RNs opening cases, LPNs making all revisits?

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Specializes in Functional Medicine, Holistic Nutrition.

Does anyone work for an agency in which RNs are responsible for performing the SOC (and any subsequent OASIS assessment) and then the LPNs make all the revisits? My agency is moving toward using this model and I would like some feedback on your experience with this.

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Sounds to me like some RNs are going to find it more difficult to find home health work in your area. Also a good excuse to lower wages. Nice for the LPNs who get the work, not so nice for the RNs who don't.

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Specializes in Functional Medicine, Holistic Nutrition.

The RNs will still be full-time...they will still be listed as the official "case manager" and carry a large caseload double the size of a typical caseload. They will be responsible for keeping up to date on what is going on with their patients and make visits as necessary for pts who are declining in status. Basically, performing much less hands-on care and more telephonic assessment and case management at a higher level, like insurance case managers. I can't provide all the details because I don't want to be recognized. But- no RNs are being let go, although the purpose of this is to reduce cost on the managed care population only...

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Specializes in Pain Management, RN experience was in ER.

That's what my company does. I do all SOCs, ROCs, SCICs, Certs, and Sups. You stay very busy doing all the oasis paperwork and you go to cert your patient that you haven't seen since the admit... or maybe never at all if a different RN admitted them.

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Yes, this is how it is at my agency. I don't like it. I feel like many times I am recerting/ROC'ing a pt. that I really don't have a good idea about what is going on with them. It seems like it is our b**t as the RN if something goes wrong with the pt. paper work etc. It is really our license and it stinks. To save money, my company insists the LPN do the visits.

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Specializes in ER, L&D, ICU, LTC, HH.

That is why I left Amedisys. I do not want to stay up all night with paperwork. I did not become a RN to be a government paper pusher.

~Willow

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Specializes in Functional Medicine, Holistic Nutrition.

Thanks to everyone that replied! To those whose agencies are currently doing this, is it with all patients regardless of payor source, or just your managed care patients?

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Specializes in Functional Medicine, Holistic Nutrition.

Willow- Does Amedisys use this model as well?

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Specializes in ER, L&D, ICU, LTC, HH.

Yes in TN they are. Not sure about other areas. ~Willow

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Specializes in Home Health.
Does anyone work for an agency in which RNs are responsible for performing the SOC (and any subsequent OASIS assessment) and then the LPNs make all the revisits? My agency is moving toward using this model and I would like some feedback on your experience with this.

I think many agencies do this, it is seen as better utilization of RN's and LPN's. I find it offensive, as an RN, and feel used. Agencies also "use" RN's to do the Admit, Recert and ROC Oasis for PT only patients - I find this abusive also. Would downgrade my license to LPN status if I could, then I could see many more patients, without the worry of added paperwork when it comes to the Oasis and all the other work that comes with it. And, no, the extra pay for Oasis is not that much - for me it is less than double a regular visit and it takes about 2 - 3 hours total, including visit, which bumps the pay down to about $18.00/hr, a little more than I made right out of nursing school 24 years ago. Why do I do it? I would never work in a hospital again.

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Specializes in COS-C, Risk Management.

Our agency also utilizes this model and it can work well if applied appropriately. About half of our cases are opened by the RN and staffed by the LPN for revisits. The RN generally makes the decision about whether s/he will keep the patient or delegate to the LPN. What is required in using an RN Case Management model is great communication between the staff. I expect the RN and LPN to communicate at least weekly and more often if there are issues with non-compliance or non-adherence to the medical regimen. The RN retains the ultimate responsbility for the case and is responsible for 30-day summaries on all his/her patients, as well as the recert or discharge. It really isn't any different than LPNs who work on hospital floors, the RN still retains the responsibility for the patient care.

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Specializes in ER, L&D, ICU, LTC, HH.

You must be a manager this is not a better way.

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