a flabbergasted nurse

FB Thread Re Pet Peeve

What is your biggest ”pet peeve” with home health today? No agency names please. I am writing a blog/podcast potentially.

  1. Patients wanting visits after 1pm but also don’t want a visit the same day as another discipline
    *Another discipline scheduling when I have gone xy day/time for the past month. Thankfully my current team usually doesn’t have an issue with this
    Kayla Termeer the “11am to 2pm window but not during lunch” and the “I don’t like morning visits can you come at 3 or 4 pm” people kill me.
  1. Unrealistic productivity demands in rural territories.
    No productivity consideration for mandatory meetings lasting over an hour
    Patients who agree to address bathing at IE then when the COTA goes in they repeatedly refuse
    Getting “in trouble” for poor outcome measures when patients are non complaint
    I think that’s enough
  1. Communication, communication, communication!
    Unrealistic productivity numbers with very large territories.
    Lack of appropriate staffing to effectively cover visits and provide proper care.
  1. Management not understanding that to be a good therapist, my visit is going to be hands on with focus on the patient and not with my face in the computer. As a result, I need to spend time outside of visit finishing my documentation and feel we should be given extra comp for this and calls made to doctors.
  2. Scheduling; unsecured pets; safety – Do you have a scheduler? Yes but to work around preferences, other appointments and other disciplines, like working a puzzle every day
  3. PPV model, but expecting calls/emails/texts to be done outside of visits. I could rant on this topic for daaaaaays.
    100% this. PPV but yet you have outside of the visit/ note itself – scheduling, family communication, reports for doctors or for the company if they have a medication non compliance or fall. Unpaid. I don’t mind doing them I know it’s part of being a good clinician to make sure all this is taken care of. It would just be nice to get paid without continually asking for compensation or change of way with the company. Most times the answer is no basically (I’ll pass that on to the higher up’s)
  1. Lack of insurance coverage of DME/AE
  2. Scheduling on the patients part. I can easily get mine done, but for example: I say I can come at x time but the patient has all these restrictions ie: only come between 1-2 . Hope that makes sense.
  3. Cockroaches 🪳 not my biggest pet peeve but it’s one of them
  4. No raises. Poor or no benefits. Lots of unpaid time. Paperwork. Every little extra thing adds up and takes away from treatment time, unless you’re me and it just takes away from my personal life.
  5. Utilization management – is this about number of visits allowed? – Yes, 100%. Bane of my existence currently. yes. I get 1x per week regardless of pt need.n report the company – MyNexus is the worst, although Humana is rolling out their own UM department. Eventually all payors will follow suit. It’s especially hard on OT and HHA use at the moment. I haven’t heard of MyNexus but I despise Humana and have since my first SNU days. MyNexus is a utilization management company working with commercial advantage plans. They are gatekeepers with the sole purpose of saving the insurance companies money.
  6. The significant amount of work you do that you technically aren’t getting paid to do when you are paid per visit such as scheduling , documentation, emails , calling MD goes on
  7. Scheduling, being asked to cover an area thats the opposite direction of my designated area, last minute “can you take this person and see them twice”, having to pay for materials out of pocket
  9. To build upon Colleen’s point, I’m the sole SLP in my company which means I do all evaluations, treatments and reassessments. I have no assistant. PTs and OTs only do evaluations and reassessments. Treatments are paid at reduced rates- only .9 point per visits. This means that while I may have the same number of “points” per week as an OT/PT in my company I have to do 25%-30% more visits to achieve that number bc of the reduced point value of regular treatments. I work harder to make the same or less money. interesting, I’d like that system.Paid same amount for routine/reassessments seems unfair, reassessment definitely takes longer than routine. – routines are paid .9 points. Reassessment 1 point and evals 1.25. It’s a terrible system if you have to do your own routines which you obviously aren’t.- in my current system I have option to do routines, but I choose to pass many to a PTA because she is AWESOME and I want to support that.So, she actually makes more than me I’d guess cause she can do so many routine visit. When I have a day with only routines it feels very manageable and often done by 6pm. – that’s terrible that visits aren’t even 1 productivity 👎
  10. The driving. I covered 50+ cuties in HH.
  1. “He’s very friendly” dogs that want my throat
  1. Seeing nurse hourly rates skyrocket while our wages remain stagnant in the most dangerous setting
  1. The people writing the documentation systems! They sit at a desk ok all day and likely have never been in a real visit.
    Most are nursing focused and include so much outside of our scope – i left home health because my supervisor was a nurse and was trying to make me see or keep people on caseload when they were not appropriate for home health therapy anymore. Then I was the only PT for a 900 square mile radius and was questioned why I wasn’t seeing people more often. It was ineffective therapy and I felt ethically pressured so I left
  1. Unpaid time like scheduling patients, calling in SOC for each eval and calling doctors. Requesting accurate frequencies (like 2x per week for someone with dysphagia and speech difficulty from parkinson’s) and only getting 1x per week regardless of need. Not being able to complete documentation during visit if I want to actually have a face to face visit with my patient.
  2. My biggest pet peeve- poor communication followed by poor communication. Did I mention- poor communication? HA!!!
  3. Just accepted my first HH per diem position and nervous with a wee bit of anxiety reading all these haha – still better than the unethical 90+% productivity rate they want at a SNF or outpatient wanting you to bill 4005 units a day, or literally breaking your body down in acute care 🤣 I will still take these complaints (all of which I agree with) over another setting. At least you have some time in your car alone. 🤷‍♀️-don’t be! I am PRN w 3 companies, after 11 years as a rehab director in a SNF. HH is still the best to go… and some of these concerns they’re having don’t really affect a PRN person. In my opinion.- I just dropped from full time to PRN, it drastically affected my work life balance in a positive way. Good luck!- even though we have complaints, home health is BY FAR my favorite practice area.
  4. Scheduling
  5. Documentation time!
  6. Unpaid work. Documentation. Smokers. Pets. Patient getting sent to the hospital and Noone telling me.
  7. Scheduling – Companies trying to mandate therapy visits on an algorithm this is interesting. What is the algorithm generally causing? – 8 shared visits for all disciplines or worse ☠️☠️😵‍💫 we don’t “have to follow it” but we get asked why repeatedly when we are over the “model” which is based on diagnosis, functional scoring of oasis and hospital risk among other things… – does you agency utilize a company that analyzes data to get to this model? – my company does and they want you to change answers per their algorithm stating oasis is only data collection but I continue to tell them it’s data collection based on assessment and observation and I won’t change answers if it’s not accurate as that is Fraud !!
  8. More and more paperwork, not flexible with time off, scheduling, productivity
  9. Nurses telling me how to do my job – and a scheduler who acts like you’re a child! – I was always sure to call them keyboard warriors and pencil pushers before I hung up then quit
  10. It is interesting that no one has mentioned dealing with agencies cutting visits or putting PT in first and then OT later as these subjects are constantly brought up on this page.- I am surprised as well. I thought that would be #1 issue. This is very informative. – that was going to be my answer! – that’s such a problem where I work. Limited visits!! Our patients are upset, they need more visits. And we’re not even making productivity. It’s hurting us and them alike- just commented this prior to me seeing your comment. What you said is definitely a huge issue in home health.
  11. The inability to compete with wages by large hospital based agencies
  12. Needing to make calls to doctors offices and knowing darned well that those doctors could not care less/don’t want those calls.- does the agency tell you why you have to do this? -we were told it was a Medicare rule at one company- that it was to be a phone call, another company allows faxing 🤦🏼‍♀️🤷🏼‍♀️- I have fax on my Phone. It’s the only Way – It is a requirement that you “notify” the physician. Fax works.
  1. Experience doesn’t matter. Same pay rate from new grad to 20 years in the field.
  2. Tolerating and encouraging fraud. Letting patients mistreat therapist so they can continue to be reimbursed. Poor patient care.
  3. Scheduling
  4. Invite Medicare to listen
    HHC eating into all aspect of your life it goes with you wherever when ever you go. There is a always some one text, calling , emailing you. There is always late Documentation. Scheduling around doctor appointments, other disciplines, patient’s sleeping and shows schedule!
  1. Agencies mandating number of visits prior to initial evaluation or worse, After IE, writing care plan for 2w4 and getting approval for 1w2, 2w1. Then being told to change the IE. Zero regard for patient need or clinical decision making.
  2. Scheduling/unpaid work. I’m home health private peds. Parents constantly texting/calling me at all hours with high expectations.
  3. The nature of the job is hard having to supply my own materials/assessments, but I understand that. I just wish my company could employ some type of virtual assistant/scheduler who could handle a bulk of the scheduling.
  4. NO SHOWS.
  5. Scheduling and lack of accountability, placing more office work on field employees rather than the ones that have access to office things.
  6. Scheduling, communication with scheduling, management controlling allowed visits and changing allowed visits based off a model instead of what the patient actually needs, difficulty getting AD/DME, PTO, and trying to get a hold of doctors. 😬
  7. How everyone wants afternoon visits🙄 And apparently we can’t get paid milage on our way to our first patient and after we’re done with our last patient, so if they are out of town, I don’t get reimbursed miles for that!
  8. 1-Limiting visits on pts !!!
    Especially when they need multidisciplinary approach so obviously patient is more involved therefore needs more visits!!!
    2- trying to change answers on oasis to state it’s only data collection but it’s data collection based on assessment
    3- too much documentation
  1. Houses without visible numbers. OT being treated like red headed step children
  2. The “recommended” therapy visits with the therapy utilization guide. It’s gotten better, but my evaluation and judgement is far more accurate than a computer analysis from SOC by a non therapist
  3. Documentation 100%. I don’t have a paid per Visit model. We are paid per minute and even getting paid to do my documentation it’s still the worst part of the job.
  4. Lack of communication between discipline and as a COTA…Occupational Therapy seems like we aren’t valued as much as PT or nursing and OT only gets a few visits because of the payment model for reimbursement.