I work in home health full-time, and have for quite a few years now. I wanted to chime in. I agree with what Breanne wrote in the previous post. There have more than a few homes which I thought were filthy, and certainly in which I felt uncomfortable. If you've worked in home health, fill in the blanks because you've no doubt seen it all. The agencies for which I worked took the stance of, "We accepted and admitted the patient, now we "own" the case and can't discharge without "valid" reason. In each case, I asked myself two questions: First, "Is there anything in this mess that is unsafe for the patient?" then, "Is there anything in this home that is unsafe for me?" Obviously, this gets tricky and I think mostly without clear-cut answers. But, in a few cases where I assessed that the patient would be at risk, I first recommended an MSW consult (where applicable and available). After the MSW assessment, as a team we decided whether the case should be referred to protective services, or whether it was more appropriate to inform the patient that we would have to discharge if they were unable/unwilling to make recommended changes. In one case, I called protective services myself, then the patient angrily "discharged" us. Bill Maloney, OTR
----- Original Message ---- From: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]> To: [email protected] Sent: Thursday, October 4, 2007 2:00:08 PM Subject: OTlist Digest, Vol 33, Issue 4 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Ethics of D/C Treatment (Hart, Breanne) 2. Question regarding duplicate services (Cim Viken) ---------------------------------------------------------------------- Message: 1 Date: Wed, 3 Oct 2007 15:20:21 -0500 From: "Hart, Breanne" <[EMAIL PROTECTED]> Subject: [OTlist] Ethics of D/C Treatment To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="iso-8859-1" I'm probably going to ask more questions than I've answered by the time this message is over, but here I go...I used to work as a low vision OT and went into a lot of homes- some of which were very unclean and foul smelling. I had one little lady who had several cats that were indoor/outdoor cats and her home reeked of the litterbox. And she asked me if it smelled, telling me that she had asked others and they all told her it was fine. Although it was painful, I told her the truth. Her home was also infested with fleas. I told her that too. I've been in a patient's home and had a roach crawl across the table where we were sitting. I went to a lot of homes where the cleanliness was less than desirable, but I treated the patient as long as I was safe and able to safely help the patient. If there were ways I could assist or get assistance, I did. I guess the question is, is the patient aware of the situation? Is the home's cleanliness interfering with the patient's functional ability/health or is the lack of cleanliness as a result of the pt's decrease in function? Are there family members present and/or aware of the state of the home? Finally, you have to ask yourself if you are discharging because you can have no impact on the patient or their environment OR if you are uncomfortble in the environment and discharging for that reason. Breanne K. Hart, M.S. OTR/L Occupational Therapist Bay Medical Center ________________________________ From: [EMAIL PROTECTED] on behalf of [EMAIL PROTECTED] Sent: Wed 10/3/2007 2:00 PM To: [email protected] Subject: OTlist Digest, Vol 33, Issue 3 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: Ethics of D/C Treatment (Mary Giarratano) 2. Re: Ethics of D/C Treatment (Mary Alice Cafiero) ---------------------------------------------------------------------- Message: 1 Date: Tue, 2 Oct 2007 17:19:25 -0400 From: "Mary Giarratano" <[EMAIL PROTECTED]> Subject: Re: [OTlist] Ethics of D/C Treatment To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="windows-1250" Hi Ron! If the patient is in danger from the poor conditions, have you considered calling protective services? We have had several situations where we have received patients as a result of a protective service placement - I'm in an SNF. We have also had situations where the local home care agency refuses to provide care unless the home environment is cleaned up to keep everyone safe (patient and their staff). It certainly is an ethical dilemma! Mary -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Tuesday, October 02, 2007 3:15 AM To: [email protected] Subject: [OTlist] Ethics of D/C Treatment Hello All: I would like to hear opinion on the ethical considerations of discharging patient treatment because the home environment has a very foul smell and very unclean? Thanks, Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ******************************************************************************** ****** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn ******************************************************************************** ****** No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: 9/29/2007 9:46 PM No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: 9/29/2007 9:46 PM ------------------------------ Message: 2 Date: Tue, 2 Oct 2007 16:23:08 -0500 From: Mary Alice Cafiero <[EMAIL PROTECTED]> Subject: Re: [OTlist] Ethics of D/C Treatment To: [email protected] Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=US-ASCII; delsp=yes; format=flowed I have notified doctor's before when the home conditions were unclean or unsafe. Most of those cases were when the patient was also being seen for wound care, and I thought that it was probably futile to treat the wound in the patient's current environment. This was in addition to the policy/procedure of the home health company. Mary Alice On Oct 2, 2007, at 4:19 PM, Mary Giarratano wrote: > Hi Ron! > > If the patient is in danger from the poor conditions, have you > considered > calling protective services? We have had several situations where > we have > received patients as a result of a protective service placement - > I'm in an SNF. > > We have also had situations where the local home care agency > refuses to provide > care unless the home environment is cleaned up to keep everyone > safe (patient > and their staff). > > It certainly is an ethical dilemma! > > Mary > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On > Behalf Of > Ron Carson > Sent: Tuesday, October 02, 2007 3:15 AM > To: [email protected] > Subject: [OTlist] Ethics of D/C Treatment > > Hello All: > > I would like to hear opinion on the ethical > considerations of > discharging patient treatment because the home environment has a > very > foul smell and very unclean? > > Thanks, > > Ron > > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > ********************************************************************** > ********** > ****** > Enroll in Boston University's post-professional Master of Science > for OTs > Online. Gain the skills and credentials to propel your career. > www.otdegree.com/otn > ********************************************************************** > ********** > ****** > > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: > 9/29/2007 9:46 > PM > > > No virus found in this outgoing message. > Checked by AVG Free Edition. > Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: > 9/29/2007 9:46 > PM > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > ********************************************************************** > **************** > Enroll in Boston University's post-professional Master of Science > for OTs Online. Gain the skills and credentials to propel your career. > www.otdegree.com/otn > ********************************************************************** > **************** ------------------------------ -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED] End of OTlist Digest, Vol 33, Issue 3 ************************************* -------------------------------------------------------- Confidentiality Notice: The information contained in this e-mail is intended solely for the person(s) to whom it is addressed. This information is the property of Bay Medical Center and may be confidential. If you are not the intended addressee, you should not distribute, copy or disclose this e-mail. Please notify the sender immediately if you received this e-mail by mistake and delete this email from your system and destroy all printed copies. ------------------------------ Message: 2 Date: Thu, 4 Oct 2007 08:57:36 -0500 From: "Cim Viken" <[EMAIL PROTECTED]> Subject: [OTlist] Question regarding duplicate services To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" I need some good critics and I know I will get them here. Is this statement true? 1. Coders can use either medical or treatment code for diagnoses; and they can use both if provided. 2. No where does it say OT and PT can't use the same diagnostic code (medical or treatment ICD codes). 3. The duplication of skilled services can be determined by looking at treatment plan and goals. 4. Using the same diagnostic code, doesn't mean duplication of services. Some examples: CVA, Arthritis, diabetes neuropathy, low back pain, etc. Thank you for the information. Cimberly Viken, OTR/L Disclaimer: This message contains privileged and confidential information intended for the use of the addressee only. If you are not the intended recipient, you are hereby notified that any disclosure, copying or distribution is strictly prohibited. ------------------------------ -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED] End of OTlist Digest, Vol 33, Issue 4 ************************************* -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
