Use of HH Aides

[wonderbee, BSN, RN]

We often run across situations where an aide would be appropriate for hygiene. We don't employ them (medicare doesn't reimburse for them... not a skilled need) and have to borrow them from our sister hospice agency so we don't use them unless there is an absolutely glaring need. Is this common practice?

[cookie102]

i am not understanding,,,, i have always worked where a home health aide was a covered service under medicare as long as the patient had a skill need (SN, PT, OT)

[wonderbee, BSN, RN]

Maybe I am the one who is not understanding. I would like to hear from others on this. Either medicare covers the service or it doesn't and if I'm being told it doesn't and it does, I want to know. Our use of HH aides is very sporifice and upsets clients who are promised this kind of care by the facilities who refer them. Sometimes the RNs are sent in to do the job... buff and puff. Not fair to the patients or to us.

[NRSKarenRN, BSN, RN]

prior 484.36 condition of participation: home health aide services

2008: chapter 7 - home health services [pdf, 426 kb]

50.2 + 50.7 medicare benefit policy manual

[annaedRN, RN]

We use them if we need them, and if I am not sure I can order an OT eval. It's included in part of the lump sum for the episode that Medicare pays us. If having a HHA helps to keeps them independent at home then the HHA is there. If the need continues when the need for SN/PT/OT is over then we refer to Office of Aging to get HHA from community providers.

[wonderbee, BSN, RN]

Thank you everyone. I have a better understanding of the situation. I'm still fairly new to HH being just 6 months in this month. Ours is a struggling start up agency so employment of an aide is an area where they choose to cut corners.

[jnette, ASN, EMT-I]

hmmm...all our patients have HHAs if they want one. Interesting.

Most definately covered by MCR.

Are they cutting corners due to lack of HHA staff ?

[NRSKarenRN, BSN, RN]

Had to dig through New Medicare combined manuals for regulations, added to above post.

Home Health Aide is a covered "dependent" service, meaning patient must have SN or PT as primary service to be covered. Services need to include hands on personal care at each visit.

Since "OASIS" er nursing staff wants to see an improvement in patients function by discharge, my agency also request OT order from PCP whenever HHA needed to help improve patients bathing functional ability (if possible) and OASIS functional scores

:w00t:Never realized dollar store plastic salad or meat tongs could be used as stocking helper or bathing aid to extend reach till OT taught me that trick.

[caliotter3]

Although I've worked for agencies that provide aides for home care clients, I've only run into one on one case. It was an insurance case. Each of my agencies, when the subject was brought up, spoke about the use of aides as if it were an accepted practice and I know they would never provide a service not covered by the appropriate payor. Most of the time since there are full time licensed staff in the home for X number of hours per day, the licensed nurse does the ADL tasks as part of their assigned duties. I'm sure this is the reason more aides are not on these cases. Too much expense to have two personnel in the home doing overlapping duties when one can handle it all during an 8 hour shift.

[wonderbee, BSN, RN]

The agency in the OP is struggling for every dollar. An aide is considered a luxury. I think you have to spend money to make money. Clients are often in need of ADL assistance for bathing. I can think of a lot of patients who had that needed service withheld from them because they came to our agency. Word gets around and people talk.