Question regarding alternative therapies

Home Health Columnist / Guide · Feb 8, 2006

Cell phone is a lifeline in case of safety issues in our urban/suburban agency.

Staff get reimbursed $20/month with receipt of bill. Do you have a text message beeper? How do you communicate with the office?

Since i deal with high amount of poor persons, many without phone service, making calls on patients phone back to office not an option--plus HIPPA issues re discussing pats in clients home. Pay phones almost no existent in my area.

When I started out in homecare doing infusion and case managing 35 pts, cell phone bill often $500-800/month for 1000/ minutes. Prices are so much more reasonable now. One can always get prepaid phone to keep calls to absolute minimum. If your area is close to office, can see how one may pop in to make calls. Longer your in homecare, more staff after you to complete items while in office so longer one can stay away is usually better.

I am studying for a degree in Natural Health - interested in preventive care, using herbs, homeopathy, power of the mind, acupressure etc

This is a very touchy area. Agency is responsible for ANYTHING you do. Many docs are not open to alternative suggestions. Before you do anything, make sure the powers are aware and that PCP is contacted first before ANY suggestion to the patient. I'd make sure i had good rapport with doc before discussing any of this.

Did use 'power of the mind" aka guided imagery when doing blood transfusions (due to bone marrow transplant and unable get counts up after 3 months) with one patient who didn't belief in "hocus pocus". Asked him after i gave him IV benadryl and started blood if i couldn't just state "Blood now going in to body, attaching to cells, delivering more oxygen and causing cells to multiple and counts to go up...let thy body heal". He reluctantly agreed.

Between my guided imagery and birthday present of hockey puck signed by Philadelphia Flyers star, his spirits boosted, blood counts stayed up after 4 months. & years later whenever I see him in the community, I'm credited to bystanders as nurse who saved his live. Just tread cautiously here.

weetziebat · Feb 8, 2006

Karen,

Yeah, we use a text message beeper, which can only access other beepers. Not much good except to send messages to office. May check out cost of cell phones. :rolleyes: Just something else to traipse around with me that I don't want! We only get paid for one trip to the office daily, and have been 'warned' by other nurses that the further you can stay from the office the better off you are. :chuckle

Thanks for the heads up on alternative therapies. Did ask my superivisor her opinion and she hesitated, said she didn't know and would look into it. I know even my own PCP, whom I love dearly, thinks its all , well, if not hocus-pocus, at least a very slow acting, mostly benign waste of time. Things change slowly, especially where the AMA is concerned. Thanks for sharing your story. Made me feel good to know others believe in it. :icon_hug:

homehealth43130 · Feb 14, 2006

alternative therapies are not considered a skill under a plan of care and would not be reimbursable as a stand alone visit. If you did receive an order for x therapy x times a week, what happens if you cannot see the client, is there anyone qualified to provide this service if you are ill or on vacation? As to the cell phone - it is a safety issue. You can get one and not let the agency know your number so that you can use it for emergencies only - car accidents, flat tires, mechanical problems etc. We are a rural agency and it is handy to have to locate patients who give very general directions. I can understand your reluctance for a cell phone, as I was the same way until I needed one due to receiving a page about an emergency and the client didn't have a phone.

weetziebat · Feb 15, 2006

HomeHealth, thanks for the info. I know the AMA will fight tooth and claw to keep natural therapies out of allopathic settings - making everything a 'disease' and only 'allopathic' meds are allowed to treat 'diseases'.

Guess I was just hoping there was some way to perhaps slip it in there via one of the few open minded allopaths, but think I'll just have to keep my ideas on using homeopathic remedies to myself. I appreciate your information.

As far as the cell phone goes, going to get one for work only. For something like $3.50 the phone company will print out a list of numbers called, and if there are any personal calls I'll pay for them, and work numbers will be paid by the company. Sounds fair to me.

renerian, BSN, RN · Feb 15, 2006

Good question/thread. I would love to know where you are getting your degree. I went distance at Clayton College and they have that program as well as nutrition and I took the BS/MS nutrition programs. Are you studying to be a certified herbologist? That is the only way I would consider talking to a Dr about any herb/my preference. I would feel the need to be certified in any alternative therapy to ask the DR only because of the nature of the TX, the newness etc.

When I got my degree I took one class about prescribing to ensure that I did not prescribe due to the paper thin line of that aspect. I don't recommend to any patient any herb for that reason. If they ask me about the herb I teach them about the herb/have 3 huge herb books and always tell them ASK your doc and document it.

Herbs, I have a few docs in the past that have agreed or ordered rarely. They are drugs basically (long and short of it), they are unregulated and some can be deadly.

If the person's Doc has a degree in Homeopathy then they would most likely have already addressed what your thinking about.

Thanks for posting the topic.

renerian

weetziebat · Feb 16, 2006

Hi Renerian,

Yeah, its Clayton College - and right now, I should be finishing up the BS in Natural Health this year. I really like the school. Not sure where to go from there. Thinking of heading towards the Master Herbalist degree, although I'd like to delve deeper into homeopathy.

Know what you mean about the fine line of teaching, without attempting to diagnose, treat or prescribe. I just encourage preventive care, which especially in Home Health, are the way to go, right?

Are you doing anything work-wise with your nutrition degrees? I have a local friend who is studying for a BS through Clayton, in nutrition, with the hope of landing a job at an Hawaiian spa. Sounds good, no?

My feelings are that alternative therapies (alright, so I don't believe wholly in ALL of them) work, and even if it is by the power of suggestion, what is wrong with that? I know myself that I can feel like I'm dying, go to my doc, ready to prepare my final arrangements, talk with the doc for 5 minutes and walk out of there feeling better than I ever have. Yeah for mind power! A still largely unexplored frontier.

Traveler · Feb 17, 2006

A cell phone is really a lifeline in hh. If you are taking call you really have to have one. This is even necessary where we are- in about 75% of the area we cover there is no cell service (rural), but they can leave messages when I'm out of the area. Pay phones are hard to come by these days and cell phones are pretty cheap. Our co. reimburses $25/mo for cell phones. You can also take it on your taxes if you itemize under misc. expenses on schedule A as well as federal mileage minus what the agency pays you (usually lower than fed).

As far as alternative therpaies, you are there for the hha providing skilled services (usually under Medicare) and need to address the POC and goals. If you want to make recommendations (as I often do) about alternative therpaies that may want to look into or ask their MD about, that is fine. If the patient is interested in any alternative therpaies that you can offer, it is probably a better idea to offer that service outside of your actual visit with the agency. Be very careful though. If a patient has a wound I will tell them that increasing protein, vitamin c, and zinc have been shown to increase wound healing times. I have also given patients phone numbers of practitioners (myofascial release, etc.) that I think might be able to help them. All you can do is make recommendations, but you really need to address the POC.

weetziebat · Feb 17, 2006

Walking that fine line can be pretty tricky. Today one of my patients was complaining about how bad her allergies are year round, and how she hates to take pills, especially because they cause her many side effects.

I, gingerly, mentioned that I also have tons of allergies, and find Zicam (a homeopathic) nasal gel made for allergies to really be helpful to me.

She appeared interested, and I suggested she speak with her PCP before taking any non-prescribed meds, even OTC, explaining how all meds and herbs etc. can interact.

Guys, do you think that is O.K? or am I pushing it even mentioning something like that? :uhoh21: Her allergies have nothing to do with the HH visits, just an oft mentioned topic where we live - in the valley of allergies. So, technically, not in the POC.

Home Health Columnist / Guide · Feb 17, 2006

That type discussion totally appropriate.

Just like telling wound care pts Vitamin C + Zinc (found in Multivitamin like Centrum Silver --get the stor brand for pocket book savings) and protein aid in wound healing. For those with chronic wounds, I also mention that one of the wound docs in our area recomends Arginine for his patients. They now have a supplement RESOURCE Arginaid with arginine as an ingredient so it must be working. (Helped my Dad with necrotic toe s/p blood clot after triple AAA repair.)

Now if the client decides to start taking OTC vitamins and herbs, you must inform the PCP and include on plan of treatment(POT), checking for drug/ herb/vitamin interaction. JCAHO dinged us for one patients vitamin regemin + OTC drugs not on POT.

weetziebat · Feb 18, 2006

Good to know. And thanks for the tip about Arginine - I hadn't heard that. Glad it helped your dad.