Deleted
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Post by Deleted on Jun 23, 2019 19:11:31 GMT -5
As most of you know, my husband was released from the hospital last Tuesday. He is doing great at getting around the house independently, etc. He does use his walker and cane, and he doesn't try to do things like stairs. But it is startling how well he is doing. He is pretty much independent. What he was hospitalized for was an internal bleed that they couldn't find a source for. That's happened before. I will add that he is on home oxygen, which is a change from before. That is a separate company from the Home Health Care services I will mention below.
One of the "conditions" of his release is home health care services to help him get stronger. On Thursday we had a visit from the person setting all this up. On Friday we had a visit from two therapists (occupational and physical) plus the nurse. Because of a misunderstanding, they all showed up pretty much at the same time. Well, actually the therapists planned to show up at the same time since their initial assessment overlapped.
So the nurse just called and he wants to come out tomorrow, Monday. Remember he was here Friday. I don't see the point because DH has two doctor visits this week already. .
I'm just not understanding what the nurse is adding to the equation other than costing the insurance company.
We already have visits scheduled with the therapists for next week. They backed off 2X a week because of his previously scheduled appointments. The need for physical therapy to improve his strength and balance we understand.
Does anyone have any experience with home health care nurses?
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Sharon
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Post by Sharon on Jun 23, 2019 19:18:42 GMT -5
I am going to guess that the nurse is to make sure that the therapies are working, that your DH is improving, etc. They may also monitor medications and make sure that they are being taken properly, prescriptions filled etc.
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Post by Deleted on Jun 23, 2019 19:39:58 GMT -5
I am going to guess that the nurse is to make sure that the therapies are working, that your DH is improving, etc. They may also monitor medications and make sure that they are being taken properly, prescriptions filled etc. No, he is doing none of that with the meds. That might be a useful service for a senior living alone, but it would involve a lot more than a weekly visit. I have taken over the medication aspect, and DH is fine with it. The nurse is "simply"monitoring his vital signs. That is it. If DH wasn't already scheduled for four doctors' visits in the next two weeks (!), I could see why that would be useful. But with two doctors' visits next week, we don't see the purpose. We have a blood pressure machine and scale. We know the signs to look for. And it isn't like the guy is going to be back to monitor again until another week has passed. Also, the therapists would be the ones to assess whether the therapies are working, and they have already scheduled such an assessment at the end of the 8-weeks they are currently scheduled to be working with. They are also the ones who are going to work to get him off the oxygen therapy with breathing exercises.
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GRG a/k/a goldenrulegirl
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Post by GRG a/k/a goldenrulegirl on Jun 23, 2019 20:03:53 GMT -5
Caveat: I lean toward the cynical.
I suspect the insurance company is covering its butt. Your DH likely comes close to needing a stay in rehab, but it’s cheaper to send him home and have a visiting nurse keep an eye on him.
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Sharon
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Post by Sharon on Jun 23, 2019 20:16:57 GMT -5
Caveat: I lean toward the cynical. I suspect the insurance company is covering its butt. Your DH likely comes close to needing a stay in rehab, but it’s cheaper to send him home and have a visiting nurse keep an eye on him. It could also be the hospital, if a Medicare patient is readmitted within a certain time frame they will dinged by CMS on there medicare reimbursements. Do you know if it is the hospital or the insurance company that is requiring the nurse?
My Mom was readmitted last summer with the same issue within two weeks of the first occurrence. There were social workers questioning her living situation and was she taking her medication, could she afford her medication etc.
I work for a health insurance company, mostly as a quasi IT person, but I know they have an entire department that is dedicated to making sure people don't get readmitted and that they are doing what they are supposed to at home. They said it is cheaper in the long run.
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adela76
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Post by adela76 on Jun 23, 2019 20:21:01 GMT -5
I certainly have a healthy degree of skepticism and mistrust of the health care system. But in this case, I wouldn't say that the home health company or nurse are deliberately taking advantage of you. I also think you're right, and that perhaps you don't need the nurse to visit again on Monday. But remember that the home health care company probably has a standard care regimen that prescribes X number of Y visits in Z interval. There's probably some tweaking due to condition and severity. But they probably haven't taken into account your personal circumstances, your level of involvement in your husband's care, and your husband's appt schedule next week. So, perhaps you are getting the same home health schedule that an 85-year-old living alone would get if he were discharged for a similar reason. A key goal of the home health agency (and your insurance company) is to prevent your husband from getting re-admitted because his condition worsens. It's much cheaper to pay for a few (hundred) visits by a home health nurse than a re-hospitalization. And there's probably a liability component too (if his condition does worsen can the home health agency be at fault for failing to catch it?). Personally, I would allow the nurse to come and see how things go for a few weeks, before talking to the agency about scaling back the nurse visits.
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CCL
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Post by CCL on Jun 23, 2019 20:59:53 GMT -5
Caveat: I lean toward the cynical. I suspect the insurance company is covering its butt. Your DH likely comes close to needing a stay in rehab, but it’s cheaper to send him home and have a visiting nurse keep an eye on him. It could also be the hospital, if a Medicare patient is readmitted within a certain time frame they will dinged by CMS on there medicare reimbursements. Do you know if it is the hospital or the insurance company that is requiring the nurse?
My Mom was readmitted last summer with the same issue within two weeks of the first occurrence. There were social workers questioning her living situation and was she taking her medication, could she afford her medication etc.
I work for a health insurance company, mostly as a quasi IT person, but I know they have an entire department that is dedicated to making sure people don't get readmitted and that they are doing what they are supposed to at home. They said it is cheaper in the long run.
Here's some info from Medicare: www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.htmlIIRC the diagnoses affecting this are acute myocardial infarction, heart failure, coronary artery bypass graft (CABG) surgery, pneumonia, acute exacerbation of chronic obstructive pulmonary disease and elective total hip arthroplasty and total knee arthroplasty.
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wvugurl26
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Post by wvugurl26 on Jun 23, 2019 21:14:49 GMT -5
If it's covered under Medicare, I'm pretty sure at least weekly skilled nursing visits are required. I know nursing visit notes are one of the big things we look for in the medical record when doing audits of home health agencies.
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Post by The Walk of the Penguin Mich on Jun 23, 2019 21:58:36 GMT -5
When I was infected, I had weekly (or whenever necessary) home health nurse show up, along with PT 3x weekly. The home health nurse assesses the conditions and see a bit more than a 15 min doctor visit.
In my case, she did my PICC line dressing, drew blood, made sure that PT was doing what they were supposed to do, kept an eye on my incision, made sure I was eating well, and I suspect checking to see if I complied with my infusion schedule and assessing my mental health.
I think I had 3-4 visits that first, then it was weekly. In reality, I thought she was a great resource.
ETA: I was not under Medicare, but private insurance.
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Deleted
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Post by Deleted on Jun 23, 2019 23:03:49 GMT -5
I should have mentioned that the nurse upset and confused my husband, who has some cognitive problems, by telling him what "we" will be doing to address his cardiac problems. DH bluntly told him that he had two cardiologists plus the heart valve team. He trusted their advice, not the nurse's. Had the nurse kept it general, it might have been ok.
Anyway, DH is refusing the nurse's services at this point. I tried to make it clear, however, to both the therapists and nurse that they needed to hear that from me, not DH. I have medical power of attorney. The nurse will not visit this week per DH's wishes. We will discuss it again after he visits his primary care doctor this week.
You guys are right. It is probably tied to Medicare.
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TheHaitian
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Post by TheHaitian on Jun 24, 2019 6:02:51 GMT -5
I should have mentioned that the nurse upset and confused my husband, who has some cognitive problems, by telling him what "we" will be doing to address his cardiac problems. DH bluntly told him that he had two cardiologists plus the heart valve team. He trusted their advice, not the nurse's. Had the nurse kept it general, it might have been ok. Sorry to break it to your husband , and maybe because I am the son of a nurse, I would trust my care to a nurse 100 times before I trust it to just the Dr. You spend more time with your nurse and they monitor your progress closely (good or bad), including vitals, more likely to inform the “Dr” if something is wrong or not. Don’t discount the help of a nurse and please don’t piss off the nurse. Believe me they don’t want to be in your house anymore than you want them too, but they have a job to do.
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ners
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Post by ners on Jun 24, 2019 6:04:15 GMT -5
Hugs @bamafan1954.
I totally understand not wanting the nurse to come since you will be following up with doctors this week. That being said the nurse may catch a small issue before it becomes a bigger issue.
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azucena
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Post by azucena on Jun 24, 2019 6:29:08 GMT -5
SS - a good nurse coming in 1-2 times per week is likely to notice more subtle changes in your husband (good and bad) than you do because you're seeing him every day and you're also too close to the situation.
You might also be surprised by how many questions you have come up so having a nurse check in will be handy and give you quicker answers than calling the doctor.
Plus, the nurse is on your team so you'll have the mental advantage of not caring for DH alone which is huge.
- spoken as someone whose husband had home health care during our 20s
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NoNamePerson
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Post by NoNamePerson on Jun 24, 2019 7:47:30 GMT -5
Just tell them you don't want them to come and don't answer the door if they show up
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hoops902
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Post by hoops902 on Jun 24, 2019 8:52:57 GMT -5
It's probably a Medicare requirement...it's also probably a good idea. So your nurse is schedule for Monday, but it seems unnecessary because there are 2 doctor visits scheduled later in the week. Doctors visits can be cancelled, postponed, moved, etc for all sorts of reasons completely beyond your control. Imagine the problems if a hard requirement is a weekly reading of vitals and now it's Thursday afternoon and the doctors cancel or postpone the appointments. If you're on the nurse's schedule, it's completely possible that's the only time during the week the schedule fit.
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Post by empress of self-improvement on Jun 24, 2019 9:08:16 GMT -5
It's an insurance thing. DH had a nurse for about two weeks after his release for vertigo two years ago. Of course, he wasn't enthusiastic about it but sucked it up. She was really cool and answered his questions. Stupid as they may have been. He's going to be going on Medicare so it should be interesting to see what the future brings.
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Deleted
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Post by Deleted on Jun 24, 2019 9:21:50 GMT -5
We have had home health care nurses before when DH had blood poisoning. They were a necessity. We understood their function, which was to take blood each week and check his pic line.
This guy pissed DH off. He has way too many "degrees" for a nurse with only one of them being in nursing. The others are in hospital management, Alzheimer's patient management, etc. And yet for someone who claimed a degree in Alzheimer's patient management, he confused and upset DH with his assertions of what he would be doing to manage DH's cardiology problems.
I'm not worried about pissing the nurse off. If he is a professional, he is not supposed to allow himself to be pissed off. He's worked with difficult patients before, no doubt.
Anyway, the nurse can come the next week, and we can perhaps settle into a schedule and routine that won't upset DH so much. All three services (occupational therapy, physical therapy, and the nurse) swarming on DH at once was a little overwhelming and confusing. I won't let them do that to him again.
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TheOtherMe
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Post by TheOtherMe on Jun 24, 2019 9:23:31 GMT -5
There is the issue of Medicare penalizing hospitals if the patient is readmitted within a certain amount of time. I think Medicare doesn't reimburse and hospital has to eat the cost.
If the patient is non-compliant, wonder who pays then? It won't be Medicare.
Explain to the nurse what is upsetting DH. I will also echo the advice of don't piss off the nurse. Not a good idea at all.
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Wisconsin Beth
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Post by Wisconsin Beth on Jun 24, 2019 10:28:46 GMT -5
My Dad had the Unit Secretary (that's what her badge said and how she introduced herself) and asked some questions. I grasped maybe a third of it but Mom was following along. Basically, Mom took Dad to the ER 2 weeks ago for breathing issues. He had pneumonia. She called 911 Sunday morning and he was transported to the ER/Trauma at the same hospital with worse breathing issues (but no pneumonia this time) but they want to cover their butts.
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Works4me
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Post by Works4me on Jun 24, 2019 16:14:45 GMT -5
Would your husband deal better with a female nurse? Many men, especially those in his age bracket deal beter with women as nurses. They grew up and then lived in a time when women were nurses and men were doctors or orderlies who provided muscle.
It sounds like this guy was too assertive and overly impressed with his own degrees and credentials. Call your home health agency, say that your DH did not "click " with this nurse and ask for a different nurse, a female if possible. The right nurse can be an invaluable asset and as you have seen the wrong nurse can blow it all apart.
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Deleted
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Post by Deleted on Jun 24, 2019 17:21:34 GMT -5
Would your husband deal better with a female nurse? Many men, especially those in his age bracket deal beter with women as nurses. They grew up and then lived in a time when women were nurses and men were doctors or orderlies who provided muscle. It sounds like this guy was too assertive and overly impressed with his own degrees and credentials. Call your home health agency, say that your DH did not "click " with this nurse and ask for a different nurse, a female if possible. The right nurse can be an invaluable asset and as you have seen the wrong nurse can blow it all apart. Great advice! I do think it is a personality conflict as much as anything else.
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