London Turtle

So help me out here. Division of Aging (or Division of Health and Senior Services) as it is now called in my state; is aware. Perhaps this is not the same as APS. I don't know. I have always been told to hotline circumstances like these to DHSS. And perhaps this is not the same from state to state. If anyone can direct me to APS I would be so appreciative. Most of my hotlines result in very little help. So if there is anything else I can do, I will!!

I have been in numerous homes that are so filthy and disgusting. The smell is so intense, that I can smell it on me after i leave, and so I try to get home and shower, but that's not always possible. Some homes the roaches are so bad I'm sure that I have them crawling on me when I leave. One home, this poor dear lady who did not know that her home was unacceptable by most. I came in one day and when I went to put the BP cuff on her I saw she was literally covered with bed bugs. I had never seen a bed bug before, but had seen there description. I knew right away what they were. She had lived like this all her life. When I hot lined it the social worker said he knew (he was raised in the same town) and knew the family well from childhood. The house was so bad you could see through to the outside in several places, the rain poured in in several places, including on her bed. She fried her morning eggs in the same unwashed skillet for years, ate from dirty dishes, did not know what a shower was, an out door toilet, no running water (ok that used to be acceptable) and in the winter, sat in the same chair by her wood stove day after day. There was no other place in the house that was warm. I could go on. It took several hotline calls, but we finally got her out of there. And yes I've seen dog poop on the floor many times in many homes. Another home, my patient lives with her daughter and all the kitchen counters are piled a foot high with dirty dishes, The dining table, a foot high with food stuff. You can't even walk around in the kitchen for all the junk piled, and every where else in the house is about as bad. The daughter is able, but evidently not willing. I can kinda understand if there is some developmental disability. It does not make you a bad nurse if you choose to leave. You have to be in there 8 or so hours? Most the homes that are filthy I can leave in 30-45 minutes. And haven't refused, but I'd like to. I cannot imagine staying an entire shift!

Scooter, thankyou for your reply

I always wonder if i could see the blood when I pull back on a B-12 injection since the B-12 is red, any comments or experiances with this??

I had a patient who went into insulin shock when he gave himself an injection, and the insulin went into a blood vessel

Thanks for your reply, Renerian. It goes on and on....... Would still like to hear from any other nurses who do In Home HH.

I SO agree w/ you. But the majority of nurses I talk to like the per visit pay and I can only figure their patients are close together or they work real fast. I think per visit pay encourages sloppy nursing. If your hurrying, watching the clock your more likely to forget or miss something. Your might be less likely to give your patient time to talk about whatever is going on with them. I have always tended to be detailed in my nursing. My first year's eval w/ this company my supervisor said I was too thorough. And at that time we were payed by the hour, but our time was kept track of to measure productivity, my productivity was usually lacking, whereas another nurse who worked in my area had wonderful productivitly. Later, after she left the agency, i picked up her patients and every one of them told me that much of the time she didn't take their v/s, made errors in their med tray, and would be in and out like a whirlwind. I know from f/u in her patients charts, her charting was minimal. Our supervisor knew what she was doing and let her get by with it, and it would have only made me look bad to c/o, so I pretty well kept my mouth shut. I've checked with other agencies and like Isearl said this is the trend for home health, and it does appear that they are all going to pay per visit. Our agency has already been in trouble with the state, so you'd think they would do every thing they could to keep their act clean, but obviously the money talks. I don't want to change jobs, I don't want to work at any other kind of nursing. I've been in HH so long I'd be like a fish out of water to do any thing else. Besides that I Love HH nursing.

I make my own schedule. And plan my visits so I'm not going any farther than i have to. But there are always exceptions, and I've spoken to my supervisor anytime I have to go out of my way, I'm denied for any extra pay. I have asked frequently, but always get turned down. So it makes me feel like I'm asking for something special above and beyond what the other nurses are getting. I don't think that most of the nurses are traveling this much, but I don't really know for sure. Another factor is if the visits take longer than usual. I have 2 in home patients--long term, that are diabetics that take 5 insulin injections a day, I fill 35 syringes for each of these patients plus a med tray, not to mention an assessment and anything else that comes up, so both these visits are very long. There is another nurse that does alot of driving to get to the office. I drive 68 miles and she drives 80 I think, and we were having a nurse meeting and talking about the excessive mileage, and she was told that maybe she should go find her another job. I hate being so far away from my patients charts, and try to get into the office once a week, but that doesn't always happen. I know that this company has set these rules and it would surprise me if they helped us out with this problem.

I have a patient (home health) that reported to me twice some time ago that her urine was black. 2 separate episodes and none since, I never heard of this and the Doc didn't seemed concerned. She had no catheter. And I never saw it. She's not one to make stuff up and she's not confused. Got any ideas?

In Missouri, we have In Home nursing: Nurse visits that are authorized by Senior Services, funded by Medicaid. The visits are supposed to be maintence type nursing ie: Med set ups, Insulin set ups, VS, Nail care, Labs, Monitor skin condition. We are authorized to go into home 1xW, or 1xM. It is actually a very good program, but many downsides. If we are authorized say, 1xW, and this patient has a med change, and needs help to adjust med tray w/ new RX, were not authorized to go and make that change, but we can do it on our own time or the Agency's time, -if they decide to pay the nurse for the visit. Or, say the Doc suddenly decides he wants labs done, and Wow! you were just in the home yesterday. Now Senior Services has come up with a new plan which sounded so good, but now that we are doing it, we find out we are doing a whole lot of freebie work. They want us to do semi-annnual visits on all our In Home clients. The form we fill out is 5 pages and a med list. Very time consuming, repeating some info 3 times. If we are already in the home for nursing then we fill out this extensive form along with our regular visit report, copy and send to SS, orders to Doc, and original to Agency without any extra compensation. They form may take 30 min to an hour or more to fill out, not to mention just directing all the paperwork to where it's supposed to go. If there's not already nurse visits, and we have only a caregiver in the home, then we actually do get paid for the visit...wonder of wonders. One of the reasons to do these visits is to ensure that the services we offer that client is adequate and reasonable. So when I find the client needs more help, this form goes to SS with request to caseworker for whatever change the client needs. One time I had made a request for a service change, and 3 weeks later when I hadn't heard from the caseworker, I called him to see what was up. And he said "Oh I didn't read the paperwork" So I'm assuming these mounds of forms will be stockpiling in these client's charts and rarely if ever read. I think Medicaid dreamed up this program to get alot of work done for free. I am not happy. Does any one else do In Home nursing? Is this throughout the US, or just Missouri? Does anyone else have any opinions on this subject. I used to LOVE home health, but it's hard to love your work when you don't get paid for what you do.

I've worked in home health a long time and never have I minded the smoked up atmosphere near as much as the filth, the roaches, bed bugs, and other creepy crawleys. I also don't like dogs that jump on you or a patient that has to have a dog in their lap while I'm trying to do an assessment. Or you sit on the couch and get up just to find dog or cat hair all over your clothes. Just recently, I had a patient who would not controll her dog, and my assessment was not so good trying to hear a blood pressure with a dog on her shoulder.etc, etc... She realized my assessment was lacking, and complained to me about it, so I asked her if she would expect her Doctor to do an assessment with her dog jumping all over her. She got the point and from now on the dog is locked in the bathroom while I'm there.

Our company started pay per visit about a year ago. I don't like it because I cover a 4 county area. And these counties are large. If all my patients were fairly close together it would be great, but because they are mostly far apart from each other, mostly rural and country roads, my pay check has decreased considerably. It does save the company money...mine!