providing unskilled services in the home

eddy · Aug 26, 2005

Does any one currently provide services to clients that are no longer considered to have skilled needs? What do you all think about providing recommendations for various medisets that are available, mediset fills, b/p's, weights, FSBS, "check in" assessments to monitor compliance? I invision it as a private pay service for family members that live a distance away or individuals who just want to make sure every thing is going ok; health maintaince checks. Maybe contract with physicians to provide these "extra" services to their patients. I am looking for an independent contractor idea that is a low tech, low stress deal; would work with primary care physician of the patient to cover services. What kind of services can we as nurses provide that will fall under independent nursing function under Ohio nursing laws so I wouldn't have to be covered? I could not find any thing on website. I am an RN with an associate degree; I have experience with pain management, rehab, case management and home health.
Thanks for any feedback.
Dee

Keep in mind that even though you are providing non-medical services, you are still an RN, and god forbid, should something happen to your client and they or their family decide to sue you, they can argue that you were an RN regardless and should have caught/fixed/whatever the issue. Be very careful about what you speak to physicians about, even in terms of reporting any changing conditions. If it is the kinda stuff that a homemaker/companion would not be qualified to talk about then you shouldn't do it. To do so is to "perform" as an RN and therefore perform outside of your state regulations (unless properly licensed/certified to do so) as well as give proof that you are indeed performing as an RN, substantially increasing your liability exposure (ie. getting your pants sued off). These things HAVE happened in the past to a lot of well intentioned nurses, so make sure you are still properly insured as an RN as well as a business, present your clients with a specific job description outlining your duties and scope of "care" and STRICTLY abide by it. You can never be too carefullllllllllllll. :)

Good luck!

eddy · Oct 5, 2005

I'd like to add that I am good friends with a homecare company owner. Here's what she says.

Competition in this industry is growing at an astounding pace right now. On the private side, blame that on the franchises promising big riches and granting rights to anyone with the cash to buy in. Most of the people buying into these things have no idea how to price services and are often willing to undercut ANY price just to get the business. They often quickly go out of business, but for every one that does, two new ones pop up.

On the medicrazy (medicaid/medicare) side, reimbursement is so low you'll have a hard time making any money. Unless you are willing and able to do a pretty large volume it's hard. For most of the categories you are paid by visit or hourly and supplies/consumables are non-reimbursed items. You have to eat those costs. In other words, the people that least need service are usually the only profitable (maybe) customers. Ones that fly through dressings and basic treatments can and often do cost more in supplies than the hourly/visit rate! You'll become a cynic quickly as you are forced due to economic reasons to turn down cases that need you most. If you turn down too many, your referrals will likely suffer and the profitable cases can dry up too. Often you HAVE to take some unprofitable business just to keep the flow coming.

I really hate our medicrazy system.