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The Gap RN: Home Health Care's Failure.

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Rumble channel description: I've been a Home Health RN Case Manager for 12 years. I've switched jobs many time hoping to find an employer who is willing to pay Home Health clinicians to actually do the work mandated by CMS (the governing body of Medicare.) In one way Home Health works well: as a service that can save money and keep patients at home by providing periodic technical services. This is task based work and while it technically requires an RN, it is hard to justify the license protectionism used to require an RN for a job that only requires a short list of repetitive skills & minimal nursing assessment. Task based work is needed for about half of the patients followed by HH. For patients coming home with an IV (PICC/Midline really), that's fine, but what of the patient just returning home from the hospital after a heart attack with a new pile of pill bottles, a stack of illegible paper work, and no energy to adapt to their newly prescribed lifestyle? These people need Case Management. Home health regulation requires RNs to provide case management, which includes a wide range of tasks from clarifying MD communications, educating the patient/CG, modifying behavior, connecting resources & on & on. Case Management is 1. Time consuming. 2. Hard to measure and justify worker's need for higher pay. 3. Unpaid, easy to lie about and therefore often not provided. 4. vulnerable to a spectrum of time delays from waiting on hold with MD to educating patients who want to tell you stories about the grandkids. 5. LVNs can do tasks. Case Mgmt requires an RN with extensive medical knowledge, communication skill, etc. 6. Finally, if done correctly, Case Management can be the most valuable service HH clinicians provide, even in cases where we were referred for simple task work like wound care or IV mgmt; an LVN will change your bandage but an RN asks "why did you get the wound in the first place?" But, obviously, the old cliche holds true for labor and quality of care in HH: YOU GET WHAT YOU MEASURE. During an agency's every other year state survey, HH clinicians (only a few selected by management!) are tested on a few silly skills like "clean bag technique". Surveyors go on a few visit with clinicians and the sit down at a computer to assess our practice by reviewing our documentation. AND.... You get what you measure. HH Agencies have teams of QA auditors to review paperwork, maximize billable ICD-10 codes, and make sure the clinicians' paperwork LOOKS good for survey. You get what you measure. You can measure wounds, that an IV (PICC) dressing was changed weekly & foley cath monthly. You can easily read nursing documents to see the nurse CLAIMED to have taught CHF management and the pt/CG verbalized/demonstrated understanding; they WILL NOT look at time stamps and QA notes to discover this intervention only got documented after the note was returned for correction by QA. It would be costly for the state to follow a nurse for the management of a 60 day POC to see if they actually do what they document; why do intense, random in depth regulatory assessments that would produce a safe & effective Home Health Care industy, when you can check everyone on a predictabe schedule after giving them a cheat sheet? So. The tax payers get what CMS measures: a $129 Billion medicare funded HH industry that changes band-aids and produces terrific documentation. This system is failing so badly that CMS has started experimenting with austerity. They changed the payment structure to resemble No Child Left Behind. Agencies who perform poorly on CMS's chosen metrics get paid up to 3% less for the next year. These metrics are also used to assign a Star rating which referral sources can use to provide new business in the form of new patient referrals. But what are those CMS metrics? Do you want your mom going to a 5 star agency? Because You Get What You Measure and you'd be surprised what some of these measurements are. As a nurse I'm even more surprised how difficult it is to find any primary research referenced by CMS to justify these metrics or any of their regulations. I'm a nurse. You'd expect I could go on CMS.gov, a medical regulator, and find useful information. But there is little medical language at CMS.gov. The lexicon used is one of lawyers, business & accountants. On initial glance, most of the publications and public Q&A at CMS.gov involve figuring out who gets paid, licensing requirements, and what bureaucratic forms to fill out. Even the one good item I found, "State Operations Manual. Appendix D - Guide to Surveyors" contains pages of detail on computer network security (which should be handled by a third party!) and only the most abstract of descriptions akin to what you'd see in a job posting when mentioning Clinician's responsibilities and how HH is to care for their patients. You get what you measure; some metrics ensure quality pt care, while others gloss over the labor requirements implied by regulations to justify a pay structure that refuses to allow clinicians the time needed to do their job. Fraud is an open secret in HH. They won't say it out loud, but fraud is held up by management as the gold standard as demonstrated by their star nurse (the one billing 10 visits/day) to a poorly educated, over worked labor force who generally gets all their education about home health filtered through agency managers for whom profit is the only priority. There's A LOT of clinicians that are happy with this set up. They can get paid to do 10 visits/day, create fraudulent documentation and make $200K/year for making idle chit-chat with patients. I went into nursing because I thought it sounded like honest, fulfilling work for good pay. But the better I get at my job, the more time consuming it is, and since we are paid per visit, I find myself with a decade of experience and unable to support myself despite knowing the job better than most of my peers. We don't even get OT! We are (illegally in CA) classified as exempt employees because it is a skilled profession & we can supposedly use our judgement to reduce the demands on our time. But nurses use the Nursing Process: we are mandated to DO SOMETHING if we see a problem, and as your assessment skill increases, you see more problems. YouTube is full of HH nurses providing life hacks to streamline the HH work flow, but I have seen nothing that can turn the 60-80 hour FT caseload into a livable, ~40 hour work week. If we practice according to the law, we have little ability to control how long a job takes. The other YT videos are all titled "Why I quit HH in 6 months." In conclusion, there are 3 kinds of HH clinician: Ex, criminally negligent, and economically abused. The purpose of this channel is to explore in detail How and Why HH regulations are what they are as I go down a list of problems I've observed and seek documentation to justify the absurd. I hope to inspire other clinicians (and lawyers/accountants who can translate CMS.gov) to participate, ask questions I haven't thought of, and help fix an industry who's philosophy I love, but who's negligence and abuse I can no longer tolerate. - TheGapRN@proton.me

Health Care All Tips

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Health. Love. Hacks. Facts. Our mission is to create informative, videos about what matters most to you. Health Care All Tips loves to produce videos that offer relationship advice, tell you about the latest and greatest tips and hacks that will save you hours of work, give health advice that will keep you healthy and active, and create inspirational videos to help you succeed in life and in love. We love reading all your comments and discussions. We really want the Health Care All Tips Rumble channel to be a community of people who want to help each other. We want to be your Health Care All Tips and hope you enjoy our channel. :)

BABY CARE LOOK

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"Welcome to our nurturing haven for parents and caregivers on BABY CARE LOOK! Dive into a world of expert-guided baby care that caters to every infant's needs. From soothing lullabies to invaluable tips on feeding, diapering, and sleep routines, our channel is a trusted companion in your parenting journey. Discover delightful DIY baby crafts, learn about developmental milestones, and access evidence-based advice on health and safety. Join our supportive community, where we share heart warming stories, troubleshooting solutions, and the joy of watching your little ones flourish. Subscribe now for a wealth of resources and reassurance as you embrace the art of tender baby care."

health care tips and facts specially relationships and mental health to physical health.

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health care tips and facts specially relationships and relation of psychology to physical health. According to a psychological research 70-80% of our diseases are caused by mental disturbance and depression. An estimated 26% of Americans ages 18 and older -- about 1 in 4 adults -- suffers from a diagnosable mental disorder in a given year. You will get scientific ways about mental health support. So subscribe and stay connected..!

Gain the best Animals' knowledge to take care of your Pets in a good way 🐾.

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We provide interesting and educational content about pets and animals! Our channel is dedicated to sharing facts, tips, and knowledge about pets, and we are passionate about helping pet owners provide the best care for their furry friends. At BetterPetsLife, you'll find a wide range of videos that cover various topics related to pets and animals, including how to choose the right pet for your family, how to train your pet, how to keep your pet healthy, and much more. We also share interesting facts and stories about different animal species, and we explore the amazing world of wildlife through our informative and entertaining videos 🐾. Whether you're a seasoned pet owner or a new pet parent, our channel has something for everyone. So, come and join us on this exciting journey, and let's learn and explore the fascinating world of pets and animals together.

"RenewBuilt: Building Restoration, Design & Care"

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"Welcome to StructureSustain! Unveil the Art of Restoration, Building Excellence, and Sustainable Maintenance. We're dedicated to exploring the world of preserving, designing, and maintaining structures that stand the test of time. From historical landmarks to contemporary architectural marvels, our channel is a treasure trove of tips, techniques, and insights. Join us in celebrating the beauty of structures and the secrets to their enduring splendor."

Mastering Canine Care and Training: The Dogs Academy's Guide to Optimal Health and Obedience

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Discover comprehensive insights into canine care and training at The Dogs Academy. Our expert-guided resource offers invaluable tips for training your dogs and ensuring their optimal health. Explore effective techniques and strategies to nurture obedience while prioritizing your furry friend's well-being. From obedience training to holistic health practices, The Dogs Academy empowers you to create a joyful and thriving life for your beloved pets. Are you facing problem with your Dog's behavior? You can learn more on -Secrets to Dog Training: Stop Your Dog's Behavior Problems! https://bit.ly/43XAm2N Do You Know Music Help with Your Dog's Anxiety Problems : https://bit.ly/47sPZ5A Learn The Treatless Dog Training Secrets by Anthony Louis : https://bit.ly/3Qy6oPY How To Housetrain & Potty Train Any Dog : https://bit.ly/3OOJ1At Brain Training for Dogs - Unique Dog Training Course! : https://bit.ly/456hz6T Wild Belly Dog Probiotic: https://bit.ly/3QwDfEE

"Journey to Serenity: Exploring Mental Health & Self-Care"

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Welcome to Peasatisfaction, your go-to destination for insightful and empowering content dedicated to enhancing your mental well-being. In a world that often moves at a frantic pace, taking care of our mental health has never been more important. Our channel is a safe haven where we explore a myriad of topics related to mental wellness, self-care, and personal growth. We believe that every individual deserves to lead a life filled with balance, positivity, and resilience. Join us as we dive deep into the realms of mindfulness, self-discovery, and practical strategies that can uplift your spirit and foster a healthier mindset. From expert interviews to relatable discussions, we're here to provide you with the tools you need to navigate life's challenges with confidence. Expect a collection of engaging videos that touch upon: - **Mindfulness Practices**: Immerse yourself in mindfulness techniques that promote relaxation and reduce stress, allowing you to savor the present moment. - **Self-Care Rituals**: Discover self-care routines that nourish your mind, body, and soul, promoting a sense of well-being from within. - **Emotional Resilience**: Explore methods to build emotional strength and resilience, empowering you to overcome adversity and embrace change. - **Positive Psychology**: Uncover the science behind positivity and learn how cultivating optimism can lead to a more fulfilling life. - **Navigating Mental Challenges**: We address a range of mental health topics, from anxiety and stress management to cultivating healthy relationships and boosting self-confidence. Our mission is to provide you with the knowledge, inspiration, and support you need to embark on a journey of self-improvement and mental wellness. Whether you're seeking guidance, inspiration, or a sense of community, [Your Channel Name] is here to accompany you every step of the way. Don't forget to like, subscribe, and hit the notification bell to stay updated on our latest uploads. Let's thrive together and prioritize our mental well-being! Disclaimer: The content on this channel is intended for informational and educational purposes only. It should not be considered a substitute for professional medical advice or treatment. Please consult with a qualified healthcare provider for personalized guidance.

Pet Care Diaries

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Welcome to Pet Care Diaries, the ultimate destination for pet lovers and owners alike! Join us on Rumble Channel as we embark on an incredible journey, sharing invaluable insights, heartwarming stories, and expert advice on pet care. Whether you're a seasoned pet parent or thinking about adopting a furry friend, our channel is a treasure trove of information to enhance the bond between you and your beloved companion. From the moment you hit play, our captivating videos will immerse you in a world of wagging tails, gentle purrs, and playful paws. Discover viral content that showcases adorable kittens exploring their surroundings, loyal dogs performing impressive tricks, and exotic pets displaying their unique behaviors. Each video is carefully curated to ignite joy, spark curiosity, and deepen your understanding of the wonderful creatures that enrich our lives. Our dedicated team of pet enthusiasts and experienced veterinarians ensures that our content is not only entertaining but also educational. Discover essential pet care tips, grooming techniques, dietary advice, and training strategies to create a safe and loving environment for your furry friend. We cover a wide range of topics, including canine companionship, feline behavior, avian care, small mammal care, aquatic pets, and more, catering to the diverse needs of pet owners worldwide. With our commitment to search engine optimization (SEO), we make it easy for you to find the content you're looking for. Our videos are meticulously tagged with viral keywords such as "cute pets," "funny animal moments," "pet training hacks," and "amazing pet tricks," ensuring that you won't miss a single moment of pet-filled joy. You'll also find practical guides on "how to choose the perfect pet," "pet-friendly travel tips," and "healthcare essentials for your pet," optimized to provide the most relevant and engaging results. Join our thriving community of pet enthusiasts who share their own stories, tips, and experiences in the comments section. Engage with like-minded individuals, exchange knowledge, and build lasting connections with fellow pet lovers from around the world. Pet Care Diaries on Rumble Channel is your go-to destination for all things pet-related, combining the power of heartwarming content, expert advice, and the excitement of viral keywords to create an unforgettable experience. Subscribe to our channel today and embark on an extraordinary journey filled with laughter, learning, and unconditional love. Pet Care Diaries on Rumble Channel – where pets and passion come together! Keywords: pet care, pet parents, pet lovers, viral content, pet training, pet tricks, pet behavior, pet health, grooming techniques, dietary advice, search engine optimization, cute pets, funny animal moments, pet-friendly travel tips, healthcare essentials, pet enthusiasts, Rumble Channel, unconditional love.