General question

WAGONER7052@YAHOO.COMWAGONER7052@YAHOO.COM
in Oasis General
Ok I need help from all of you .... This is not an oasis question. I am wondering if anyone has any advice/regs/ JCAHO documents something that states home care doesn't have to admit a non compliant, very high risk patient that is unsafe at home?
Mandy

Comments

  • sjmuhlenkamp@mercer-health.comsjmuhlenkamp@mercer-health.com
    edited April 2017
    Per COP 484.20
    Patients are accepted for treatment on the basis of a reasonable expectation
    that the patient's medical, nursing, and social needs can be met adequately
    by the agency in the patient's place of residence.

    Joint Commission PC.01.01.01 states that organization has a written process
    for accepting a patient that is based on its ability to provide the care,
    treatment, or services required by the patient. The organization has a
    written process for accepting a patient that includes the following:
    criteria to determine the patient's eligibility for care, treatment, or
    services AND procedures for accepting referrals.
    The organization accepts a patient for care when the patient's medical,
    nursing and social needs can be met in the patient's residence.

    So if you/agency feels that the client's needs will not be met (due to past
    noncompliance, very high risk---beyond scope of your care), then you do not
    have to admit. That being said, be careful of the "noncompliance"
    issue----is it really noncompliance or could it be lack of
    understanding/finances/inadequate support from caregivers---just to cover
    yourself in that arena. Also you should have policy which states all of
    this.

    That's my take on this situation :)
    Sharon
  • aidatacan2002@yahoo.comaidatacan2002@yahoo.com
    edited April 2017
    Sharon., you are correct., explore caregiver., state assistance/private/family., explore meds not compliant with and MD may change due to side effects patients don't like., ease of administering meds: insulin pen versus pre drawn insulin properly labeled and so forth., then you have to evaluate if this becomes a self neglect issue., contact state social worker/ md and request for a "well being check"., if I am missing something please let me know., actual case: referred to us as a third HHA., 76 yo alert/oriented., labeled non-compliant ., on Lasix and metformin., patient stopped Lasix due to urinary freq., but still urinates a lot. ., SN went in BS 400mgdl., so: DM meds changed., sugar decreased., Lasix restarted., edema came down ., sugar got controlled then - less urination., patient educated on freq urination with elevated BS and benefits of Lasix., patient compliant with medications ., discharged happy., MD happy
  • aidatacan2002@yahoo.comaidatacan2002@yahoo.com
    edited April 2017
    Different case., but I need help., patient with non-healing fungating mass to the left breast ., wound nurse on board., orders dressing changes 2-3 times a week., no competent caregiver to change the dressing., lives in assisted living fac. Patient is unable to change the simple dressing., hands are stiff and knarled with arthritis ., since this is non-healing., on and off bleeds ., MD agrees with dressing frequency., been with us for 2 episode., how do I discharge this patient? Or is this a long term Home health service to a patient., I called by telephone Keppro., QIO for Illinois and nurse said it is okay as wound dressing is a skilled need but I don't have a document to present in case this case gets audited for too long service., please advise ., thank you. Aida
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