set up for fraud?

[IHeartPeds87]

So much paperwork, it's ridiculous.

That's basically how I felt at work pretty much everyday. I was talking about the concept of fraud in healthcare, and I brought up something that I thought would be interesting to allnurses:

I used to work at a residential facility caring for people with DD. Loved the clients and taking care of them....and that was the only thing I liked about the job. A horrible work culture, and unsupportive management.

I felt like the management set us up for fraud. Case and point, there were a few clients who were on fifteen minute checks. What this meant, was every fifteen minutes one of the staff members had to go and get a visual on what/where this client was at the residential facility and right it down on a sheet and sign it. This had to be done every fifteen minutes from 5 a.m- 11 p.m.

Excuse me. This was so ridiculous, for several reasons. One, they never "assigned" any one caregiver/nurse to do this, it was supposed to be done "as a team." But every hour everyone had assigned tasks to do with other clients! So there were times when it wouldn't get done (sections of it).

Weeks later, that piece of paper would be in my mailbox. The implication was to fill in the blanks and sign off on it. I was just a caregiver, not licensed, but I felt like this was wrong. I went to my supervisor and was like "um, I don't remember what patient X was doing at 11:30 last tuesday!" And my supervisor basically told me to look at hte schedule that day and see what was going on to try and 'trigger my memory.' I told her I couldn't remember, she said fine, took the sheet from me.....and put it in a coworkers mailbox!! What the heck!!!

how is this not fraud? how are you not being set up for fraud? I find it insane!

So many things were weird about that facility. I remember being 1:1 with a patient x all day. I then remember having to chart for three patients total....one of which I hadn't seen ALL SHIFT because I was out with patient x at appointments. How can this possibly be okay? I asked my supervisor, and she told me to talk to other members of hte team to get a feel for how the other patients were doing and go from there. EXCUSE ME??? I am supposed to write and sign off on something that a COWORKER SAYS??

I'm sorry, but all of this feels like management sets up the nurses and the caregivers for fraud!! I even read through these boards and constantly see people saying things like "at the end of the shift we go in and sign off on all the checks."

I'm sorry....all of this insane paperwork seems like a waste of time, space, and energy....and just a way for management to blame the caregivers/nurses when and if a legal problem arises!!!!

Was that just a really toxic work environment? I didn't realize it at the time. Was that just a bad place to be working or do other people have similar problems?

[BrnEyedGirl, BSN, MSN, RN, APRN]

I have never worked LTC, for this reason and so many others I hear daily. I have friends who do work LTC and tell many of the same stories and worse. I feel your pain. I can't imagine working like that,.however there are those folks out there that love LTC and are good at it (prayers to you all).

Can't really give you any advice,..maybe some of the LTC folks will chime in on how things are handled in different facilities.

[lylenrn]

I think you are correct in thinking management is setting employees up for a fall. I have worked in psych facilities where we had patients on 15 minute checks. It all works fine to go back and forge charting....until an incident occurs. EX: there was a suicidal client who hung himself in the bathroom. On the 15 minute charting it listed the client as being in the cafeteria for lunch. Guess who's going to have to account for that error in charting during the investigation?? Seems management is only concerned about being in compliance "on paper".

[mazy]

It is common practice in LTC to call in staff members after the shift is over...even weeks later if necessary...to fill in holes in documentation, i.e. sign of those pesky little holes in the MAR that you forgot to sign when you were running around like an insane person trying to get meds to your 30-40 patients on time. It is common practice and state knows about it, but if they want to, they will ding the facility.

I worked in a facility that lost it's Medicare certification because of documentation fraud precisely for that reason. That issue did not affect the nurses, State was going after the facility itself.

With that facility, State was so desperate to shut them down for some pretty horrifying things, that they knew were happening but couldn't catch the facility at. I think it was one of those things like the myth about Al Capone -- after all the horrendous murderous things he did, they finally got him into jail for life because of mail fraud. (was that a myth? Was that Al Capone? It was someone in the mafia.)

I would never in a million years chart that I did something for a patient that I didn't work with. How exactly are you even assigned to care for a patient if you are not even in the facility? No. I would not stay in a facility like that. You were smart to leave.

I did one time work with a patient who was on a 15 minute security check because of an abusive family member who we were having trouble getting out of the facility permanently (I'm not even going to go into how badly administration handled that). But the patient was bed ridden and it was just a question of parking the cart outide her door for the shift.

We did have a q 15 minute sign off sheet in the MAR but I don't know if it was an official/State required document, it looked to me like an administrator had just typed up something in Word and put it in the MAR as a reminder to the nurses and of course as a CYA in case something happened with the patient.

They requested that we sign off on it but no one had time or even remembered, what with the 50 million other things we had to chart on, and eventually it vanished. I usually documented in my nurses notes that I had parked the cart outside the patiet room and was checking her round the clock.

[P_RN, ADN, RN]

income tax evasion. Capone that is.

[Chico David, BSN, RN]

I do have an even better one: before nursing school I worked through the summer at a LTC facility. The staffing on the night shift consisted of one licensed nurse and 8 aides (if everyone showed up) for 150 patients. I won't go into all the details of the dickensian horrors of the place, but at that time the aides were supposed to chart on the patients, but were not allowed to do any narrative, only check a series of boxes. Much to my amazement, the charting was done at the start of the shift, describing essentially what we expected to happen that night. The arrangement of the work was such that we were getting people up for the day at the end of our shift, so there was no time to chart then. Everyone showed up at 11PM, sat down with their charts and recorded what was going to happen that night. Psychic, I suppose. All the patients were very long term, and changed relatively little, so during the short time I was there, there were no major foul-ups related to this practice.

The one thing I clearly remember about the charting is that there were only four choices for mental status:

Alert, Confused, Noisy, Depressed.

Those choices were the sum total of what we could record about a patient's mental state.

Bizarre!

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

To those who work LTC and really care, I hope you get a special place in heaven. I could never do what you do. But I've heard so many nightmare stories about LTC being more about $ than patients (1 pair of gloves per week, wash and re-use!) that I've sworn to end it all before I'll be mistreated like that.

[namazonian]

Wow, my goodness! I've been now considering applying to LTCs simply because I haven't really been coming up with anything in the job front and this along with other stories scare me. *sigh* I just hope that it doesn't come down to me working at such a place but if it does, I pray that I have the strength to grin and bear it.