4evernrs

I have been in home health for nearly 20 years, and I have been around the block enough to know that this sort of thing happens in a lot of agencies - but that by no means makes it 'okay' or 'expected'. Nobody is allowed to change one iota of information on an Oasis assessment, including the coding, without collaborating with and obtaining permission from the clinician that performed the Oasis assessment. My job is SPECIFICALLY to review and collaborate with the nurses (or therapists) regarding their assessments, and provide guidance/counsel on the reason certain changes might be necessary. Because coding is an extremely complex undertaking in and of itself, most agencies utilize certified coders to ensure they are not losing revenue due to poor coding, OR, on the flipside, getting into trouble for 'upcoding'. However, nothing should be changed without the assessing clinician's permission. Ever.

You don't want to be on that ship when it sinks....sail away!!!

The fact that you recognize these first-time shortcomings speaks volumes! You will be fine. It sort of sounds like you were thrown to the wolves, though.. I'm wondering if maybe you were shortchanged on your orientation? Someone should have clearly defined the expectations beforehand...and oriented you to any equipment that you were expected to use. It DOES get easier :)

It took me 18 months, but during that time weathered 2 family crises. I've heard of people completing in 6 months, though probably with little outside demands on their time. I think without the family issues, I could have easily finished in 12 months.

One thing that I insist on with our orientees, is that their training be initiated on PAPER, rather than the computer. They have to understand all the necessary elements on paper before they know what to look for in the electronic chart. NOT that our orientation "program" is by any means a good one - we essentially just try to tailor it to each individual.

A slightly elevated temp can be an early symptom of dehydration - I remember this from nursing school....but have also seen it many times in the field.

Kate, I feel your pain!!!! I can't for the life of me understand it. It's not like I'm just being a judgemental "office person"....I HAVE done the field nurse's job. And I did it completely, succinctly and correctly for many years. It's not rocket science, but you're right...now matter how much you preach, teach and beg, it seems that nothing changes! ....But then, why should it when they get paid regardless of whether they turn in mystery meat or filet mignon....

I may have misspoken about the staffing contracts - I'm not 100% sure about the licensure requirements for that, but I would think that a home health agency license would also cover licensure as a nurse registry (staffing). Life insurance assessments - I can only think of one company at the moment, which is Carelink. Basically, they pay for nurses to go out to patient's homes and complete evaluations to help determine eligibility. Private pay - advertise anywhere and everywhere: churches, bingo halls, MD office lobbies, etc. You will want to have patients pay up front for private services - at least until they are established and you are relatively confident that they are going to pay you. Credit cards are great if you are able to take them. Good luck!

What about offering private pay / private duty services? Life insurance assessments? Try CareLink. You might also consider staffing contracts (temp staffing) to get you over the hump. Good luck to you!

I commiserate with you all! F2F is truly proving to be the stumbling block that CMS intended it to be. What a PIA! Docs simply don't know what to write on the forms - yet we're not allowed to provide standardized language... We've had a variety of responses - some signed but blank, some completed yet signed inappropriately by RNs or staff other than MDs. We also are asking our reps to get them up front with the referral. Wow - did they have to hit us with F2F AND therapy reassessments at the same time???

That's entirely too much! 30 to 32 is what our nurses are expected to do - and those are UNITS, not visits (i.e: a SOC = 2 Units).

I never had a "lab kit", and disliked taking my entire bag into a questionable environment, so I would generally use a smaller tote to take in ONLY the things I thought I would need for that particular visit. (I don't do a lot of visits these days, but when I do, I use a disposable tote). I would always plan ahead for what I needed to draw and make sure I had enough equipment to do 3 sticks (beyond that, it's time to call someone else!), and 2 of each kind of tube. Never thought of using a tackle box - that would have been kinda cool for car stock.

I think our agency has looked at most everything out there, and I've come to the conclusion that there is no 'shining star' amongst HH softwares. It all comes down to what works best for the way your agency does business. Just know this - it's the questions you FORGET to ask that will cause you heartache. Take your time in selecting a product....start with a list of 'must haves' and 'would be nice to have'....and go from there. Do NOT compromise on your needs. These systems are expensive and chances are you will end up with a 3 year contract, so you REALLY want to be comfortable with your choice. Best of luck to you!

Torture

I've been wondering about this too.... I have limited inpatient experience. 1 yr rural hospital, 9 months as charge of an Alzheimer's unit, and a handful of shifts as a temp nurse. I've been primarily in home health for the past 16 years, and the latter 10 of that have been in management. I recently was turned down for my first choice FNP program, and have since applied to another. I'm thinking maybe I should get out and do a few weekend shifts at a hospital for some hands on.... does this seem logical? I feel, in some ways, that home health has been beneficial - such as reading literally thousands of sometimes cryptic H&Ps and working through the clues to figure out what exactly was going on with the patient.

I graduated in 94 and worked for 1 year in a small, rural hospital. That 1 year was invaluable to me. Being such a small facility, I gained experience in everything from ICU to emptying the trash. It was agonizing, exhausting and awesome all at the same time. That experience gave me the confidence and competence to make the jump to home health, and that's pretty much where I've been ever since. I am now a supervisor and advise all of our interviewees that you must have a solid knowledge base, be confident in your assessment skills, organized, self-motivated and energetic. It's hard to have ALL of those qualities without some solid experience behind you. I suppose it's possible to succeed in home health right out of the gate, but I think the odds would be seriously stacked against you.

Leanne - I'm currently waiting for a decision on admission to Frontier. None of my reference letters came back in sealed envelopes. Two were faxed and the other was sent back to me unsealed. Anyhow, Frontier told me it was still okay to submit them. I agree with you on not wanting to ask people to jump through hoops once they've agreed to complete the reference form for you :)

I recently graduated from their RN-BSN program. Absolutely loved it! It is the most flexible program I could find, which I needed with my hectic schedule.

I don't know the exact figure, but I do not think that a LUPA per visit reimbursement is anywhere near $200. I'm thinking that it is probably about half of that. (Does anyone know the figures???) You also have to consider all the overhead that goes into securing the referral, processing the admission, scheduling, QA and billing staff. To some extent I'm sure that the "loss of potential revenue" is wrongly termed "losing money", but in a sense, it very likely is a loss after all the work that is involved in a LUPA episode.

Thanks for the response! I called Frontier and was told that the refernces will be accepted even though they are not in sealed envelopes :)

Congrats! I am hoping for FNP (class of 85?). Anyhow, I have a question - what kind of form did you take to the doc for you health certification? (...A health examination that includes documentation of immunity to Rubella and Hepatitis B, and freedom from tuberculosis in a communicable stage...) Is the health statement necessary to apply - or do you just need to be able to provide one prior to clinical? Also - I got my 3 references, but none of them followed directions. I received them all back via fax instead of in sealed envelopes. Do you think this will be a problem? I hope not, because I would HATE to ask them to do it over again, and I really don't have any others to ask. Thanks for ANY info you can help with! :)

Here is a "word" that I hear from coworkers on what seems like a daily basis........and it drives me INSANE..... "Irregardless" Grrrrrrrr!!!!!

Not sure I understand what you are saying.... something about Oasis being responsible for lack of care???? Please clarify.

Get the consent signed FIRST - you don't want to go through the whole thing, only to find out they are going to refuse to sign the paperwork! Good luck!

Congratulations!