1. Maxim Healthcare Services
Homecare Services

2. Types of Homecare Skilled Care Unskilled Care Non-Medical Care CNA HHA
Aid
Respite RN
LPN PT
OT SLP
Companion
Consumer Direct

3. Private Duty Nursing Services
State regulated program in Alaska
One-on-One direct patient care in the home
Skilled care preformed by a RN or LPN
Providing nursing intervention and judgment to a patient with a chronic medical condition
Continuous care for at least 8 hours per day
Also referred to as “Shift Care”

4. Who Qualifies for PDN Services?
Patients with a “physical health status that would justify admission to a general acute care hospital or long term- care facility”
Patients requiring “continuous care” defined as 8 hours or more per day of care which is “routinely provided by the nursing staff of a hospital”
Patients are receiving services for “a life threatening condition”
Services needed to assess, administer treatment and monitor/maintain skilled interventions.
Meaning a patient must have a chronic condition where nursing judgment is used and nursing interventions are preformed

5. Common Conditions Where PDN May Be Recommended
Disabilities
Complex Intravenous Therapy
Chronic Illness
Cardiovascular Disorders
Catastrophic Injury
Gastrointestinal Disorders
Neurological Disorders
Congenital Disorders
Renal Disorders
Immunological Disorders
Blood Disorders
Cancer
Palliative Care

6. Admission Criteria The following criteria must be met for admission:
Patient is under the care of a physician
Patient agrees to homecare
Home environment must be adequate for safe & effective clinical care
There is a plan in place for medical emergencies
Able & willing caregiver to participate in care
Adequate funder source to support patient’s healthcare needs
Homebound criteria met for Medicare

7. PDN Care
The goal of skilled nursing care is to help improve the patient’s condition or to maintain the patient’s condition
Typically looks like
Medication Administration
Give Injections
Wound Care
Monitor changes in medical status
Enteral feedings
Tracheostomy care
Manage assisted ventilation

8. Upon Admission
An initial comprehensive assessment is performed by an Internal Clinical Supervisor (RN)
Appropriate clinical personnel are assigned based on skill set, experience, and personality as well as scope of service
Patient & caregivers are oriented to the services to be provided & administrative policies
A Plan of Care is developed collaboratively by the assessing RN, office Clinical Director, ordering physician, patient and family (caregiver)

9. Plan of Care
The PDN provider works with the member’s physician to develop a Plan of Care
Plan of Care includes:
A Medical Assessment performed by an RN
Medication and Treatment Orders
Treatment Goals
Methods of Care to be used
Plan of Care Coordination by Nurses and other Healthcare Professionals
The Plan of Care must be re-evaluated and signed by the physician every 60 days

10. PDN Employment Requirements
License/Certification Verification
Supporting I-9 Documentation
Knowledge Exam/Screening
Health Certificate
Comprehensive Specialty Screening Evaluation
PPD Test
Criminal Background Check
Reference Checks
Prospective Employee Interviews
Any Specialty Certificates

11. PDN Cases Assigned to Nursing Staff by
Skill, Education, Training, and Availability of Personnel
Patient Acuity
Language & Communication Requirements
Geographic Location
Patient Case Load of Nurse

12. Readmission Rates in Alaska
According to Medicare.gov

13. National Readmission Rates by Diagnosis

14. Cost of Pediatric Patients with Medical Complexity
Costs of care for Children with Chronic Conditions accounts for 32.7% of all healthcare costs for pediatric patients
These patients account for 27.2% of the rehospitalization costs
Only 36% of Children with Medical Complexity received home healthcare services
Article from American Academy of Pediatrics, entitled Patterns and Costs of Healthcare Use of Children with Medical Complexity

15. Unmet Needs of Pediatric Ventilator Patients
56.2% of patients surveyed (122) reported an Unmet Need
Less than 10% were for preventative or specialty care
40% of those reported their Unmet Need for Home Health Care
Study entitled Ventilator-Dependent Children & the Health Services System – Unmet Needs and Coordination of Care by Jennifer L. Hefner and Wan Chong Tsai

16. Case Management Considerations for PDN
Case Managers gather input from hospital staff, nursing agency and primary or specialty physicians to deciding the number of medically necessary hours of skilled nursing care
Take into consideration the number of skilled needs the patient has
What are the caregiver’s abilities and the nature of the member’s illness
The goal is to make the family as independent as possible, with the intention of helping the patient’s condition improve

17. Other Types of Homecare
Intermittent Services
Short-term skilled interventions usually involving multiple disciplines including RNs, PTs, SLPs, etc.
Unskilled Companion Services
ADLs
Medication Reminders
Transfers
Other Hands-On Assistance
Non-Medical Companion Services
Basic ADLs
Custodial Care
Meal Prep, Transportation Assistance, etc.