Home Health

Question 1

Where do we get referrals for home health

Answer 1

• Physician
• Hospital
• SNF
• ALF
• TLF

Question 2

Three key areas mus be addressed prior to discharge

Answer 2

• Medication reconciliation
• Structured discharge communication
• Patient education

Question 3

Medication reconciliation

Answer 3

• the patient’s medications must be cross-checked to ensure that no chronic medications were stopped and to ensure teh safety of new prescriptions

Question 4

structured discharge communication

Answer 4

-information on medication changes, pending tests and studies, and follow-up needs must be accurately and promptly communicated to outpatient physicians

Question 5

Patient eductaion prior to diacharge

Answer 5

• Patients and their families must understand their diagnosis, their follow-up, and whom to contact with questions or problems after discharge

Question 6

Face-to-face encounter

Answer 6

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

Question 7

Who performs and Signs the FTF Encounter

Answer 7

• 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

Question 8

Criteria 1 for qualifying for homebound status

Answer 8

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

Question 9

Criteria 2 for qualifying for homebound status

Answer 9

• there must exist a normal inability to leave home;

- leaving home must require a considerable and taxing effort

Question 10

Qualify for homebound status

Answer 10

• 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

Question 11

Eligibility for Therapy

Answer 11

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.

Question 12

OASIS Outcome and Assessment Information Set

Answer 12

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

Question 13

Medication Reconciliation

Answer 13

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 *

Question 14

Geriatric Issues related to Pharmacology

Answer 14

Increased drug use
Altered response to drugs
Adverse drug reaction
Relationship between drug and function

Question 15

Polypharmacy

Answer 15

Patient’s drug regime includes one or more unnecessary medications, more than just a number of drugs.

Question 16

Wounds measure

Answer 16

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

Question 17

Wounds documentation

Answer 17

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

Question 18

Advanced Beneficiary Notice ABN

Answer 18

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

Question 19

There are three triggering events for which an ABN must be given:

Answer 19

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.

Question 20

Bag technique procedure

Answer 20

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.