Home Health Flashcards
Where do we get referrals for home health
- Physician
- Hospital
- SNF
- ALF
- TLF
Three key areas mus be addressed prior to discharge
- Medication reconciliation
- Structured discharge communication
- Patient education
Medication reconciliation
- the patient’s medications must be cross-checked to ensure that no chronic medications were stopped and to ensure teh safety of new prescriptions
structured discharge communication
-information on medication changes, pending tests and studies, and follow-up needs must be accurately and promptly communicated to outpatient physicians
Patient eductaion prior to diacharge
- Patients and their families must understand their diagnosis, their follow-up, and whom to contact with questions or problems after discharge
Face-to-face encounter
FTF encounter must be related to the primary reason for the home care admission. it is a requirement of payment
FTF enocunter must occur within the 90 days prior to the start of home health care,or within the 30 days after the start of care
- new condition that was not evident during a visit within 90 days prior to start of care, the certifying physician or NPP must see the pt within 30 days after admission
Who performs and Signs the FTF Encounter
- Certifying physician
- physician who cared for the patient on an acute or post-acute facility directly prior to being admitted to HH, and who had privileges at the facility
- qualified non-physician practitioner working in conjunction with the certifying physician
Criteria 1 for qualifying for homebound status
the beneficiary must either:
- because of illness or injury,need the aid of support devices such as crutches,canes, WC and walkers; the use of special transportation;or the assistance of another person in order to leave their place of residence
- have a condition such that leaving his or her home is medically contraindicated
Criteria 2 for qualifying for homebound status
- there must exist a normal inability to leave home;
- leaving home must require a considerable and taxing effort
Qualify for homebound status
- the patient may be considered homebound if the absences from the home are infrequent or for periods of relative short duration or are for the need to receive health care tx
ex: adult care centers, religious services, ongoing outpatient kidney dialysis or outpatient chemo or radiation therapy
Eligibility for Therapy
To be eligible:
- your condition must be expected to improve in a reasonable and generally predictable period of time
- you need a skilled therapist to safely and effectively make a maintenance program for your condition
- you need a skilled therapist to safely and effectively do maintenance therapy for your condition.The home health agency caring for you is approved by Medicare (Medicare certified).
- You must be homebound, and a doctor must certify that you’re homebound.
- You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.
OASIS Outcome and Assessment Information Set
Head to Toe assessment of all systems. Diagnosis specific and Co-Morbidities Functional measures Fall Risk assessment Re-Hospitalization Risk Home assessment Medications Financial, social and family support
Medication Reconciliation
EVERY VISIT
Rx
OTC
Misc: ointments, eye drops, CBD, holistics
Document: Name, dosage, quantity, frequency, route, any special instructions
Hospital → SNF → > 75% chance of medication discrepancy *
Geriatric Issues related to Pharmacology
Increased drug use
Altered response to drugs
Adverse drug reaction
Relationship between drug and function
Polypharmacy
Patient’s drug regime includes one or more unnecessary medications, more than just a number of drugs.
Wounds measure
Measure: CLOCK method on anatomical position of patient.
Length: 12-6 O’clock Width: 9-3 O’clock (in centimeters)
assess eahc visit
- must measure 1x/wk
- need orders for tx
Wounds documentation
Name type of wound and date of onset: Skin tear, burn, ulcer (pressure, arterial, venous stasis)
Stage Pressure Ulcers/Injuries I. II. III. IV
Stage of healing:
Describe wound bed and surrounding tissue:
Drainage: what type and how much
Tunneling: measure if present
Undermining: measure if present
Odor: describe
Advanced Beneficiary Notice ABN
Designed to protect the beneficiary and the home health agency (HHA). It informs the beneficiary of an expectation that Medicare will not pay for the care, and allows them to make an informed decision about whether to continue care. An ABN must be given to the beneficiary when the care is physician-ordered and a Medicare denial is expected for one of the following statutory reasons:
Services not medically reasonable and necessary;
Services are for custodial care only;
Beneficiary is not homebound;
Beneficiary does not meet intermittent care requirements
There are three triggering events for which an ABN must be given:
Initiation of Services, when you determine at the start of care, that an item and/or services may not be covered by Medicare.
Reduction of Services, to inform the beneficiary of cessation of one discipline when another is continuing, or an unplanned decrease in number of visits provided.
Termination of Services, when the HHA determines the services may no longer be covered and the beneficiary asks to continue services.
Bag technique procedure
Select a healthcare bag that has at least 3 separate compartments, at least one of which should be lockable to secure patient records.
Designate two “clean” compartments, one for clean disposables and the other for patient records.
Pack the bag with necessary supplies before leaving for visits. Pack hand washing supplies near the top or in a side pocket where they are easily accessible.
Store the healthcare bag in a clean storage container or other separate compartment in your car.
Do not take the healthcare bag into infested homes or homes of patients with antibiotic resistant infections such as MRSA
Identify a clean and safe area for the healthcare bag. Never set the healthcare bag on the floor. Always choose a place to set the bag that gives you enough work space, is close to the patient, has a source of water, and is away from children and pets.
Plan where you will discard disposable items and sharps ahead of time.
Spread an impervious barrier on the surface before setting the bag down.
Remove hand washing supplies first. Wash and dry hands thoroughly, following proper hand washing technique.
Remove any items needed for patient care, including any necessary personal protective equipment.
Close the bag before performing patient care.
Wash your hands again if you need to re-enter the bag for additional supplies during patient care.
Only dispose of sharps in an approved sharps disposal container. The sharps container must be kept in a separate “dirty” compartment or a designated sharps container pouch. Never put used sharps directly in the bag.
Discard disposables in a sealed trash bag or biohazard bag. Follow local and state regulations for infectious waste disposal.
Bag soiled reusable items that cannot be cleaned in the patient’s home and transport them according to agency policy. Do not put these soiled items back into the healthcare bag.
Wash your hands, then repack and close the healthcare bag.
Clean and disinfect the healthcare bag weekly by hand washing in mild soap and warm water and air drying. Then spray both inside and outside with SaniZide Plus, and air dry again.
