Time spent in one home

Libby1987 · Feb 9, 2015

Your example would not be a skilled visit where I work. And if you're searching for something to teach then I'd say the POC went longer than needed or you might be missing assessment needs.

I spend 30-45min, 30 for simple visits such a pro times and staple removal or uncomplicated CHF or pneumonia type assessments. I usually front load my teaching at SOC and the follow up and review along with the approp assessment on subsequent visit.

KelRN215, BSN, RN · Feb 9, 2015

Average 30-45 minutes. Can be as short as 15-20 min for simple subq injections and as long as an hour and a half if there's a first dose of IV antibiotics or my patient's mother is in the middle of having a near nervous breakdown and I have to talk her down off a ledge.

lashuna1028 · Feb 10, 2015

This is my first home health job. Well I was actually hired to be their Hospice case manager but they have me helping with home health patients since hospice census is low. And I really dont mind BUT I was not formally trained to do home health and was told nursing is nursing.. While that is true the philosophy of home health is different and also the documentation. So I ask because it seems as though most of their patients do not have a need of skilled nursing that I can identify. Some of their patients have been on service for at least 2 episodes or more yet the SOC or 485 have not been completed so I would go in blind of what patient needs. Seems like they have a lot of Abnormality of gait, DM II, type patients where the visit seems redundant and pointless to me. So I dont know, I dont like it. I dont feel like I've made a change with HH patients. I feel like Im missing something mentally with the whole concept and trying to figure it out on my own.. I only have one direct patient care wound care patient so far that requires a wound vac..

Another problem is, someone else in the office does all the assigning for the patients and they switch nurses around all the time for the same patient every week. I dont like that. As a hospice nurse, I am used to being with a patient from beginning to end.

Libby1987 · Feb 10, 2015

Holy moly, that doesn't sound good. The patients may not have a need for skilled nursing which is a problem or they may have a skilled need but the documentation neither supports it nor defines it.

If that's how the home health side is run, I wouldn't feel anymore confident re the hospice side. Both are very different benefits with different qualifying and reimbursement criteria. If I were you I would read up on the Medicare guidelines to make sure you are providing care that is in compliance. You want to know the definitions of 1) medical necessity, 2) homebound, and 3) skilled service to start.

KelRN215, BSN, RN · Feb 10, 2015

This is my first home health job. Well I was actually hired to be their Hospice case manager but they have me helping with home health patients since hospice census is low. And I really dont mind BUT I was not formally trained to do home health and was told nursing is nursing.. While that is true the philosophy of home health is different and also the documentation. So I ask because it seems as though most of their patients do not have a need of skilled nursing that I can identify. Some of their patients have been on service for at least 2 episodes or more yet the SOC or 485 have not been completed so I would go in blind of what patient needs. Seems like they have a lot of Abnormality of gait, DM II, type patients where the visit seems redundant and pointless to me. So I dont know, I dont like it. I dont feel like I've made a change with HH patients. I feel like Im missing something mentally with the whole concept and trying to figure it out on my own.. I only have one direct patient care wound care patient so far that requires a wound vac..
Another problem is, someone else in the office does all the assigning for the patients and they switch nurses around all the time for the same patient every week. I dont like that. As a hospice nurse, I am used to being with a patient from beginning to end.

I'm confused. How can the patient have been on service for multiple cert periods with no SOC or 485? How is your agency getting paid for the services you're providing without any plan of care/orders? I have patients who've been on service for YEARS (some coming up on 5 years) but they have concrete needs (such as subq methotrexate for autoimmune diseases and incompetent parents) and plan of care is updated q 60 days.

caliotter3 · Feb 10, 2015

Your instinct tells you the patient has no need for service because the patient has no need for service. And switching the nurse around every week, even if done without intent, makes for an added lack of continuity. Maybe that is part of the goal. No continuity, no progress, remain on service. You might want to rethink this position if you do not want to take on the challenge of overhauling the operation that you seem to have discovered.