1. Jeremiah, Melissa RN, CHCE

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When I first became a home healthcare nurse, I discovered a unique language that I needed to become fluent in. I also learned new words are frequently added to the home care dictionary. Are you new to home care? Here are some of the commonly used terms that you will hear, with a brief description of their meanings.


The Patients Plan of Care is also called the 485, and those new to the field are sometimes completely thrown when someone speaks to them about the 485. Where did we get the term 485? The Home Health Certification and Plan of Care Form that many agencies use was once called the HCFA-485; Health Care Financing Administration or HCFA is the former name of Centers for Medicare and Medicaid Services.


Medicare patients must be homebound. This doesn't mean the patient can choose to be homebound; this is a reality, not a choice. Not owning a car or never having a driver's license also does not qualify one as homebound. You need to look at what the patient is actually able to do and the Outcome and Assessment Information Set (OASIS) is a great source for this. Patients are, at times, on two ends of the spectrum as to whether or not they correctly relay their homebound status. Some patients are afraid to admit they are homebound as they feel vulnerable and stretch the truth about what they are able to do. On the other hand, some patients will go overboard when telling of their physical limitations. This is why, in order to answer the OASIS questions, you must have the patient demonstrate what they can do.


As a registered nurse or physical, occupational, or speech therapist, you may need to do a brief "sup," a "joint sup"; or an "HHA sup." When a patient is receiving nonskilled services, they are required to have a supervisory (hence the term "sup") visit every 30 days. This is sometimes called a brief sup as you are not going there to assess the patient; your purpose is to assess if the home healthcare aide (HHA) services the patient is receiving are satisfactory to the patient and meeting their needs as set by their care plan. If the patient is receiving nonskilled services, every other sup visit must be done with the HHA present in the home, hence this is a "joint sup." If a patient is receiving skilled services, you must complete a "sup" visit every 14 days, which can be done in conjunction with a routine visit, with or without the HHA present.


An area that is increasing in its importance and no longer kept in a silo for the office staff to contend with is Quality Assurance Performance Improvement (QAPI). Some veterans may refer to it as "QE," "QI," "QA," or "PI"; but the current acronym is QAPI. Under QAPI there will also be Performance Improvement Plans (PIPs) that are different for each agency. PIPs are the playbook for how your agency is going to correct areas where they fall short when benchmarked against other agencies. All employees are to be involved in helping to improve your agencies' QAPI and PIP performances. A good place to look into this is that shows Quality of Patient Care and Survey Results for individual agencies. Your willingness to help improve your agency's publically reported numbers will help make you a rising star in your agency.


There may be periods of frustration as you improve your fluency in the language of home healthcare. Be open and let the "seasoned" employees know you are not understanding the point they are trying to communicate. You'll get it eventually and one day you will be the veteran taking the new clinician under your wing.