Remember the good old days when we not only had to do the Medicare Home Health 485, but 30 days after the 485 we had to submit a Medicare Home Health 486? Oh joy, how we did not enjoy that!! In looking back at those times however, it occurs to me that perhaps the 486 was a better form — at least the physicians got more out of them. My personal physician complains to me every time we meet about how she finds no valuable information in the 485 and I have to agree, it doesn’t mean much to someone who doesn’t regularly work with them. It doesn’t mean much to anyone to be frank. What it has done is make the plan for care disjointed for home care staff and doctors alike. My biggest complaint is that many agencies use the 485 as the plan of care, and staff never prepares a plan that is all together. This causes considerable disconnect, especially for staff new to the industry.
My other concern is the lack of critical thinking that this form (and computers in general) has created for home health staff. It has created a “check box mentality.” Home Health Care is much more than checking the boxes. I guess I miss the old days when we actually prepared home care plans on a form that had the nursing diagnosis, the interventions, expected outcomes, who would be doing what, and the date of the expected outcomes. For a visual learner as I was, and 82% of nurses are, I was able to visualize the plan in one sweep across the page. It all fit together. It was also much easier to teach staff new to home health how to do care planning. It fit cognitively and required critical thinking to really individualize the care.
If I could redo the forms that we are required to fill out for Medicare, I would throw the 485 out completely. I would have a form that listed the working diagnosis and current medications in one, much like the top part of the current 485. That would be the physician’s form to sign verifying that the diagnosis and medications are correct. The actual plans of care would be developed by the individual clinicians according to their own discipline. Each discipline would be responsible for signing their own plans of care.
Physicians would get a narrative note at the end of each 60 days, updating them on their patient’s progress or lack thereof, and the clinician’s plans for the next 60 days. That would be meaningful to the physicians as members of the team, and make care more coordinated and clear for everyone working with the patient.