Tuesday, November 15, 2011

Do You Know How Visiting Nurse Service Works?

I do now, but it took having surgery to find out.

While in the hospital, a representative from Visiting Nurse Service came to see me.  We spoke briefly and she said someone will get in touch with me once I was back home.

I was released on a Sunday and sure enough, Monday I received a call from a nurse who would come to see me for an initial evaluation.

What an exciting Monday - the nurse ordered supplies for me, noted the type of assistance I needed, took my vitals, checked my wounds and left.  Needless to say, he was mesmerized by the frame and rods running through my foot.  He had never seen it before.

The next day I received a call from the coordinator at VNS.  I was offered a home aide a few times a week for 4 hours each visit. As far as my insurance was concerned, I had unlimited (approved) visits as long as I pay the co-pay.

This was so helpful to me.  I now had someone to help me shower, get upstairs, heat up some food for me and even do my personal laundry.

There also had to be a visit from a nurse each week to establish my need for continued home care.

And there lies the rub!

Apparently it didn't matter that I could not manage to take a shower alone, cook for myself, or do much at all without help.  What only mattered was the fact that the nurse had to justify my having help based on a medical need only.  So if I had a skin infection where the pins and rods went into my leg and foot, that would justify having a home aide.

And for each week I had a home aide, I had to have a visit from a nurse, who was actually my case manager.  If she could not find a medical condition then I could not qualify for the home aide.

I could not understand this because a home aide is not allowed to do anything "medical" for me anyway.  They cannot help with wound care, for example.  I was on my own for that.  Where I needed assistance was of no concern to how this system works.

Had I not had the skin infections, which were the result from having all these foreign object inserted into my foot and leg, I would not have qualified for the home aide.  I cannot imagine how I would have managed alone for that first month at home.

More than likely, I would have had to privately hire my own home aide.

And now a word about the organization which partners with VNS, supplying the home aides:  what a mess!  At first I was told that I live in an area where there is no public transportation so it would be difficult for them to get me an aide. Not everyone has a car. Try finding that information in any of their brochures.

The first aide they sent to me was not someone I wanted around.  I never even saw her wash her hands! Then different aides kept coming.  All of a sudden, there were aides with cars.

There was no consistency of who came and when they arrived.  I had such little energy and was in pain, but I had to spend my time showing each new aide what I wanted, where things were, how to help me get upstairs, etc.  It was just complicating things.  One day an aide showed up but no one had even called me to tell me anyone was coming.

This is not a fault of the aides.  They came to do their job.  It was the coordination which needed much improvement.  After many frustrating calls to the aide coordinator, I instead worked things out with the VNS representative who called me with updates each day to let me know who was coming and when. This person deserves high praise for all her help.

I did eventually get "discharged" by the nurse because I no longer had a medical necessity to justify an aide.  Thank goodness I am now able to manage many things myself, using my ingenuity and determination.

My advice is to be prepared when you are in a situation where you may need a home aide after surgery.  Look into hiring someone on your own so you will have someone to call upon if you don't qualify for the medical necessity clause!