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The Ugly Step Sister



Mandy Estes, Haydel Consulting Services LLC

Okay, so it probably wasn’t nice of me to put Mandy’s photo near the Ugly Step Sister title.  It is a coincidence, I promise.  I was going to introduce Mandy to you as I published her first post for our blog but I think she did a pretty good job of that herself.  Mandy can be reached via email any time you have a question or comment.  I hope you appreciate her unique take on things as much as we do.


For those of you who don’t know me, I am Mandy Estes. I have gotten a chance to meet some of you lovely nurses out there when I visit, and the best part of my job is meeting new people and getting to “visit” as we like to say here in south Louisiana. I have worked in homecare for a while now for a LARGE company and a small company and now I am blessed to be employed at Haydel Consulting. Can I say I love my job? Who wouldn’t love their job, if it sometimes consisted of writing a blog about the results of a Medicare 101 quiz? Regulations and tests make me giddy.

Throughout my home health career I have familiarized myself with state minimum standards, but I had not sat down and actually read the federal guidelines from front to back until recently. If you haven’t either, you should at least get started. Below is a link to them, it contains very valuable information and will only make your agency more successful. So, let’s get back to the subject at hand.

Observation and assessment. I want to call it the ugly step-sister to teaching and training.  Overuse of observation and assessment is like sending and engraved invitation to Medicare that reads,  “Hey, Medicare send the contractor to look at my charts!”

I don’t think anyone was too sure what to do with question 46, because the guidelines are somewhat vague when it comes to continued observation and assessment after the golden 3 week time frame. I could quote the guidelines verbatim but I don’t want to bore you all so much that you unsubscribe to Julianne’s funny and informative blog on my first attempt.

In a nutshell, the guidelines say this is justified as a skill when there is a risk for complication or exacerbation, but in addition the nurse is evaluating for modifications in the treatment plan. This means they actually want us to do something about the problems we are observing and assessing, not just stand around and write a detailed nurse’s note of our findings. We have all done it; even me.

Make a plan then take action by writing a case conference or calling the doctor’s office. In order to meet criteria, the plan of care must change.

The guidelines specifically address that a longstanding pattern of watching and waiting is not reasonable and necessary.

Let’s all make a pact to read section 40.1 of the federal guidelines focused on skilled services. If you will learn something you didn’t already know and maybe you can share it with the rest of us.  Experience tells that if one person missed something, chances are a lot of people did.   Education is a powerful tool and in our industry education is a must! Stay tuned, there is more to come.

4 Comments Post a comment
  1. Shawnee Johnson #

    I guess it wasn’t clear on the test how long we were going to continue ‘watching and waiting’ before we decided whether or not the patient was stable. I thought it would be a reasonable thing to do in the scenario, but not forever!
    Thanks for providing a fun test and continued feedback. I enjoy this blog.

    December 14, 2011
    • Mandy #

      Thanks for following Shawnee. Even in the magic 3 week time frame mentioned in the Medicare guidelines, we still need to be identifying possibe “holes” in our plan of care that could be plugged up and avoid that next exacerbation or rehospitalization. That’s why this question did not address a specific timeframe. Keep following for more info on this subject in the weeks to come.

      December 14, 2011
  2. Gail #

    Well, Welcome, Mandy. I am sure that you will be a pleasant addition to the witty repartee encountered in this blog. I have only been in home health for a year and 10 months and have been in learning mode for most of the time. I learn something new everyday and this blog is a big part of that. I check it almost every day to see if something new and different has been revealed. I am so uninformed re: LUPAs, PEPs, and that sort of thing. So the more I am prompted to investigate, the more I learn. Y’all keep up the good work.

    December 15, 2011

    • Gail, Mandy can’t answer, I don’t think, because I just gave her all of the passwords to get into the blog. However, we are all too glad to answer short questions and emails if you can’t get in touch with your office or you just don’t understand something. When you have been in home health for 20 years, some things that seem so obvious to us are not obvious at all. They have just been ingrained into our tiny little minds. We do not charge for short emails and questions and we do not go ‘tattle’ on nurses who ask intelligent questions. It actually helps us to remember how strange all of this seems to an outsider! (Please don’t call to ask us what to do if you accidentally kill a patient who was rude to you for the 6th visit in a row. That will not turn out well for you or us.)

      December 15, 2011

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