A Tragedy Named Linton
What Agencies can do to lessen their chances of a catastrophic incident related to nurse mental health issues.
Posts tagged ‘julianne haydel’
Oct 11
It’s that Time Again
It seems like every week or so we are learning of a new way to get very sick and, well, die. It’s not always pleasant to read the news but, even in the wake of all these new viruses, there are some old ones that command respect.
The one that immediately comes to mind is the Flu. It is boring in comparison to Monkeypox and it doesn’t kill as many people as Covid but really, how important is it to you that your virus is interesting? Do you care how many other people are dying when you are on life support?
Last year, the flu wasn’t as much of a threat as it has been (and will be).. Everyone stayed home and wore masks. Smart people did not hang out in crowded places and N95s became available. Jeff Bezos and delivery companies made a ton of money but I don’t begrudge them considering the alternative would have been a higher risk of contracting Covid.
Compare last year’s isolation to this year. School’s are well populated judging by the long lines of traffic when school lets out. People are going out again to shop and eat and visit. The President has erroneously declared an end to the Covid Pandemic and the CDC has revoked its advice that people in healthcare facilities should wear masks. Please note that the CDC did not prohibit masks in healthcare facilities although the department of motor vehicles might take exception if you don’t remove your mask when you take a picture when you renew your license.
So the flu is a real threat this year. If you have never had a case of the flu, consider yourself lucky. Death is an attractive alternative when fevers reach 104 and every muscle in your body aches. Furthermore, the flu is contagious before symptoms appear. That means you can go out to several family homes and give them the gift of flu before you even know you have it.
When a nurse is out with the flu, it isn’t for a day or two. There are no badges of honor for going to work sick with the flu. All of the uninfected nurses have to pick up the slack (and overtime). And flu season peaks in winter when it already takes extra time to visit patients. Roads may be icy and the holidays and end of year tasks cause everyone to get behind.
And that’s what the flu is like for us. Imagine the patients!
In the 2019 – 2020 flu season, the last year for which data was collected, 38M people were sick with the flu resulting in 400,000 hospitalizations and 22,000 people died from the flu or flu related complications. The virus that causes the flu is quite adaptable and mutates often to get around immunity. Because of the ever changing nature of the influenza virus, the flu statistics vary each year.
The vaccine is mostly free but even if you pay out of pocket, it is cheap. If you are an agency that doesn’t pay for your employees to get flu shots, I want you to remember this when you’re writing those overtime checks. There is no charge to Medicare patients and that includes those receiving hospice care. Home Health and Hospice can bill Medicare although many agencies choose not to bill. You may also administer the flu vaccine to spouses and other Medicare recipients who live in the house. For billing purposes, there is no physician order needed. Get an order anyway.
With one exception, the flu vaccine is unable to cause the flu. The exception is the nasal inhaler vaccine which does contain minute quantities of the live virus so there is a similarly small chance that it could give the flu to the recipient. All other vaccines do not contain live virus particles. Because it takes a while for the vaccine to offer full protection, it is possible to get the flu in the week or so after the vaccine which is a good reason to get your flu shots early. And it is possible to contract the flu after being vaccinated but these cases do not cause as many hospitalizations and deaths.
Finally, the CDC has a boatload of resource materials that you can use as teaching guides or even wallpaper. Midway down the CDC Resource page are infographics and fact sheets. The CDC receives billions in funding. Make use of it. You don’t want to be known as the nurse or therapist who wasted billions of dollars and current CDC information will support any complaints about you or your agency.
If misery could be contained in buckets, each case of the flu would fill ten or so home depot buckets. Think about that and prevent some misery.
It seems like every week or so we are learning of a new way to get very sick and, well, die. It’s not always pleasant to read the news but, even in the wake of all these new viruses, there are some old ones that command respect.
The one that immediately comes to mind is the Flu. It is boring in comparison to Monkeypox and it doesn’t kill as many people as Covid but really, how important is it to you that your virus is interesting? Do you care how many other people are dying when you are on life support?
Last year, the flu wasn’t as much of a threat as it has been (and will be).. Everyone stayed home and wore masks. Smart people did not hang out in crowded places and N95s became available. Jeff Bezos and delivery companies made a ton of money but I don’t begrudge them considering the alternative would have been a higher risk of contracting Covid.
Compare last year’s isolation to this year. School’s are well populated judging by the long lines of traffic when school lets out. People are going out again to shop and eat and visit. The President has erroneously declared an end to the Covid Pandemic and the CDC has revoked its advice that people in healthcare facilities should wear masks. Please note that the CDC did not prohibit masks in healthcare facilities although the department of motor vehicles might take exception if you don’t remove your mask when you take a picture when you renew your license.
So the flu is a real threat this year. If you have never had a case of the flu, consider yourself lucky. Death is an attractive alternative when fevers reach 104 and every muscle in your body aches. Furthermore, the flu is contagious before symptoms appear. That means you can go out to several family homes and give them the gift of flu before you even know you have it.
When a nurse is out with the flu, it isn’t for a day or two. There are no badges of honor for going to work sick with the flu. All of the uninfected nurses have to pick up the slack (and overtime). And flu season peaks in winter when it already takes extra time to visit patients. Roads may be icy and the holidays and end of year tasks cause everyone to get behind.
And that’s what the flu is like for us. Imagine the patients!
In the 2019 – 2020 flu season, the last year for which data was collected, 38M people were sick with the flu. The flu caused 400,000 hospitalizations and 22,000 people died from the flu or flu related complications. The virus that causes the flu is quite adaptable and mutates often to get around immunity. Because of the ever changing nature of the influenza virus, the flu statistics vary each year.
The side effects of the vaccine are generally mild unless the recipient of the vaccine is allergic to eggs. For the majority of people any mild side effects can be treated with tylenol or ibuprofen. It is mostly free but even if you pay out of pocket, it is cheap. There is no charge to Medicare patients and that includes those receiving hospice care. Home Health can bill Medicare although many agencies choose not to bill. You may also administer the flu vaccine to spouses and other Medicare recipients who live in the house. For billing purposes, there is no physician order needed. Get an order anyway.
With one exception, the flu vaccine is unable to cause the flu. The exception is the nasal inhaler vaccine which does contain minute quantities of the live virus so there is a similarly small chance that it could give the flu to the recipient. Because it takes a while for the vaccine to offer full protection, it is possible to get the flu in the week or so after the vaccine which is a good reason to get your flu shots early. And it is possible to contract the flu after being vaccinated but these cases do not cause as many hospitalizations and deaths.
Finally, the CDC has a boatload of resource materials that you can use as teaching guides or even wallpaper. Midway down the CDC Resource page are infographics and fact sheets. The CDC receives billions in funding. Make use of it. It would be a shame to waste billions of dollars and current CDC information will support any complaints about you or your agency.
If misery could be contained in buckets, each case of the flu would fill ten or so home depot buckets. Think about that and prevent some misery.
It seems like every week or so we are learning of a new way to get very sick and, well, die. It’s not always pleasant to read the news but, even in the wake of all these new viruses, there are some old ones that command respect.
The one that immediately comes to mind is the Flu. It is boring in comparison to Monkeypox and it doesn’t kill as many people as Covid but really, how important is it to you that your virus is interesting? Do you care how many other people are dying when you are on life support?
Last year, the flu wasn’t as much of a threat as it has been (and will be).. Everyone stayed home and wore masks. Smart people did not hang out in crowded places and N95s became available. Jeff Bezos and delivery companies made a ton of money but I don’t begrudge them considering the alternative would have been a higher risk of contracting Covid.
Compare last year’s isolation to this year. School’s are well populated judging by the long lines of traffic when school lets out. People are going out again to shop and eat and visit. The President has erroneously declared an end to the Covid Pandemic and the CDC has revoked its advice that people in healthcare facilities should wear masks. Please note that the CDC did not prohibit masks in healthcare facilities although the department of motor vehicles might take exception if you don’t remove your mask when you take a picture when you renew your license.
So the flu is a real threat this year. If you have never had a case of the flu, consider yourself lucky. Death is an attractive alternative when fevers reach 104 and every muscle in your body aches. Furthermore, the flu is contagious before symptoms appear. That means you can go out to several family homes and give them the gift of flu before you even know you have it.
When a nurse is out with the flu, it isn’t for a day or two. There are no badges of honor for going to work sick with the flu. All of the uninfected nurses have to pick up the slack (and overtime). And flu season peaks in winter when it already takes extra time to visit patients. Roads may be icy and the holidays and end of year tasks cause everyone to get behind.
And that’s what the flu is like for us. Imagine the patients!
In the 2019 – 2020 flu season, the last year for which data was collected, 38M people were sick with the flu. The flu caused 400,000 hospitalizations and 22,000 people died from the flu or flu related complications. The virus that causes the flu is quite adaptable and mutates often to get around immunity. Because of the ever changing nature of the influenza virus, the flu statistics vary each year.
The side effects of the vaccine are generally mild unless the recipient of the vaccine is allergic to eggs. For the majority of people any mild side effects can be treated with tylenol or ibuprofen. It is mostly free but even if you pay out of pocket, it is cheap. There is no charge to Medicare patients and that includes those receiving hospice care. Home Health can bill Medicare although many agencies choose not to bill. You may also administer the flu vaccine to spouses and other Medicare recipients who live in the house. For billing purposes, there is no physician order needed. Get an order anyway.
With one exception, the flu vaccine is unable to cause the flu. The exception is the nasal inhaler vaccine which does contain minute quantities of the live virus so there is a similarly small chance that it could give the flu to the recipient. Because it takes a while for the vaccine to offer full protection, it is possible to get the flu in the week or so after the vaccine which is a good reason to get your flu shots early. And it is possible to contract the flu after being vaccinated but these cases do not cause as many hospitalizations and deaths.
Finally, the CDC has a boatload of resource materials that you can use as teaching guides or even wallpaper. Midway down the CDC Resource page are infographics and fact sheets. The CDC receives billions in funding. Make use of it. It would be a shame to waste billions of dollars and current CDC information will support any complaints about you or your agency.
If misery could be contained in buckets, each case of the flu would fill ten or so home depot buckets. Think about that and prevent some misery.
Mar 22
Mar 10
COVID-19 for Visiting Nurses
How should home health and hospice visiting employees address Covid19 and protect staff and patients?
Dec 17
Company 1
Suzanne May, age 61, served as the administrator of a hospice referred to by the Feds as Company 1 for more than a decade She was a both a registered nurse and a certified hospice administrator. She signed a plea deal admitting to fraud on December 3, 2019 and now faces five years in prison followed by three years supervised release, a $250,000.00 fine and to top it off, a $100.00 special assessment. Hopefully, her lawyer can negotiate a deal where the special assessment is knocked off of the overall penalties.
Altering Legal Documents
To keep it short and simple unlike the official documents, Ms. May has admitted to:
- Using white-out on a Certificate of Terminal Illness. If you can’t figure out why that might be a problem, it’s best that you resign now.
- Adding dates to Notices of Election after the clinical records were requested from Medicare. I do not know how Federal Investigators knew when the dates were added.
- Ms. May relieved some patients of the burden of initialing forms by adding their dated initials to forms. The Feds are alleging that it is not possible to sign and date documents after death.
In an impressive display of organizational skills, Company 1 employees, led by Ms. May, kept a log of all changes made to the documents after the request for records was received.
This audit, performed in 2017, followed a 2015 audit in which close to $400,000 was returned to Medicare. As a certified hospice administrator Ms. May knew what was required of the hospice in order to be paid. And, to her credit, she made sure every detail was complete but only after her clinical records were requested by Medicare. Timing is everything.
Look Again
This post teaches you how to go to jail. Free meals, a warm place to sleep and a break from your needy relatives may be your ticket to jolly holidays. Surely the worst prison food is better than fruit cake and squash casserole.
In no way am I condoning the actions of Ms. May. I also recognize that the criteria for payment is sometimes preposterous. Claims for reasonable and necessary care provided to eligible beneficiaries are denied payment every day but that is a subject for another post.
In this case no patients were harmed as a result of Ms. May’s actions. Nobody dies from a date added to a document after they die. If jail is your ideal vacation, this seems to be the way to go if you don’t want any patients to be hurt along the way.
If you wish to remain home with your loved ones, I assure you that no matter how tempting it is to add a date to a form because the patient didn’t, and you know the correct date and personally witnessed the patient sign the form, it isn’t worth it. When a physician doesn’t date his or her signature and you know when the orders were signed, adding the date seems more like a courtesy than a felony but you would be wrong in making that assumption.
If this sort of behavior was evident on a state survey and a plan of correction to the state was required, it would probably include an educational piece like, ‘The DON will hold an inservice to teach the nurses things that they already know but didn’t do.’
If you are finding these problems during clinical record and billing review despite teaching the nurses repeatedly it’s time to try something new.
Cut your employees some slack. Home health and hospice nurses who provide excellent care to your patients are worth a little extra time. Review their paperwork with them as it arrives at the agency – which usually occurs before the time (and possibly the patient) has passed to get an ethically dated signature. Help them develop habits.
On the other hand, if a nurse blatantly commits fraud, investigate first and then terminate them. You are also obligated to report them to Medicare and their State Board. A good orientation will ensure they know the rules. Protect your nurses and the agency by providing a complete orientation including compliance.
Do not bill (or alternatively, pay back the money) if you have found out that a nurse was taking shortcuts. It is painful to take the right steps but not as painful as the quarter million fine Ms. May will pay (plus the assessment fee).
If you are a visiting nurse, you know the rules. You know what to do and mostly you get it right but it only takes a couple of bad care plans or notices of election to cost an agency tens of thousands of dollars.
More concerning to me is the probability that some nurses are encouraged to ‘do what it takes’ to get billing out the door. Without using the words, ‘go commit fraud’, some employers leave employees feeling like their jobs are on the line if they hold up billing. If you feel that the only way to keep your job is to fill in the blanks omitted by a patient or a physician, I guarantee that unemployment is a better option.
Everything else aside, ask how Medicare knew the documents were altered by Ms. May and friends after the patient died. The Feds are not psychic. They did not have a seance summoning J. Edgar Hoover who revealed the exact time that dates were placed on documents. They obviously knew something that was solid enough for them to request 100 charts.
I’m willing to bet that Company 1 is not the real name of the hospice and that this story has just begun. Until we find out more, do yourself and your patients a favor and do things the right way. If you are preoccupied with compiling charts for an audit, care to your patients will be compromised. I’ve seen it too many times.
As always, your comments are welcome or you can email your thoughts.
