that reply, is that all I can speak for are the branches I worked for at the time I worked there. You are right, I don't know about every branch for both companies I worked with. One of the companies I worked for I would never work for again, but they did nothing wrong at the branches where I worked. I am a nurse and we work closely with the PT's so, the branches I worked with at the time I was there, were doing nothing wrong. My original point was that she should have mentioned all the companies and not just Amedisys. To me, only mentioning the one company makes it sound like she's got an axe to grind with that company otherwise she would have mentioned all 4 companies. I could be totally off base, just my observation. I too support people speaking up if something is going on that shouldn't be, but to just mention one company and one program when more are involved, isn't right.

My question to you is why do you just mention Amedisys? There are other companies involved in this "investigation". " Senate Finance Committee had launched an investigation into the practices of Amedisys Inc., Gentiva Health Services Inc., LHC Group Inc., and Almost Family Inc." If you are going to mention one you should have mentioned the other three also. Could be a disgruntled employee? I have worked for 2 of those 4 companies and I can tell you from experience, at the branches I worked for (and between the 2 companies, I have worked for 4 different branches), there is nothing to the investigation. Stop trying to stir up trouble.

The agency I work for offers benefits for full time (32 hours and up). The benefits are good, and cost about $55 (depends on what you select for your benefits) per week. I know others in our area offer benefits also, there are 3 huge companies, that are hospital based and offer benefits.

Wow, what Gentiva did you work for? Was this when they took over a smaller homecare company. I have dealt with many, many people at Gentiva and only ran into a couple of nasty ones. The office I work in now is awesome. We just had an internal audit and did pretty good. As I said, I have worked for Gentiva on and off for 22 years, I keep coming back to this company, and I have worked for this company in 3 different states. The only problems I have had was the Phoenix office and they were beta testing the electronic charting, and had a few people that you shouldn't turn your back on. Other than that, everyone I have dealt with has been wonderful, even the ones from corporate have been great.

Well, I've worked for Gentiva on and off for 22 years. First in Indiana, then Arizona, and now California. I like the company, obviously. There are good and bad people in every company (office). The biggest thing I don't like about it is almost all the offices are pay per visit, the ones that aren't are heading in that direction. I have heard most companies are going PPV. You can either be pay per visit with beneifts, or per diem. They do not hire salary or hourly anymore that I know of (field nurses, office staff is still hired in hourly and salary). The crew we have here in California are awesome, I love this office. I had some issues with the office in Arizona, so I guess a lot of it is office specific. The office I am in right now, is still on paper and only the Phoenix area and an area in Florida are on on electronic, but it is coming. The insurance is good, altho, they are switching in 2010, so I'm not sure how it will be. I have not worked for the other company, but I have read numerous posts on here that have not been favorable to them. Feel free to email me if you have any questions. I moved out of Indiana to get out of the cold and I waited until my son was grown and had his own life. I love it here and don't regret one bit moving, altho it is hard not living around any family anymore. Good luck!! Edited to add: lol I just noticed you are in Indiana also. I lived in Muncie for many, many years. I don't miss Indiana one bit, altho I do miss my family a lot. :)

I worked for a company in Arizona, 32 hours per week. I met my par on Thursday morning, first visit, so I made plans on Friday afternoon. I ended up with 30 visits (at 32 hours I was suppose to have 20-24 modified units/wk). I was called at 2 pm on Friday for a SOC that had to be done immediately and when I said no I had plans for that afternoon, my boss asked me if I met par, I told her yes, I had met it Thursday morning, and she stated, we own you from 8 am to 5 pm. I told her I was part time, and worked 5 days a week. that I worked this job because it was flexible. She told me again, we own you from 8-5 M-F and she would have to talk to me about this. I went in and told her my contract I signed said nothing about working 8-5 M-F, it only specified 20-24 modified units per week. She tried to tell me that it was not a contract, just an agreement. I laughed and told her I was part time, and I would not work 5 days a week and be available from 8-5. Now I work for the same company in California, and have not been told that once. I work 4 days a week 32 hours. Maybe it is branch to branch specific. This office I work for has been great so far. Good luck. I would find a company that fits your needs, and doesn't commit fraud.

I agree with HHheart. Stay away from palm pilots/handheld phones. I worked for a company that used Homecare Homebase, and it worked ok, they then switched to their own program, still using handheld phones, and it was such a huge headache. It was slow, slow slow and very unreliable. Go with the tablets/laptops. I am back to working on paper, which is ok, but can't wait to go back to electronic charting with a program that works.

I can't imagine precepting for nothing extra. It is your time, takes longer to do visits, and is time consuming on the preceptor part. They should give you a bonus. You could usually do more visits in the same amount of time you spend with a new nurse, therefore you would make more money. I just think that they should give something extra, plus the nurse is doing my visits, where if I did the visit myself, I would get paid a visit rate and most likely get home earlier, my time is valuable to me. Granted with preceptors it does make retaining the nurses easier, but should you burn out or make your veteran nurses feel slighted? Employers need to realize, that precepting is not just a walk in the park and it helps to retain nurses. My employer made it sound like I should feel lucky to get anything at all, since all I had to do was "stand there and watch her do the visit".

Thanks for the reply. She asked me if I thought I was being cheated and I told her I had to go home sit down and look at things, and I would let her know. I am going to go back to her and show her the numbers. Originally I was told I would get visit pay for the visits, and if I spent 4 hours (whether in one day or several days) I would get the $72 also. Then all of a sudden I was told today, that if she does the visits, she gets the visit rate, I get the the visit equivelent (which depending on how many patients we see, is less money). I didn't mind doing it if I was getting paid as she first stated (and BTW, I did tell her when I first started that I wanted the rates in writing, and she just didn't have the time then, and says well there is nothing really set in stone by the company, it is a branch by branch decision). Anyway, if they don't change that, I will not be precepting, it takes a lot of time out of my day that I could be doing my own visits.

I was wondering what everyone's company pays for precepting new nurses. My company has asked me to precept new nurses. My reimbursement is as follows: If I do the visits and she tags along, I get the visit pay, plus if I spend 4 hours with her, I get $72 (buy only if I am doing the visits). If she does the visit and I am supervising her, I get their visit equivalent. For example, we went out the other day, did 4 visits (2 were in the same home, a couple we have on service), and she gets paid for the visits themselves. I get the visit equivalent for 4 hours which is 3 visits. So she made more money than I did for those visits. These were my normal visits, so had I done them as I had planned I would have been paid for the 4 visits. I don't think as a preceptor I should get less money than the one I am precepting or am I just being money hungry? My boss said she thought I was making out OK for not having to do anything by supervise. I say it is not worth my time to make less money than the person I am precepting, or than I could make doing those visits on my own. Usually you only do the visits the first couple days then the new nurse does the visits for the rest of the time you are precepting. Also their visit equivelent is (instead of paying you hourly, they pay this way for meetings, inservices and case conferences), from 0.5-1.5 hours is 1 visit, 1.75-3 hours is 2 visits, 3.25-4 hours is 3 visits, 4.25-5 hours is 3.5 visits and so on. I don't agree with this as case conferences usually last 1.5 hours. I am curious how other agencies pay precepting and meetings, ect. Thanks for the info in advance.