Not knowing which skilled nursing procedures that your home health agency will or will not perform can be a costly oversight.

This had been my oversight and personal experience.  Whenever you sign up for Home Health services,  you should always have the home consultation nurse point out right then which group of medical procedures that are not covered on their urgent call/home visit list.   The consequences could be not only inconvenient, but expensive to you if you don’t. 

Take for example, MIC  G-tube re-insertions.  If your elderly and ailing senior inadvertently snatches out their G-tube (or it gets pulled out by you),   Some HH agencies do not require their nurses to come out to your residence for gastric tubes to be reinserted–even though you may be one of their clients.  Most likely the caregiver will need to call EMS to transport your bed bound senior to the ER to get it reinserted.

Ordinarily this would be proper procedure because doctors are the ones who generally reinsert gastric tubes.  After it is inserted, x-ray technicians at the emergency room will normally x-ray the area to ascertain proper placement.

However, some HH agencies do allow RNs and LPNs to come to the patient’s home and reinsert inadvertently snatched out tubes or insert new ones.  –Wouldn’t that type of home service be more convenient for your senior and the family?   Seniors who are very frail and have contractures, undergo a good bit of stress and trauma when they are taken through the ER experience.  Taking them to the ER should be reserved only for emergencies.   Reinserting a MIC g-tube is not an emergency.

This is why having the procedure done at home is better.  Qualified HH nurses who came to our home did not require the services of an x-ray tech to mechanically check for proper insertion because they employed other methods of ascertaining that the tube was indeed in the stomach. One technique they performed–after inserting the tube–involved pushing a little air in the g-tube with a syringe.  They then listened with a stethoscope for a low volume groaning sound of air, traveling through the the tube.  Another  “checking technique” they performed had been to get a syringe and simply draw out a little green and/or yellow stomach acid from the stomach (Don’t forget to push back in the stomach acid after you view it).   These two methods proved to be a sufficient way to indicate that the g-tube is in the stomach.

I have had HH nurses to come to my home and insert new tubes in my mom on a regular basis.  And this “checking technique” is the procedure that they had performed.  We did not have to go to the ER.  Sadly, all agencies do not offer this service.

So, not knowing in advance that your home health agency do not provide this service could be very inconvenient and costly.   It happened to my mom with a particular HH agency.  …No one came when I called.

She was not 100% Medicaid.  She had to pay for the transport to the ER out of pocket.  We ended up waiting for hours at the E.R. just to have a g-tube reinserted.

Yet, it seemed so unnecessary.  The main reason you sign up for Home Health–in the first place–is for trained nurses to be on call for your “special needs” senior during these times of urgencies.  They should be there when you need them!   Generally, they are.

Besides, many of them do supply and ship these g-tubes to your home via UPS.  So, if one of their medically approved devices get pulled out or malfunctions over the weekend, at least they could do make available a  qualified nurse on stand-by for contingencies like that.  The HH nurse then could make the needed after hours home visit to help resolve the urgent issue at hand.

If you are already a member at the HH agency, a doctor’s order would not necessarily be needed to require the HH nurse to do a simple home visit just to reinsert a g-tube which had been accidently pulled out of the stomach at home.

Now of course when a new one needs to be inserted, doctor’s orders are needed first to have one ordered.  That, however, can be planned well in advance.

Please be aware that some g-tube reinsertions may require  outpatient attention at a hospital.  Do not hesitate to ask your doctor well in advance  about the difficulties and particular type of g-tube your senior has.

Caregivers can also plan to have their senior’s regular doctor schedule an appointment with a private clinic to insert a new g-tube– if he does not himself perform those types of procedures.  Note that some clinics also may not perform this procedure. For all that do, many health insurances will cover the cost.

So, please read the fine print and ask questions beforehand.  You never know when you might need Home Health to come to your home after hours or on the weekend to assist you in an urgent manner such as this just to hear that they don’t provide that service.