Acceptance to Service Policy
The Agency maintains policies for the receipt, processing and the evaluation of persons referred for services. A log of all persons referred for service is maintained. Names of any persons not accepted and the reason for rejection are noted. Persons residing outside of the service area or those in need of services not provided by the Agency are assisted in contacting the appropriate resources.
Acceptance to Service
Referrals are received in person, via telecommunication, etc. Anyone can make an initial referral. This includes, but is not limited to family members, social workers, discharge planners, physician’s office etc. The Agency accepts a physician order for referrals that are communicated verbally by discharge planners, nurse practitioners, physician’s assistants, or other authorized facility staff members. The verbal order is followed up by a written document that is signed and dated by the attending physician. During hours of operation, nurses, therapists, or social workers receive intake information.
Each patient referral is evaluated based on the following criteria:
- The anticipated needs of the referred patient-each patient referral is assessed to determine if the needs of the patient can be met with available staff at the agency within the 48- hour required OASIS requirement. Should there be a delay due to staffing levels within the organization, the physician will be notified of delay and orders received for later admission to the agency. Should the physician determine a required 48-hour admission, the agency will not accept the referral or seek alternative source for admission with immediate notification of the physician.
- The home health agency’s case load and case mix averages are determined at the beginning of each day via report to the intake department. The report shall update the number of RN/therapy visits scheduled for each day. The admission roster shall include a list of RN’s and PT (therapy only cases) available for Start of Care Visits per location. Referrals received are accepted only on basis of timeliness as well as the skill and competency level of the admitting clinician.
Information related to this policy and the Condition it relates to shall be published on our website and updated at least monthly.
The overall policy relative to the Condition and related Standards are reviewed, analyzed and updated no less frequently as services change but no less often than annually. Updates will include, but not limited to:
- List of Services Offered-to include specific skill levels such as any specialized wound care, psychiatric services, palliative care, etc.
- List of Service limitations, such as potential late admissions, lack of specific disciplines that may be needed (such as dietitian, respiratory therapy, etc).
- The frequency at which patients are typically seen. For instance, 30-60 day episodes, skilled nursing and aide services intermittently, and no services other than those on a per visit” basis, etc.
A Registered Nurse and/or appropriate staff member evaluate those patients accepted for referral. An initial evaluation includes a determination if the care ordered by the physician can be adequately and safely performed at home, assessment of the patient’s care needs, and to ensure that the patient meets the admission criteria.
Orders for Care
A verbal order to begin care and to perform a patient assessment is documented either on a physician change/verbal order OR in the Physician’s Plan of Care. The patient must be under the care of a physician who will confer with agency staff and sign orders for patient care. The individualized and unique plan of care specifies the care and services necessary to meet the patient’s specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that is anticipated will occur as a result of implementing and coordinating the Plan of Care.
Referral Interview
Calls during office hours are transferred to the clinical manager or designee who obtains initial client care information. Agency intake staff performs a “referral interview” to determine the applicant patient’s homebound status and the need for skilled and intermittent care.