Tired of ALFs throwing us trainwreck patients with little to no information on referrals.

[Patchouli]

It’s hard enough to keep up with the documentation in home health admissions, along with phone calls, communication, etc. The patients these ALFs are taking are absolutely not appropriate for their facilities, but all their administrators see is dollar bills. They throw home health in to manage wounds, foleys, chest tubes, etc, and they don’t even bother giving the home health agencies proper background, or useful information such as date of Foley placement, urologist name, or even telling us they have a Foley if we are ordered for wound care or physical therapy… They have minimal staff, and we can’t even get assistance with checking bottoms on hoyer patients, and when we come in to do wound care, we’re stuck doing full care because they haven’t taken care of their residents basic toileting, or peri cleanup, even though we don’t work there, and have 6-8 other people to see who could be 20-30-50 minutes apart. Report, communication, background, information all basic nursing stuff. Whoever does intake at these ALFs needs some serious education. It’s getting old, and I for one am tired of going above and beyond, only to have it happen over and over. Tired of having people thrown to us to figure out when we didn’t get the information they did. I was at a home health opening for three hours because I wasn’t informed of amount and severity of wounds, even though I called the night before with questions, and was given false/inadequate information, and wasn’t informed wound care would be daily, wasn’t informed they had a catheter, wasn’t given surgeons name, wound care orders, or date of f/u appts. We are all tired but this is ridiculous. Do better or get out before you take others down with you. Your coworkers, residents/patients, and outside assistance such as home healthcare nurses, and physical therapists deserve more.

[DallasRN]

I have little to add other than to say I experienced similar things during my (very) short stint in home health.  As a result of your findings, the nurse is almost constantly running behind, being questioned as to why they are behind, receiving complaints from patients, family members, administration people, etc. And if you leave something as minor as a paper towel on the cabinet, your supervisor is notified before you can even get in your car.

And who suffers?  Patients.  Human beings in desperate need of help.  So sad.  The saddest thing, I think, is home health could be one of the most satisfying areas of nursing to work in yet all the extraneous garbage makes it miserable for many.  Best of luck to all home health nurses!

[GapRN]

All the work rolls down hill to the clinician who has no voice in the office, and is barely considered a team member by outside agencies. Most institutions are not even aware that you can satisfy PHI via phone HIPPA requirements with 3 identifying items; others like the VA know, but DGAF and believe in CYA above all else - especially above pt care. HH agency management need to band together to demand regulation of communication; trading referrals with other agencies by geography also seems like an obvious way to increase staff's efficiency but god forbid you tip off another agency to YOUR referral source. The intrinsic motivations of privately owned health care is criminally harmful to patients and damages the efficacy of home health by one or two orders of magnitude.

You'd think in the current labor market management would start GAF about retaining staff but all they think about is the $$ you'll get them for the next signed visit note. That money, BTW is 4-5x more than what I see on my pay check; seems like they could start paying us hourly for visits that exceed a certain time due to customer service or indicated interventions. Did you know that HH clinicians are NOT exempt employees? there is case law finding that even if your pt care is paid per visit, you still qualify for OT at your hourly office rate (x1.5). The argument that we are exempt comes from the idea that as educated professionals we should be able to control the time spent working and so should not be paid for our time. I have never met a home health nurse who felt like they had much control over the time spend accomplishing the goals that medicare guidelines require. HOWEVER, I have worked with plenty of people who "manage" their time by fabricating documentation, not educating patients, & handing off time consuming interventions to co-workers. On multiple occasions I have had these frauds held up to me by management as paradigms of excellent nurses who can see up to 10 pts a day and why can't I take on the same case load? But when I cover for these nurses, their patients are completely ignorant of their POC. I can't count the times I have been asked to DC a patient for another nurse, and instead need to basically do a SOC and start their POC from the beginning because it seems that nothing but weekly VS and billable signatures have been done after weeks of care.