Skilled nursing hours cut in home health

[Sindbad123, ADN]

I am working for a home health company for long time and I have been a primary nurse for a case for about 3 years now. My patient was told by someone that once he turns 21 years old medicaid will start to cut his nursing hours. Does anyone know what happens to the hours when a person turns 21. I think he needs 24 hours nursing since he got trach, uses vent at night, and he is quadraplegic. Anything nurses can do to help this patient keep his 24 hours of skilled nursing. I will appreciate your answers.

[KelRN215, BSN, RN]

You should probably ask the admins to move this to the private duty nursing forum. This forum is primarily about intermittent home health visits. In my state, no one gets 24 hrs/day of private duty nursing. That level of care is only provided in SNFs. Maximum hours for PDN are 16/day. Once Medicaid actually cuts his hours, he or his family could appeal.

[caliotter3]

The case gets a relook when the patient turns 21. The cases where I have been, when that happens, afterwards the number of hours stayed the same. They just changed the program that the funding comes from. The only cases I have known where hours were cut were also cases where the agency was failing to provide nurses to cover the allotted hours. Don't use the hours, lose them. This happened irrespective of the age of the client.

[Elektra6, ASN, BSN, RN]

Yes, I have a vent/trach patient who only gets 16 hrs a day. My non-vent, trached quad only gets 8 hrs x 6 days. However, I do know of a few cases where the patient has 24 hour care. These are cases where the patient does not have any family caregiver.