TBohmRN

I work in home health, and we pay our nurses hourly- not per visit. Many agencies do a point system, it really varies from agency to agency.... but in my opinion hourly would be the best option. We follow federal mileage reimbursement, which is 67 cents/mile, however we also pay for travel time. I would want to know how big is the service area that you are expected to cover? Agencies near us do have options for company vehicles, but we are small and do not. $35 per visit seems very vague. Is there additional pay for the portions of the job beyond that visit (QA, documentation, communication with other members of the care team)? A full-time nurse at our agency typically sees 3-5 patients per day for routine visits. We usually allot about an hour to be in the home. Admissions or recerts or discharges may take more than that. One thing to think about that I believe is more important than the money, is that you are in these homes by yourself, there's not a team right next to you to discuss with (like in a clinic, or SNF). Yes, you have people you can call, but it 's not the same. On the upside... I love going out and seeing home health patients. It's like going to my grandparents most of the time... however also be ware that you will see the highs and lows of elderly patients living in their homes... some have great families and support systems, but some have no one.

Yeah that was extremely helpful input… thank you! I’ve been managing to figure it out though on the days I’m not out seeing patients. Also, “a lot” is two words.

I am new to home health, but have been in LTC nursing for about 15 years. I was only involved in 1 or 2 QAPI meetings at the tail-end of my LTC work, and now am working on QAPI for the home health agency. Does anyone have any really wonderful resources? PIP's make sense to me, but I really feel like I have no idea what I'm doing. Any help appreciated!

Just wondering if any other LTC nurse's have any input on guidance in regards to out-of-facility visits for the residents and Covid. It has been said that we can allow out-of-facility visits if they are "low risk" situations, but how are facilities determining that? Does anyone have some sort of screening tool that they'd be willing to share? Eager to see our residents doing more and seeing their families more, but want to do so in a safe way. Thanks in advance!

I'm reading all of these comments, well skimming them to be honest... what are you going to do with the patient? They're justified to be there by their need for medical treatment (I'm assuming or they wouldn't be there).... is everyone going to refuse to care for the patient? Because that's not an option. I've heard it many times before also "it's their right to abuse you". I've been in different situations when I heard it... being hit, kicked, bitten, etc. I know that some patients are a handful (too put it lightly), but I feel that some patients you have to find that way to great an awesome rapport with them, and know how to (sorry to say it this way) kiss their a** to make YOUR life better too. Some patients will ALWAYS be a pain in the a**... and that sucks, but seriously... we all signed up to take care of people... we didn't sign up to take care of the completely agreeable, pleasant, cooperative, AWESOME patients. Keep your chin up, I'm sure it's not personal :) & if the patient is cognitive as you said... I'd never be afraid to put it out there plain & simple that you do NOT appreciate how she's acting/treating you, that you're trying your hardest to help her, and what is/is not acceptable.

Unsure where else to post this, and can't really find any helpful information anywhere so thought I'd leave this here and see if anyone has any input. Since our ICD 10 switchover, *every* person with depression has a dx of Major Depressive Disorder. Some staff recently attended a PASRR class and are confused now about this because they were told that Major Depressive Disorder would indicate a Level 2 PASRR. Our clinic's are using the same code for depression, and there's not many other options unless a generic "other depressive disorder" is used. Is anyone else using another code for general depression in LTC settings?

WITHOUT A DOUBT! When I started this, I was a young single mother and wasn't sure what I wanted to do with my life. My mom was a nurse, but it definitely was not on my radar growing up. I got my CNA just so I could support my son, and it snowballed from there. I have never once regretted it. I came into this profession to make a living, but I mostly definitely stayed and continued my education because I love what I do.

In Iowa, the LPN scope does not allow an LPN to perform an INITIAL admission assessment in LTC. Once the initial is done, if the LPN has taken the supervisory course required by the Iowa Board of Nursing, then they can perform skilled assessments. Not sure if there would be a difference between a LTC facility and a group home though. Sorry your state BON wasn't more helpful.

It's hard to say that they are being intentionally "withheld" from the patients. It needs to be brought up with administration/management first. Do they know it's an issue? Is it possible for the off-going staff to get supplies for the overnight staff until the issue is resolved? As someone else also stated- go ahead and call who ever has that key and ask them to swing on by the facility at 2AM and see how long that lasts. Stir the pot a bit, definitely... but slandering the facility and basically telling families that their loved ones are being neglected is a bit much if other routes haven't been taken to resolve the issue first. And if the facility is genuinely neglecting and with holding things from there residents that need them, then DIA needs to be called.

Ive worked in LTC for over 10 years. We do skilled assessments once a shift. My facility has a "skilled assessment" template/form on our system. It's basically a head-to-toe assessment, and make sure to focus on whatever brought them to skilled care. Vitals, LOC, heart lung and bowel sounds, voiding pattern, edema/skin, activity level & tolerance then treatments, wound, tubes & drains, incision, etc- all if applicable.

To each their own... everyone has their "thing". I love long term care. I'm intrigued by critical care and emergency work, however long term care is where my heart is. And as for them getting paid more... sorry to say, I make more working in a nursing home than friends working in ICU and post-crit in hospitals in surrounding larger cities (significantly more). I take much pride in caring for our community's elderly. Our jobs may be "TAMER" but they most definitely are not not LAME.

I got my LPN about 11 years ago at a community college. I continued on for my RN immediately, but ended up dropping due to other things going on (attempting to work full time and raising a child). The timing just wasn't right for me. I am now 33, and graduated from the RN program at the same community college in December. Start with your LPN. A lot of community college programs bridge to RN easily, so once you have your LPN you can decide if you want to continue on right away, or maybe work for a while first. I will say that the most beneficial thing when I went back for my RN? My experience as an LPN. I had a much easier time with pharmacology, and pathophys-related things in school. Everything just came so much easier this time around, and I know it was because of my experience in healthcare.

I would think if it hasn't been used, it wouldn't pose a threat, therefore you wouldn't need ongoing screening. HOWEVER, the first thing I would do is DC the order for PRN Compazine due to non-usage if it had been that long.