Plan of Care and home hemo

[cattlekid]

So those of you who follow along on the various dialysis-related Facebook groups may find this to be old news, but I thought I would get the opinions of those who are here but not there. 

I have been on home hemo for 17 months now.  In that space of time, I have seen my dietitian about four times and my social worker even less.  The stated reason why they are not present during scheduled clinic visits is that they have child care issues that require that they leave the office at 3:00 PM.  I do have access to them via phone. 

Normally, this wouldn’t be an issue.  However, I have had some lab values that are out of whack recently (calcium, PTH and albumin).  I know how to get my albumin up, but the calcium and PTH confound me.  I am not getting the support that I need from my dietitian on these numbers.  All she does is call me, tell me they are out of whack (both are low) and then tell me that we’ll just have to watch them for next month.  This has been going on for about three months now.

The straw that broke the camel’s back was this morning.  I spoke with my home hemo nurse and we were planning my home visit for tomorrow.  She said that she would also have my care plan for me to sign.  I told her that I was sorry to let her know that I would not be signing any care plan without having physically met with the SW and dietitian.  I did not want to make a federal case out of it, but I told her that since clinic visits are once a month and planned in advance, that they should be able to be there for my visit and make other arrangements for child care on those days.  My home hemo nurse was 100% behind me and told me that yes, I did have the right to make a federal case out of their inability to be there for clinic. 

So I am going to formally request a meeting with my SW and dietitian next week and only after I am fully satisfied with the plan to correct my calcium and PTH levels will I sign the care plan.  I will also only sign the care plan if my SW actually puts something of substance in the plan.  She always brushes me off as stable because I am working and have no financial issues.  I have read the Conditions of Care and I know that she has to address more than just the money. 

The kicker to all of this?  The State will be in next week to audit.  I can’t wait to see what will happen if I haven’t signed my care plan and my file is pulled for the audit.  I refuse to jump through their hoops just to sign off on paper that doesn’t mean anything.  I’ve had enough of it. 

Anyone in the same boat or do I have particularly lazy staff?

[boswife]

its wrong for sure for them to not be present.  In our case, on our monthly visits, our nurses and nutrition people sit quietly while we have our visit with our neph.  He is the one that helps us keep our numbers in order.  I think partly, well, our nutrition person knows what you can read on a sheet of paper off the computer, and i often was correcting her with my (oops hubbys) dr in agreement with me.  Sooooooooo, the thing is, they have that obligation to you for someone to get you strait!! It will be interesting to hear how this next stuff goes!!

[jeannea]

I did PD not home hemo. When I went to clinic I always saw the nurse, doctor and nutritionist. The social worker was always there but you didn't have to talk to her unless you wanted to. They should be there if it's a regularly scheduled clinic. I'm with you. Make a federal case out of it.

[Speedy1wrc]

Your experience sounds exactly what I was going through in center. One of the many reasons I wanted to leave so badly. The social worker was fresh out of school and virtually no experience at all. And she also was never around. She would walk by once a month and give me that 20 something smile and ask if everything was alright. When I would start to rattle off all the problems she would reply by saying that she was sorry I was havimg those issues and then walk away. The dieticina was no better. She'd hand me my labs and ask if I had any questions. Whenever I tried to talk to her about a particular value I would get the deer in the headlight look and I would just give up. The last 3 months I was there she never came in.

My new center is great! The biggest reason I decided to go there was the Home Hemo nurse. She is phenominal and throughout the training she did not disappoint. She is very knowledgeable and goes the extra mile to make sure everything is right. Plus the previous social worker and dietician from my old center moved there. They left as did many of the nurses and now they are at my new center. Fortunately the good nurses moved so I am happy.

I have learned through too many screw ups to really make a stink. I may not make friends with staff, but it keeps me alive and for me that is my biggest priority. For those staff who do a good job, I thank them and appreciate their hard work, But those who are perpetual dolts, I make sure to let them and their managemnt of my displeasure.