Behavioral health nurse home visit?

[Justmehere]

Anyone have a behavioral health nurse do home visits? My doc requested this. I’m rarely home during the day/evening, due to my work/life schedule, but I guess I need something more and everything else is falling through, so my doc requested this and my insurance authorized paying for it in full (while screwing up authorizations for counseling. Ugh.) Never done this before. Doc thinks it will be short term tool to help me stabilize while I sort out other treatment and meds. Didn’t realize I was this bad off.

 

[Joan]

Wow...I have never heard of that. Maybe a good thing thing for someone to see you in your environment? or does that seem invasive? Hope it is a good thing.

 

[Sideways]

I had a community mental health nurse visit me at home for several years. I was reluctant at first, particularly since my home is my one safe space. And, typical for me, it took a long time for me to warm to the guy.

But honestly, he was aware of all the issues I had. Visiting people with mental health issues in their home was what he did for a living, and none of my hangups about the arrangement were unique. They were significant issues for me, but he’d dealt with it all before.

It was a very different dynamic to seeing a professional in their office. He saw me how I was in my down time. That’s about as real as I’ve ever been with a T. So he was about to respond to that on a practical level.

A lot of the work we did at the start was really hands on, basic stuff. I was agoraphobic (and pre-Assistance Dog) at the time. He got me into his car, drove me to the local park, and helped me sit on a bench seat watching the river for one of our appointment. He helped me make small but significant changes to my diet (I had the knowledge about the nutrition, but he provided the hands on support I needed to actually make stuff happen). Stuff my treatment knew about, but could only really talk to me about. The home visits were more about “let’s actually change this” rather than “let’s talk more”).

I had a lot of panic about it when it started because I was worried about the judgment that would go on if someone saw me really raw. I was worried about my home being made an unsafe space. I was worried that a nurse didn’t have the necessary qualifications to add to the extensive treatment I was already receiving.

He handled that surprisingly well.

It ended badly after about 4 years of immense support, but only because the relationship had gone well beyond the boundaries of his job description. So, my suggestion would be to give it a try, anticipate an adjustment period, and stay level about the boundaries of the relationship.

If it doesn’t work? You tried. If you don’t try? It will always be a potentially missed golden opportunity.

 

[Nessa7]

I have a case manager. It's a pretty similar concept. He isn't authorized to do nurse stuff, but I think the main difference is that I'm on medical assistance.

I can't recommend it enough.

For me, one of the most helpful things has been being able to bring him a list of practical things that I'm struggling with. I've only been seeing him since April, but I have accomplished a lot with way less stress than I would have had before. I've switched psychiatrists to find one that I love. I'm doing much better financially. I got diagnosed with a neurological condition that had been misdiagnosed for years. A lot of the things that I'm working on with him now are things that I wouldn't have even considered a year ago.

I hate that this happens, but I do also really appreciate the considerably more helpful response he gets from doctors' offices when he calls. On the top of my list for this week is to have him call my general practitioner to send a referral to my insurance. If I made the call, I would be calling them for days and I still would probably end up having to get my neurologist's office to confirm that I do actually know what I'm talking about and need it. He calls and gives his title and it's done that day and I don't have to completely lose my mind.

Also, I was pretty sure you were the person that was concerned about serotonin syndrome, and it has been helpful with that for me. My reasons are different, but I also don't have faith in my ability to seek help for reactions to medications. I like that I don't have to guess if a side-effect is concerning or not. I haven't had serotonin syndrome again, but I've tried several medications that didn't work for me in the last year. Without my case manager, I probably would have spent a lot more time suffering with pills that weren't helping.

The relationship is different than a therapist. With me, one of the things that I had to adjust to was not having really clear boundaries. I spent more time thinking about boundaries than with any therapist or support group leader that I've ever had, even the ones that have had issues with boundaries. It took six months for me to get into his truck, and I honestly contemplated taking the bus back even though we were going to the same place.

A therapist also only sees what you bring to them. My case manager sees everything that happens to be around. This might not be the case as much if you live alone, but it is still occasionally weird that I'll be having conversations with other people in front of him. There's no chance that someone will randomly wander into my therapy sessions.

 

[blackemerald1]

Didn’t realize I was this bad off.

^^It may be that you are not but he doesn't want to allow things to get worse. :hug:

I think the whole concept is a great idea if you can tolerate the person seeing you in your own place. It's got so many benefits really. I am pleased for you. :)

 

[Abstract]

I really hope this turns out to be a form of support that works for you at present. It may be that he is being astute and that you need something practical right now rather than this being about you being that "badly off". The other stuff is not working for you at present. It seems you discussed that with him. All very logical from what I can see. Lets hope!

 

[Justmehere]

The agency called and when discussing that they schedule visits the night before the visit occurs, they went and reviewed the order and explained all they do is help those in assisted living take mediciations. Since I’m not on psych meds... there is nothing they can do and they canceled the care. Back to the drawing board.

 

[Nessa7]

Was it a private or government agency? At least in my area, Human Services accepts regular insurance even though it is not as common. There would most likely be a longer waiting list than with a private agency, but that could still be an option. I had to do a general intake before I did one with my case manager, but you might be able to avoid that with the referral from your doctor. The general intake wasn't bad at all, though. It was a lot of waiting around, but since I had already seen quite a few professionals, the actual assessment part was really short.

 

[Justmehere]

There are no government run home health care agencies in my state. There does not appear to be any other home health agencies that provide behavioral health support in my area. I called them all. (It took a long time.) It was pretty disappointing.

 

[Friday]

It was pretty disappointing.

Okay... so...

Home care nursing is it’s own seperate little world. There are several different divisions / branches of it... and the less common forms are run mostly by word of mouth, rather than through agencies. (Because fhere’s not enough money in it for agencies to profit by carving out a niche OR no company has claimed that niche, yet). I was working on my BSRN and had never even freaking heard of several of the forms of it until my kid got sick, and nurses started hitting me up at funerals (when you have a hospital kid, you go to a lot of kid’s funerals, as your friends kids die). Okay, that sounds bad, but it’s really not. Again, it’s a word of mouth industry, and there are caring and compassionate ways to go about asking stressed out parents about their home care situation, rather than being a sleazy ambulance chasing buzzard. And you reeeeally don’t want agency nurses doing your home care 99% of the time. (More on that below).

Since your doc recommended it? That means he/she probably knows either individuals who either use psychiatric home care nurses OR a few of the RNs/LPNs/MSWs/LCSWs (socially) who do so.

>slight tangent for a moment<

It’s more common to find RNs working on their LPN and using home care as “acute care setting hours” and MSWs working on their LCSW “supervised internship hours” than the full blown doctorates. But you do find the higher qualifications doing it, as well. Usually they have small children at home, and want to set their own hours, or are supplementing a professor’s salary (nursing professors make Jack, less than half their nursing salary, whilst medschool professors make commensurate wages as doctoring, it’s a long running scandal). Either way? You’re looking at Masters level care (6-8years) & above, most of the time. Whilst agencies? Are usually sending out people with CNAs (3 months). That’s why they’re just supervising meds, not doing any actual psychiatric nursing. You can’t get a 5th year specialty, or masters speciality, in 3 months ;) But agencies don’t want people who make 100k a year. They want CNA’s who make minimum wage. It increases their profit margin.

>back on target<

Since your doc recommended it? Ask them about individuals they know who work in the field that you can get in contact with, since the agencies in your area only do med management. Their client list may be full, but once you get tapped into the network they’ll know of others -word of mouth industry- who have space in their roster.

It’s also not freakish or bizarre to need care somewhere between 8pm-4am (ie after work, whether you get off at 7pm or Midnight). When you have medical home care, there are 3 shifts of nurses you have to -or can- fill. Nurses work all hours, it’s not a 9-5 gig. Psychiatric nurses doing parttime home care / case management? There WILL be people who reeeeally want to be able to put their kids to bed at 8pm, and then go meet with clients for the next 4 hours, come home, and wake up with their kids in the morning. The trick is just going to be finding them. If your doc doesn’t know anyone in your area, putting the word out on the nurses bulletin board at the hospital would be another avenue.

 

[Mach123]

I tell them no that I don't need them. My state insurance contacts the work out. They pester me to death with calls so they can do the visit and bill the insurance. I got in an argument with them once. I wouldn't let her book the appointment and she was giving me a ration of sh#t so I was like look, I said no nicely, now I'm telling u bluntly. And I did. I just end up getting bombed with calls the day she comes as well and "I'm late and I can't find you." Way more trouble than it's worth. But I'm in a good situation and I'm safe with my family and my pdoc and so on. They probably help some people? IDK. It's a once a year visit.

 

[Justmehere]

Since your doc recommended it? That means he/she probably knows either individuals who either use psychiatric home care nurses OR a few of the RNs/LPNs/MSWs/LCSWs (socially) who do so.

I asked the doc about this and they said they didn’t know anyone. There are a lot of health care businesses short employees right now... but maybe I could do a Craigslist ad or something... I’m not quite sure how to network to the right person. I kept asking for any suggestions from all the places I call. I’m running out of any energy to keep searching. I know, only a week into it:,

There comes a point in which it gets to be more work and rejection than maybe it’s worth? Like maybe I’m better off on my own and not trying to do this. I’m seriously wondering if I need to move to another area before I can hope to get treatment.

If there is another way to find help. I get referred back to the same places that have turned down my case a lot and s lot of questions about that and I’m like uh, call them. They referred me to you. Around we go. People get adamant that xyz place will treat me when xyz place referred me to them! I ask for other options, change the subject to something more useful and around and around I got

When you are the patient, you don’t get as far. When I call and say I’m looking for someone that does this and I don’t reveal that I’m the patient, just looking for someone, I get further, but not yet far enough.

Way more trouble than it's worth. But I'm in a good situation and I'm safe with my family and my pdoc and so on. They probably help some people? IDK. It's a once a year visit.

I think my doc was looking for visits a few times a week on an on-going basis, until stability and other support shakes out.