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Have you ever wondered whether you can return a patient’s unused supplies? If you have, you’re not alone. Everyday, countless home health agencies are finding themselves in the same position, wondering what to do with unopened packages of sterile gauze, syringes, and the like. Considering the cost of supplies and the barely there reimbursement policies, the idea of a return policy can certainly be appealing. But is it legal? Read on to find out how other home health agencies are dealing with the case of the returned supplies.
Robert B. Thornburg, a Seal Beach, CA-based consultant for the home medical equipment industry, is unaware of any current regulations that prevent home care agencies from returning unused supplies, namely those such as disposable items, nutrition-related supplies, items worn next to the body, creams, powders, and so forth. However, he cautions, "that does not mean that there aren’t any."
To be sure, there are agencies out there who take back unused supplies, given certain parameters. An Illinois-based home care agency, for example, will take back dressings if they are unopened. Returned supplies are put into a "donated supplies" closet and given free of charge to patients with decreased monetary resources.
Naomi Rubenstein, RN, QA/clinical research specialist with Palliative CareCenter and Hospice of the North Shore in Evanston, IL, notes that her home care agency’s patients are always offering to return unused and unopened supplies. "It’s our policy not to accept any supplies," she says, "because we cannot [take] them from one patient’s house to another due to possible cross-contamination." However, she adds, "Our vendors will take back supplies that have not been opened and remain in the original, closed packaging."
Other home care agencies, depending on the source of their supplies, can send them back for a refund, provided that the supplies in question are unopened, in their original packaging, and the agency still has the original invoice from the time of purchase.
On the flip side, of course, not every home care agency can or will accept unused home care supplies. Some agencies refuse to take back these items because of fears of contamination. A nurse can wash her hands thoroughly, but it gets a little trickier when it comes to washing unopened packages of gauze.
Thornburg says his "universal precautions policy prohibits retrieval of any single-use item from a patient residence. Our policy states that single-use items like lancets and needles, disposable [items], items worn next to the skin, creams, powders, drugs, solutions, and nutrition-based items are not returnable to our facility and are to be left at the patient residence."
He explains, "Common sense dictates that any home health agency’s policy state only factory-fresh items will be delivered, and that no single-use item be picked up from a patient residence, even if it is still in its original packaging. "A good rule of thumb," he adds, "is to ask yourself: Would you want this product delivered to your home?"
As he points out, unlike medical equipment, "Which is nonporous and can be disinfected with appropriate virucide solutions and then thoroughly cleaned by a technician and tagged as such, supplies are packaged in porous and sometimes partially open boxes and bags."
Detroit’s Henry Ford Home Health Care’s official policy does not allow staff to recycle any supplies to other patients, "even if the supplies have never been opened, have not expired, or could be given to a patient with no means to obtain supplies," says Greg Solecki, vice president.
Lorraine Waters, BSN, MA, CHCE, director of Southern Home Care in Jeffersonville, IN, says that infection control is definitely an issue with her agency and its policy against taking back returned supplies. "Even though sterile containers are unopened, the wrapping can act as a vector for infection," she says. "What’s more, determining if the containers are truly intact might be very problematic as well."
Once these items have been left in an uncontrolled environment such as a patient residence, Thornburg explains, they are susceptible to insect infestation, pet dander, and contamination from infectious body fluids or drugs. From this point, he says, "proper disinfection and cleaning of these items is difficult, if not impossible. Asking staff to retrieve these items can further result in infestation of vehicles, organization storage areas, and future patient residences." As for patients and their families who insist on giving back unused supplies, Thornburg suggests that agency staff should make it clear that they are willing to assist patients in disposing of items, as appropriate, but that they won’t take them back.
Nor will Southern Home Care accept supplies once they have been in a patient’s home. "Our policy," explains Waters, "is that we do not take any disposable supply or medication back that has been in the patient’s home. The family is either to dispose of the items or contact one of the free health care clinics to see if they accept donations."
While Henry Ford does not allow the reuse of unopened, unexpired supplies, it has managed to find alternate uses for them, specifically on training mannequins. "I don’t think our risk of contamination or infection is too great with this population," Solecki jokes.
On a serious note, though, Henry Ford has continued to seek outlets for its returned supplies. As Solecki explains, "We used to be able to donate them to local charitable organizations to be kept in a supply closet for patients in need. Those organizations slowly discontinued the practice," he says, noting that there are one or two left who will accept returned supplies. "We then donated the supplies exclusively to World Medical Relief, who will no longer accept the supplies. Currently, we have a sister organization in the Ukraine who gladly and gratefully accepts the supplies. We make sure we only are sending unopened packages that have not expired."
Like Solecki, Rubenstein says that her agency staff "encourage our patients to donate the supplies to shelters or other organizations that can use free supplies."
Rubenstein says staff should estimate as accurately as possible what supplies they will need, and in what quantities, and order appropriately. Waters agrees and notes that her staff are encouraged to carefully monitor supply use so that only enough items are brought into the home to last until the next home visit.
In fact, says Thornburg, "Third-party payers and/or the patient have already paid for these [supplies], so they belong to the patient they were delivered to originally. It is uncommon in the industry for organizations to grant credit to third-party payers or patients for return of these items, and it is considered unethical for an organization to sell them more than once." The bottom line? Keep close tabs on what you dole out because once they enter a patient’s home, they no longer belong to the agency.
"Return of supplies to an agency, for whatever eventual disposition, could easily look like fraud," acknowledges Waters. "It could appear that the agency was reselling the items by re-issuing them to another patient. While careful documentation could prevent that charge, it hardly seems worth the risk."
And contrary to what one might think, Thornburg notes, taking back unused medical supplies isn’t the bargain you might think. "Actually, it can be more costly to accept returns," he argues. "One can imagine patients becoming outraged at finding out these items have first been in another residence and are soiled, infested, or otherwise contaminated. One of the administrator’s Ten Commandments is Stay off the evening news and the front page of the paper with negative news.’"
[For more information, contact:
• Naomi Rubenstein, RN, QA/Clinical Research Specialist, Palliative CareCenter and Hospice of the North Shore, 2821 Central St., Evanston, IL 60201. Telephone: (847) 467-7423.
• Gregory Solecki, Vice President, Henry Ford Home Health Care, One Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500.
• Robert B. Thornburg, Home Medical Equipment Industry Consultation, 1665 Crestview Ave., Seal Beach, CA 90740. Telephone: (562) 431-7508.
• Lorraine Waters, RN, BSN, MA, CHCE, Director, Southern Home Care, 1806 E. 10th St., Jeffersonville, IN 47130. Telephone: (812) 283-2602.]