Frequently Asked Questions
Q: Do you have an office or private room to see patients in? If not how do you handle HIPAA and patient rights to confidentiality?
A: We rarely have an office or private room provided for us. We have to see the patients in their rooms, in the dining rooms, sitting rooms, etc. HIPAA does not apply to this situation since that involves medical records and this issue involves patient’s privacy. The clinician asks the patient where they want to be seen. If they are fine with being seen in their bed with the roommate in the room that is their choice. If they want to be seen in the dining room or a sitting area, as long as they agree to that it is not a violation of their confidentiality.
Q: Do you have a daily schedule?
A: Each clinician has a list of patients to see each day. However, there are no specific appointment times set for each patient. It is up to the clinician to find the patients when it is convenient and see them during the day. Once you learn patients’ schedules (i.e. physical therapy times, smoke breaks, meal times, etc.) it becomes much easier to coordinate the schedules of your patients and get everyone seen in a timely manner.
Q: Am I responsible for getting my own referrals and/or do you guarantee a certain number of patients?
A: We have regional managers and district managers who work with nursing homes to build the referrals at the home. When a clinician is hired we have a list of homes to go to and patients to see and we will make sure the clinician has enough patients to see. However, it is important that the clinician fosters a good relationship with the nursing home staff to ensure getting more referrals.
Q: What issues/diagnoses are most common in the nursing home patients?
A: Depression, anxiety, and adjustment disorders are the most common. In addition, there are a lot of patients with dementia and some sort of behavioral disturbance (i.e., aggression, sexually inappropriate behavior, noncompliance with ADLs). There are also some long term psychiatric patients with diagnoses such as schizophrenia, bipolar disorder, and personality disorders. Some nursing homes have mostly older patients but some have younger, psychiatric patients.
Q: What is involved in supervising extenders?
A: According to Medicare guidelines, an extender (LPC, NP) can be billed under licensed psychologists and psychiatrists under “Incident to”. This is a Medicare billing issue not a state licensing issue. The LPCs and NPs are still working under their own license. However, the licensed psychologist and/or psychiatrist must provide on-site supervision. This involves being in the nursing home the same time as the extender. Seeing all patients prior to the extender seeing them and signing all notes by the extender.
Q: How many times a week do you see the patients? Or you mentioned that you see patients twice a week, isn’t that too often? I am used to seeing patients once a week.
A: We see a large percentage of our patients twice a week. How many times a week we see them is based on medical necessity, clinical complexity of the case, and stage of treatment process. Usually when patients are first referred for services they are seen twice a week. Once they have stabilized and have been seen for a while they may be changed to once a week. However, keep in mind that many of these patients are suffering from multiple health problems, possibly dementia, as well as various psychological problems. In addition, the nursing home environment is a more structured environment for patients who cannot live on their own. Many of these patients would have to be placed into inpatient treatment if they cannot be managed in the nursing home. In inpatient treatment, patients are seen 5 days a week, multiple sessions a day. The nursing home environment is between inpatient and outpatient (where the patient is seen only once a week).