20 Years in Homecare Traveling a Path to a Modern Homecare World

Diane Piccard, RN

Diane began her homecare career in 1982.  Before that, she worked in long-term care, but was dissatisfied with that type of nursing and patient contact.  A friend suggested that she apply for a spot in a homecare agency.  “It’s got to do with Medicare and I know you’ll be good at it,” her friend said.  And Diane has been.  She just loves Medicare. 

Here are some of the things she remembers over her 25-year career:
• Her first joint visit during orientation.  The patient had been out of the hospital for many weeks.
• Her first experiences with pediatric homecare.  These chronically ill children had spent most of their lives in an institution.  It was thrilling to see them in the home environment, blossoming and doing things they were never supposed to do.
• Billing directly to the federal government through Office of Direct Reimbursement — no intermediary.  It was quite a change when her corporation started dealing with Blue Cross of Wisconsin.
• The evolution of the 485.  She recalls the first version of the HCFA 485 when agencies received a huge stack of the new forms, only for implementation to be suspended at the last minute and those forms discarded.  Taxpayer dollars at work…
• The continuing challenges of documentation.  Just the other day, she saw a 12-page plan of care. 

One thing she loves about homecare:  The gratitude from the patients.  They have so much trust in their homecare nurses.  Her words of advice to staff:  You need to know why you’re doing what you’re doing.  If it’s because of regulations, then know what the rule requires.  Don’t go beyond that unless there is a valid reason. 

Diane is Senior Director of Field Clinical Operations for Interim HealthCare, based in Athens, OH.  Her responsibilities include education and on-site support for Interim offices.  She is a member of the Beacon Institute and finds that it makes training senior staff and managers so much simpler.  She “absolutely loves Homecare Q&A.”
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Donna DeBlois, RN, BSW, MSB

Donna fell in love with homecare during her rotation in nursing school.  That’s when she knew this would be a more diverse and exciting type of nursing.  After starting in 1982 as a field nurse in Missouri, she moved back to Maine and began climbing the ladder to her current position as executive director. 

Here are some of her memories:
• Her first visit.  She had a flat tire.  She remembers being shocked at her patient’s socio-economic plight.
• Her first experiences with pediatric homecare.  In the late 1980s, an illiterate 20-year-old mother took her 2-year-old daughter home to die.  The little girl had never been out of the hospital, but with homecare support, the mother was able to manage a feeding tube, IV line, oxygen, and more.
• Fighting the intermediary about capricious decisions resulting in a 50% denial rate.
• Her rural homecare agency adapted technology quicker than many local hospitals, such as a port-a-cath, telehealth, and electronic records.

One thing she loves about homecare:  the collaboration between disciplines resulting in the provision of incredible care.  Her words of advice:  Work together as a team.  She has been impressed by how much is accomplished when disciplines collaborate (something that doesn’t happen in hospitals or nursing homes).

Donna is Executive Director at Kno-Wal-Lin Homecare and Hospice in Rockland, Maine.  Her agency, a member of the Beacon Institute, received the OCS Vision Award for its work with clinical outcomes and reducing hospitalizations