Do You Utilize Clinical Staff To Full Potential? Home Health Aides Can’t Be In The Shadow In PDGM. Position Yourself For Your Future Success!
Kenyon HomeCare Consulting • March 16, 2021
Today, every home health agency is trying to position themselves for success in PDGM. However, one huge missing piece of the puzzle in patient care is the home health aide. As you move forward into big payment reform, make sure you realize outcomes and cost of patient care can greatly improve with proper utilization of your aides. Let’s look at how many agencies see the home health aides now and how we need to transition them as an integral part of a coordinated care.
Our “Bath Aides” Today:
The biggest mistake in the industry is to label your home health aides “bath aides”. When a care plan is developed, it is developed around personal care and bathing, so some clinicians minimize the capability of the aide. Many agencies hire only CNAs. This means we need to see the home health aide as a certified nursing assistant. This means allowing them to work completely within scope of practice and not just doing the bath. Depending upon the state, some aides are allowed to do dressing changes and draw up insulin. Now, this means the agencies need training programs in place and must determine competency of staff completing these tasks. You may feel that not every aide on staff is suited for certain tasks and this is fine. However, in a PDGM world, you will have a difficult time surviving if you do not utilize every discipline to fullest potential within scope of practice. Let’s look at what full potential for your home health aide looks like in PDGM.
PDGM and Aide Utilization:
Our aides always need to have chronic disease at the forefront of care. Considering the majority of the patient population is dealing with chronic disease, every aide needs ongoing education regarding chronic disease care. If you can work with the aides to take a blood pressure, monitor swelling, and weights on a CHF patient, then why wouldn’t you have them do it? If they have been educated and competency is met, then have them understand why these items need addressed every visit and reported on to the nurse. This also includes consideration in the rehab process. SNFs have long recognized the use and value of restorative aides and programs within the facility. Why don’t we use the aide as part of these processes in the home? ROM or assistance with exercises is so often a part of the patient care plan, but most agencies don’t have the aide complete additional ambulation or home exercises with the patient. We teach family members and neighbors to provide skilled care, so why are you having the aides do it?
In PDGM, an aide should get a plan of care with report from the nurse as to specifics of care. This means talking about specifics related to chronic disease, personal care, and therapy focus. The aides should know what specific goals are listed in the care plan. The aide should have care goals related to advancing the patient to independence with personal care and also what specifics need reported as part of routine visits. This way, the aide is engaged in what all the disciplines are working to complete. This promotes an ongoing circle of care that is continually client-focused. This allows the nurse and therapy staff to be plugged into additional data about the patient when they aren’t present in the home. Don’t minimize the role these staffers can play in positive patient outcomes. Remember that they know more about that patient and spend more time with them than all the other disciplines.
Moving Into Aide Utilization Is A Process:
At Kenyon Homecare Consulting, we recognize that a paradigm shift with clinical staff takes time. It also takes education to staff to understand the change. We can help you with the chronic disease education for staff and agencies. We can also assist with on-site training with staff as you transition to client centered coordinated care planning. Call us today at 206-721-5091 or contact us online to see how we can help you with success in PDGM.
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Today, this article will look at little different than out typical articles. We all know the costs of losing employees and trying to hire and train new ones. It is exhausting and expensive. So, we think about our wages and benefit packages all the time. What can we do differently that makes people stay? We can’t change the job and we don’t want to keep people that don’t like the work itself. So, how do we acknowledge employees in a way that is valuable to them and that our businesses can afford to do? 5 Things To Consider About Employee Recognition At Your Christmas Party: 1. Years of Service: These can be based on milestone work anniversaries (5, 10, 15 yrs, etc.). If a person has been at your agency 11 years, you pull them up and acknowledge them in the group of employees who have been there at least 10 years up until the time they hit the 15 years landmark. This way longevity is recognized yearly. 2. Special Employee awards: Now, this may be difficult if your staff is very small, but acknowledge the employee who has gone the extra mile in the job they do. Tell the story. The employee needs to know when the employer is proud of the work that has been done. Consider a plaque or certificate. Don’t minimize the value of the employee having them to display. 3. Acknowledge all employees in the mix: Because we are a clinical industry, the administrative staff is often overlooked on day-to-day operations. Ultimately, don’t miss the chance to acknowledge the employee who was able to catch billing errors or collect on a large account. Staff doesn’t like to hear about money, but those types of collections keep Christmas bonuses in place! So, make sure the other staff knows the accomplishments of the finance department or the office manager that every caller loves to speak to. Don't ever forget the IT staff that is on call more than any clinical person in your agency! 4. Letters from the administration: Add a personal note to your staff either collectively or individually depending on the size of your agency. If you are larger, there are employees you don’t often see or get to talk to on a regular basis, so take the time so send a note with that Christmas bonus. 5. Consider the Christmas bonus: Listen, some of you can afford to do substantial monetary bonuses and that is fantastic. However, if you are not in that position, consider something in its place. Maybe small gas cards go with the letter from administration. With the cost of groceries, consider something that helps with the costs of daily living for employees. Big box gift cards in your area will always be used. You may do a lot of these things on a yearly basis to employees. All this being said, it doesn’t mean there aren’t reasons for acknowledgement throughout the year. However, your annual Christmas party is a good way to do it collectively. Between your annual party, write the individual cards to employees when you hear a patient interaction worthy of praise. Or, maybe you buy a gas card for the employee who has picked up extra shifts and always shows up on time. Ultimately, employees will feel valued. You will not regret the time, effort, and energy put into these efforts. Merry Christmas! If you want help with recruitment and retention strategies for your agency, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online today.
When you think in practical terms, what does your ICD 10 coding mean to the clinicians in your agency? It probably isn't as important as you would like. Realistically, your nursing staff cares about hands on patient care. If you want the code itself to be more meaningful, then you need to attach the concepts of patient care to the ICD coding. You may think the code itself goes hand-in-hand with the care, but this is not always true. As a clinician, there are concepts within the nursing care plan that are automatic and some that are instinctual based upon the body system causing the need for care. It's a given that medication, diet, and disease process teaching are going to be in the care plan (or should be). When you get to disease process, our experience shows the clinician doesn't always run deep into the specifics of the disease when it could lead to valuable interventions being included in care. For example, when clinicians do a care plan related to cardiac disease, are the interventions very broad to include all things related to any type of cardiac disease? If you have a patient with right sided heart failure versus left sided heart failure, how many nurses would assess the patient differently? Would your nurses change the frame of mind to look for distended neck veins or anorexia and nausea if the patient had right sided failure? Would they be in the head space of considering whether the patient's appetite changes are more about just having been in the hospital than about potential venous stasis in the abdomen? The point is that although there are certain interventions that would be the same regardless the type of heart failure, picking up on different symptoms and critically thinking through the cause is often missing in the hustle and bustle of the day-to-day. This is not a judgment on the capabilities of the nurses but more about how our nurses are trained to consider care planning and assessment. We have people for ICD 10 coding now. Most nurses are not in the ICD coding manual looking up their own codes anymore because of the specificity that wasn't the same 25 years ago. So, the nurses go out with an H&P from the hospital or doctors office and develop a care plan. It isn't necessarily with the coding in mind. So, we need to get back to basics when it comes to coding and clinical care. We need to train out staff to look harder at the coding. Our coding departments need to have open communication with clinicians and understand the concepts of care planning to understand if things are missing in the care plans. What about your clinical manager's role? Are these things considered when reviewing care plans? What about your record review process? Are your ICD 10 coders nurses that understand care planning and is it part of the coding process to review the care plan? These are things to consider when you look at your clinical practice as well as your coding solution. At Kenyon Homecare Consulting , we have a comprehensive ICD 10 coding department that can provide education to clinicians, accurate ICD 10 coding, care plan and Oasis review. Call us at 206-721-5091 or contact us online to see if we can help you merge the code with the clinical practice in a way to improve your outcomes and your bottom line. We will offer 5 free recodes to any agency that would like us to check the efficacy of their current coding system or talk about becoming your coding solution.