Things aren't always what they seem

Have you ever been in a situation where you don't realize what you don't know?

I encountered just a situation recently at work.

Although I've held my nursing home administrator license in CA since 2002, until the past year I've always worked in setting with individuals with psychiatric issues, developmental disabilities, and prisoners.  Last year I was blessed with a job as an administrator in a skilled nursing facility.  I've learned a lot this year and I'm still learning every day.

We have a contract with the veterans administration (VA).  It really has not turned out to be a good thing for us financially.  The facility where I'm at is called a post acute because our focus is on rehabilitative therapy and the bulk of our patients are short stay; between 1 week to 3 1/2 months.  There are a few long term (LTC) patients for whom this will always be their home, but we are not really accepting any new long term patients.  The VA knows this because I explained it to them the very first time I met with them to start talking about contracting with them.  They weren't pleased but they decided to go ahead and contract with us any way.  Yet they send us patients for rehabilitative therapy and then stop the therapy within a week after arrival.

Recently they had cut off therapy for one of their patients and, in this case I can kind of understand. This patient has pancreatic cancer and it would make more sense to just help him be as happy and comfortable as possible.  The nurse manager from the VA contacted me regarding putting him onto Hospice and I directed her to our director of nursing (DON).  The director of nursing services was on vacation and this nurse felt like she just couldn't wait.  I explained that we don't have any Medicaid/LTC beds available.  She kept insisting that it wouldn't be long and that if I could just give her one for a month.  Like a dummy I allowed myself to be pressured. (Goes back to that truth that I only need to do what I believe God wants me to do; not be overly concerned with pleasing everyone else around me.)

A Hospice nurse shows up at our facility on Friday and I had her talk with our DON.  Later in the day that VA nurse manager kept calling and calling and calling me.  I was busy and she would not let the receptionist put her call through to voice mail.  The DON was in a patient care meeting with family.  I finally talked with this VA case manager nurse and she kept pressuring me about the need for this patient to start on hospice that very day.  I directed her again to the DON but told her to have the hospice company send me a copy of the letter of agreement.

When I got the letter of agreement I realized that we would be receiving 1/3 less pay than we are currently for this patient if I sign the agreement and let him go onto Hospice.  I finally got to talk with our DON and she told me that she'd already spoken with this VA nurse manager and talked with her again.  Our DON asked the nurse manager what nursing services she felt we weren't providing that were needed.  That nurse manager could not tell her any.

I still didn't understand because I asked our DON how it will benefit the VA, I was thinking they would still need to pay the hospice company.  The DON explained that the hospice company will bill Medicaid and then the VA will not have to pay for anything.

So that's why this nurse manager was in such a hurry!

So I spoke with the nurse manager again and explained that we can provide palliative care measures or any other nursing intervention necessary.   I also explained that we can't really lose revenue in that manner.  She told me that she understands we're a business, but what about the patient?  I asked her what it was that the patient needed that we weren't providing?  Again there was not an answer.


I felt frustrated because she was acting like I only care about money and she wants patient care.  When it truth it looked like she wanted to get out of payment for the patient's care while causing me to lose a great deal of revenue.  It's interesting that the very DON  with whom I have problems is the one who helped me in this situation.  This DON has worked in this industry for more than 20 years and knew exactly what the VA nurse manager was trying to pull.

I pray that I would be wise in these situations.