GapRN

Get a SOC folder. Call complaint line. In the mean time, follow the chain of command. Notify the MD of supply issues - let your boss's referral source call the office and ask why they need to waste their time with the phone call. edit: Depending on how much trouble you are interested in causing, you can also double up on the regulatory agencies by reporting PPE issues to OSHA. Sounds like a bridge burning situation to me.

Wow. Pharmacies aren't really that connected to home health other than your requirements to do medication reconciliation. FYI: There's a difference between nursing at peoples homes and "Home Health Care" as described by CMS. See Medicare Benefit Policy Manual, Chapter 7 — Home Health Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c07.pdf HH requires OASIS documentation - I have diagnosed dysgraphia! doing an OASIS by hand would kill me! While your situation seems particularly suspicious, I have come to the conclusion that the entire industry of HH is a "medicare scamming operation." I'm about to delete the video in my last post because I am just learning video editing and have updated it, but check it out if you are weary of your current situation. If you are working in Home Health Care, you should have a patient folder with a medicare hotline to report problems & your orientation should have made sure you educate pts about it. I have called it before to discuss concerns and they are very personable - picking up the phone does not automatically set an auditing machine in motion.

You are describing the federal mileage requirements. I have had several jobs where they say my pts will be near me, but I end up working 20 - 30 miles away and all short distances between pts. This is the norm. HH companies are all owned by penny-pinching corps or rich kids looking for a good ROI (return on investment) and HH is great at taking advantage of labor for $$$.

I have a lot of issues with HH. I quit a year ago but I miss the pt care. Plus, the industry is so terrible that my 11 years of experience don't seem to be worth much in any other health care field.

I don't mean to hi-jack this thread, but it's old, and I can't Ctrl-f "new", "topic" "post" or find any button for new post. I just had a worker's comp phone interview. We talked for 70 min, they wanted to schedule a zoom call, and my recuiter said they called & asked for my address to mail me something, so I am hopeful. I had a similar interview last year and went down a YouTube rabbit hole, asked tons of technical questions (to show my interest and awareness of need to learn) and they said I was nice, but too many questions. I just took a general CM "course" (video w/ test) and I have very applicable exp with 10 years in home health. I am curious about the documentation, and texted the interviewer "thank you, etc... could you email me some of your documents so I can get an idea what to expect" I am trying really hard not to ask questions but... Anyway, what I'm really concerned about is local resources available for clients. In home health I had a a fairly finite list of things I could provide and that generally meant telling my team or pt's PCP to order something. I suspect I will be needing a wider range of services in WC, and I will be more directly involved in acquiring them. Is this correct? are there any experienced silicon valley nurses w/ specific resources, or anyone with general advice on what is available and how to find it? After my interview I am less worried about knowing specific diagnoses, their typical POC, timelines etc. The interviewer said they subscribe to a EBG site that provides care algorithms by ICD-10 code. But I do not feel prepared to look over an MD's shoulder in an office visit and remind him to order an MRI. I have never been bed side either. any advice short of auditing 3 years worth of patho classes in the next week? Am I missing some knowledge deficit I SHOULD be worrying about, coming from home health?

There is NO standard. If someone says there is, they're selling you something. Did you read the first link? That garbage was written for the benefit of investors. The pro's/cons of staff payment are all prioritizing profit. Page 2 talks about exempt status w/out mentioning CA case law finding HH non-exempt. Not that it matters since they openly ignore this. Look at bottom of page 5: 'does per visit pay reduce quality? study says no." What sort of nurse makes such an extreme scientific statement w/out citing references? "Extreme claims require extreme evidence" - Carl Sagan Points are arbitrary and are not capable of reflecting your actual labor done. some RV can be longer than some SOC. Do you want to be the sociopath who unloads the 1 hr wound pt on unsuspecting peers, or the sucker that follows the pt? I say this shouldn't be a choice we even need to make. What little meaning these metrics have can easily be washed out by a boss playing favorites. A SOC can be 1 hr or 4 and I can make a pretty good guess if you show me the H&P. On the plus side, if your sole goal is to make money and you like to schmooze the boss, you can work this system to your advantage. You'll sleep fine if you're that sociopath I mentioned. OMG P 6 is just straight up accounting on how owner can profit in HH. Oh! middle of P7 "To make room for more patients on caseload, staff incentivized to decrease visits per episode." This is flat out stating that LESS PATIENT CARE is a GOOD THING. I can't read that psychotic filth anymore. Give your self a moment to define "more/less productive staff"in terms of this industry document, and then in terms of a compassionate HCP and ask yourself why you went into nursing. Here's a web site that might help you to write a definition for a reasonable productivity point scale... or just scrap it and go hourly. https://guide.unitworkers.com/how-to-talk-to-your-coworkers-about-unionizing/ Edit: I think this is geographically specific, but my agency bills about $540/SN visit. I see $100 - $150 of that +federal milage (sometimes) at my per visit rate. It seems that some of our federal employees think we are worth more than that, which may explain the insane medicare documentation requirements vs the time our employers allot us to accomplish our work. I am of course assuming here that an 8 hour day w/ OT should be the liability you assume when getting a FT job. TOTAL NON-SEQUITUR: My boss bought a mansion in the CA hills 3 years after opening our agency.

I'm no expert, but AFAIK the only difference with union/non-union is that (some) unions negotiate a group contract, while each non-union individual must negotiate alone. BUT, once there's a contract, the employer is bound to it's terms. Read your contract! what are your job requirements? Go to the county "lawyer referral service" and get a cheap 30 min with someone for advice. It sounds like you're not unionized, but if you are, find out if they are bought. I don't know anything about this, but members of a corrupt union can take back the reins, but your looking at almost as much work as starting from scratch. DON'T SIGN ANYTHING until you understand the implications. As for those saying "if they don't respect you, go somewhere else." I call BS. One person says "I get a toxic vibe." well... YEAH! look up the Pinkerton's, May Day, etc. Your relationship with your employer is by definition toxic. Why do you think HR depts exist? All the gains our grandparents won at home while the boys were fighting WW2 have been eroded by lawyers. The US army has BOMBED miners; Right now picket lines are being run over by vehicles, Amazon & Starbucks are illegally & openly union busting, and, at the peril of our county's core infrastructure, the president is shoving an abusive contract down the rail workers throat and announcing the he "averted a national supply line crisis." This is before the union members were even able to read the proposed contract! BTW - I would highly recommend going to costco and loading up on staples like flour, sugar, x-mas presents etc, because all "pro-union Biden" did was delay the crisis until after the election. The Gov't is about as pro-labor as a pot-head teenager. The railroad workers are unable to live life outside of their job, but when this blows up MSM is going to gaslight us saying "look at the wage increase" even though that's not what the strike is about. Capitol will literally MURDER you if they see a benefit to their bottom line - though in recent history they have found it much more practical to character assassinate. So, the railworkers will be portrayed by the MSM as money grubbing scum eager to destroy our economy. OMG I got off topic. MY POINT is that Labor is on fire and WINNING. Those at the bottom were the first to notice that all employers are the same. They know that the business majors have taken over and all employers have the same play book. THERE IS NOWHERE LEFT TO GO. Work today is like cell phones. Each time you get a new one, it's just a little bit crappier, a little bit more expensive, a little bit less reliable, and planned obsolescence is just a little bit more integrated. The line must be drawn here! Essential workers have all the power anytime they choose to use it. Nurses are leaders, and have historically been leaders in labor. We have a job that the investors see as 100% cost, with no return. The better we do our job, the fewer billable hospital days, the cheaper the medications, the more independent our pts become. However, the people see us as the whole point, the end goal - why have a booming economy if you can't even have healthcare? It sounds like you already have open communication lines with your co-workers and everybody's pissed. You are primed to organize. If you walk away, you'll pretty soon find yourself in the same situation, with a weaker network, less power, and a learned habit of walking away from a fight. I was up all night the other day exploring [unit workers dot com]. They have a lot of info on how to start, and you can use them as a communication tool, or not. All you really need is 51% signatures stating "I want to be unionized and agree to let the union negotiate for me". Even if you do use them, the only obligation is to pay (I forget exactly) 0.8% of union dues to continue using them after you form a union. IDK... I'm currently looking at a short list of co-workers I trust and trying to work up the courage to start. This post is more about me than you.

XX y/o F lives with ??? Who assists with ADLs. Referred for ST, & SN from MD office for additional speech therapy as ability improves. We have previously seen Pt after she was hospitalized at SJRMC X/XX/XX- X/X/XX. Pt A&Ox2 & had PEG placed due to dysphagia & hyponatremia w/ seizures & had sepsis secondary to UTI. Other Hx includes A, B, C, D, E, F, & G. Pt developed a pressure ulcer from PEG during our last cert period but it had closed; It has recurred and pt is going to O'connor wound clinic on wednesdays to manage it. current wound care is Every other day: Irrigate w/ NS, pat dry. Apply periwound Triad, cover with hydrofera blue, gauze sponge, & secure with tape. Diet: bolus Jevity 1.5 275ml Q6H. SLP notified case is open and ready for therapy (Son) (111) 111-111 (grandson) (222) 222-2222 PCP Dr. xx xxx (333) 333-333 Fax: (444) 444-444 Head to toe done: VSS except for rapid breathing, c/o unspecified pain, probably referring to abdominal pain which is very tender, A&Ox2, lethargic. CG reports last 3 days small amounts of diarrhea & formed stool. Pt has abdominal tenderness & BS only present in RUQ. LCTA, denies SOB but O2 sat drops rapidly w/out O2 NC & RR is 28. HS regular, PPP, cap refill < 3 sec, no edema. Incontinent to B&B; CG previously educated and demonstrated effective bed bound/incontinence care. CG refused PEG site assessment because he just did wound care, he reports stage 2 pressure ulcer with minimal purulent drainage. otherwise skin is CDI Teaching done on diarrhea, pain mgmt, constipation mgmt & when to notify SN/MD. POC includes: Medication MGMT, Pressure ulcer prevention, pain mgmt, wound care/weekly assessment, fall precautions, constipation

Re: burnout. Look up your state's case law on Exempt status of home health clinicians. If applicable go to your county's lawyer referral service and have them write a letter stating that you are not exempt and they need to pay you OT for time over 8/40 hours. They probably won't pay you LOL. But as long as you refuse to sign anything changing you to part time status (which they will try to bully you to do) then you can keep your benefits and work 8 hour days until they build a case to fire you (which they WILL do.) If you really got gumption, start a conversation with your co-workers about why you make 1/4th - 1/5th of what your agency bills for your visits and start signing union cards. https://unitworkers.com/

Do a through SOC with SBAR narrative. List phone numbers in narrative for quick reference. Insist that If you are to follow pt, then you get 1st crack at doing the SOC - otherwise you need to review POC on your own time and need to depend on someone else's assessment. List POC goals in SOC narrative so you have a check list for re-visits and can copy/paste to DC narrative with minimal extra work. Print your narrative.

I had a patient from a SNF who had a unique Dx that I really wanted to follow. I had no experience with this Dx and I could only get orders from nurses memory. The SNF MD said he only transcribed orders from hospital and would not giver orders AND could not identify hospital MDs, nor could the SNF's medical record dept. I had no orders for a week and was not comfortable with what I heard via word of mouth but supposedly it was a daily dressing change and SOMETHING had to be done. I tried to have CG do it to CYA but they could not. They started crying, not just from freaky intervention, but general stress and I needed to jump in. I sent pt to ER after for S/Sx probably resulting from delayed Tx. FINALLY a hospital CM called me and it looked like I could get orders, talk to MDs etc, but my boss was freaked out since we had followed this complex case for a week with no orders and he wanted to refuse referral. Like I said, I really wanted to follow, and more important, I felt responsible to be pt advocate as family was stressed and we had build good rapport. My boss got increasingly agitated - coordinating with CM took most of a day and my boss really wanted to dump the pt. I really don't understand because the process of resuming care would have addressed our concerns and we would be legit, AND I would get to follow this cool case, AND we could support this family in a tight spot. Here's my question: We use Google Chats to text about pts. Suddenly, my boss removed me from the chat thread. There is information in the thread that I want. I have pending documentation for this pt that was created for me AFTER I was removed from case. Do I have any right to demand I be added back to the conversation? On a side note - any idea why my boss is angry? His concerns would have been addressed if we just continued the conversation with the CM. I thought I was going above and beyond. Instead, I seem to have been secretly blacklisted. The scheduler has not been sending new pts my way and when they do, it is one time visits, covering for other nurses, or obvious social disasters that will take tons of time and likely be non-admit.

All the work rolls down hill to the clinician who has no voice in the office, and is barely considered a team member by outside agencies. Most institutions are not even aware that you can satisfy PHI via phone HIPPA requirements with 3 identifying items; others like the VA know, but DGAF and believe in CYA above all else - especially above pt care. HH agency management need to band together to demand regulation of communication; trading referrals with other agencies by geography also seems like an obvious way to increase staff's efficiency but god forbid you tip off another agency to YOUR referral source. The intrinsic motivations of privately owned health care is criminally harmful to patients and damages the efficacy of home health by one or two orders of magnitude. You'd think in the current labor market management would start GAF about retaining staff but all they think about is the $$ you'll get them for the next signed visit note. That money, BTW is 4-5x more than what I see on my pay check; seems like they could start paying us hourly for visits that exceed a certain time due to customer service or indicated interventions. Did you know that HH clinicians are NOT exempt employees? there is case law finding that even if your pt care is paid per visit, you still qualify for OT at your hourly office rate (x1.5). The argument that we are exempt comes from the idea that as educated professionals we should be able to control the time spent working and so should not be paid for our time. I have never met a home health nurse who felt like they had much control over the time spend accomplishing the goals that medicare guidelines require. HOWEVER, I have worked with plenty of people who "manage" their time by fabricating documentation, not educating patients, & handing off time consuming interventions to co-workers. On multiple occasions I have had these frauds held up to me by management as paradigms of excellent nurses who can see up to 10 pts a day and why can't I take on the same case load? But when I cover for these nurses, their patients are completely ignorant of their POC. I can't count the times I have been asked to DC a patient for another nurse, and instead need to basically do a SOC and start their POC from the beginning because it seems that nothing but weekly VS and billable signatures have been done after weeks of care.

I graduated as BSN in 2009 & couldn't GIVE my labor away for experience. Pig in a Snake my butt. Nobody cares about anything but this quarter's profits. I ended up in dead-end home health where they openly ignore labor law, make you feel incompetent so you never ask why your pay is 1/5 of what they bill medicare, and the only way up is 24/7 DON with no life. IDK what they make, but I'd need $500K & a pension in 5 years. I did SNF for a month as a new grad but everything I read here said that would end my career. Now that the idea of having a career is a joke, I'm applying to SNFs. At least they'll give me regular work I can clock out from at the end of the day. The conclusion of this article is a joke. They want nurses who realize the system is broken and won't listen to them to fix it? Nothing will change until PROFIT is removed from our necessities of life like medicine, housing, food. Economic inequality is at the levels of Ancient Egypt. There are few ways out of that dynamic. I see 2 solutions: A personally painful National Strike with essential workers staying home (or on the street) and nobody paying their bills or buying anything. OR (more likely) riots that make George Floyd protests look like people waiting in line for the next star wars. The system is COMPLETLY captured. Our owners won't do ANYTHING that costs a fraction of a % in profits. All the solutions listed here cost money. SO THEY WON'T HAPPEN. That money needs to go to Lockheed-Martin next time we ship weapons over to Ukraine. That money needs to go to stock buy-backs. That money needs to go to the expensive front-end university research on drugs that can then be given to big pharma to patent. That money will NEVER go to improving our systems and infrastructure. The ride up since WW2 was fun, but the wheels finally fell off and the owners are now in the process of draining us like every 3rd world colony they've pillaged in the last 400 years so they can move their liquid assets to more profitable pastures. You want to fix nursing? get out in the street.

We ARE in a recession. Any propaganda to the contrary is aimed at propping up the market long enough for the ruling class to discretely liquefy assets. And yet corporate profits continue. News said to plan on a pay decrease at a time of record corporate profits hmm? Would this "news" source happen to be funded by advertising and owned by a billionaire or large corp? Inflation isn't complicated. Prices go up because the owning class think they can get away with it. Labor isn't complicated. The owning class needs YOU to make money and wants you to feel small and alone and in debt; there's a reason health insurance is tied to employment. They can afford to lose an uppity worker here and there. But they're leveraged to the hilt. They CANNOT weather mass organization for very long. If you feel any empathy for the increasing numbers of homeless, the increasing acuity of your patients and their increasingly precarious social situations then it's YOUR responsibility to maintain and improve solid middle class jobs like ours. If trickle down has ANY truth to it, it's from the pockets of you and I that the money rolls down hill to the coffee shop, toy store and farmer's market. This is what that article should have said: During a recession management will try to force concessions based on your perception that the economy is bad regardless of actual profits. Start feeling our your peers on how they feel about working conditions, unions, and their ability to endure missed wages. Make a list of your friends on paper or air gapped computer - NEVER your phone. Go to the bar. Learn your rights and have a strong core of educated people with a list of co-workers they are responsible for educating. Discuss demands & hostile tactics like: go slow; strike; call out sick; apply as a group to another work place - there are currently lots of sign on bonuses! BE VERY QUIET until you are ready to start acting. Union busting is a booming industry and will come down on you hard the moment management get a whiff. OR - learn your union - do they work for you or your employer? How much does management make? Learn how you can act under a hostile union. Push them to demand INCREASES in pay/resources/staffing/etc - inflation is the perfect opportunity; the nursing shortage is a perfect opportunity. Starbucks. Amazon. John Deer. NOW is the perfect opportunity.

I've been at several agencies looking for somewhere that follows labor law. We need industry wide labor organizing - I see the same people jumping from agency to agency, and everyone short on staff. It wouldn't take much stress on the system to give a guild some serious clout. It seems like admin is never concerned about giving field staff more work when we're paid per visit. In my state there have been court cases deciding that HH clinicians are Non-exempt; Even if we are paid per visit, they still need to pay overtime. LOL The worst part is that HH could be a vital part of the health care system like Obama tried to sell us on. But to be that you'd need to attract the staff and pay them to do the work. Instead we're paid like it's our job to get visit notes signed and untangle medicare documentation like some sort of crossword puzzle. My Husband's an RN in a hospital where we're a CYA joke and doctors think we just check vital signs. cuz that's what lots of us do.