Standard of Care (SOC)

toomuchbaloney · Jul 3

That's a question for your employer.

NurseLsat · Jul 3

I'm trying to get feed back from other people's experience with their employers to see what their agency do.

Where you work or have worked what does your agency do?

Home Health Columnist / Guide · Jul 3

In my PA area. RN does the initial eval + OASIS admission assessment for all home care clients and confirms need for skilled care services. If no SN needed (rare -usually need at least medication instruction + eval compliance), SN will admit when only Physical Therapy need identified; PT then performs initial PT eval assessment thereafter will case manage client.

Peachpit · Jul 3

Agency I worked for the SN performing the SOC could order PT/OT/ST/MSW for an eval if the SN felt there may be a need. From there it was up to the PT/OT/ST and/or MSW to decide if the patient could benefit from their service and if so, obtain the MD order to provide care based on their eval.

The SN never scheduled visits other than nursing and the HHA if the patient had HHA services.

NurseLsat · Jul 8

Thanks everyone!

toomuchbaloney · Jul 8

NurseLsat said:

I'm trying to get feed back from other people's experience with their employers to see what their agency do.

Where you work or have worked what does your agency do?

I'm retired now.

In my day, the professional who visited did the SOC for hospice but only RNs completed the OASIS and initiated the SOC for home care patients. One agency used the same software for both and another agency used a separate software for hospice. I imagine things have evolved in the 10 years that I've been retired. Hopefully the software is better.

Editorial Team / Admin · Jul 8

When I worked as a case manager in OR, our process was to place a Stat PT or OT consult in the ED. The therapist would come down and provide their formal evaluation and recommendation. If the patient did not qualify for SN (which most do not), the next steps would depend on their baseline level of function and mobility. If it was difficult for them to leave home, we would set them up with home health PT/OT (or whatever therapies PT/OT recommended). Alternatively, if preferred and available, we would help set them up or start setting them up with a temporary assisted living situation and therapy services. They would then be discharged home, and outpatient case management would finish up any loose ends.

This makes it sound easy, but other factors that go into this are out-of-pocket costs and social determinants of health, including finances and family support. Many times, patients expect insurance to cover everything, but sadly, insurance does not cover these services in most situations. Many times, the family expects the healthcare team to manage it all and feels they shouldn't have to help their loved one because they have work or XYZ -- which is very unrealistic.

This really isn't a one-size-fits-all solution. Different systems have different processes, and different ALFs have varying criteria based on their level of care. ALF is an alternative for SNFs when patients don't hit the SNF needs benchmark, as patients can still get support and the therapies they need, but these ALFs come with hefty out-of-pocket costs, not to mention the struggle of finding ALFs with available beds.

So really there are a lot of moving parts to consider and each patients outcome plan will be different.

jayni · Jul 10

I've seen it done a few different ways. My current company has PT admit if SN isn't ordered. If SN is ordered and we go but there are no needs, we put 1 more visit on for SN either one or two weeks out to give PT time to eval, then call to check in with the patient and do an SN discharge (either visit or non-visit depending on patient's preference). Other companies I've worked for they don't do that additional visit. Really depends on the company.

allnurses Guide · Sep 24

At my agency, we are told not to admit the patient/finish the admission visit, but to do a "non admit" due to lack of nursing skill or need or what have you, then notify the clinical manager and I guess the PT's visit is changed to a "PT00" or whatever. Are the visit codes universal? :)

Home Health Columnist / Guide · Oct 10

Visit billing codes are universal, however different software vendors have varying discipline codes.