[ray2512]

Im sorry. We get $25 weeknights for carring the pager, $45 on the weekend. Then an additional $25 per visit in town and so on. We also get 48.5 cents a mile reimbursement. No additional for documentation time, but that only takes 10 minutes or so. So if I make 4 visit in town on weekend I would get $145 plus mileage. Total. Thats for 24 hours. Like Friday at 5pm to Saturday at 5pm.
The fulltime on call people get salary and mileage. I feel like we should just get a day salary just like they do, since we work all day then sometimes have to take call.
Some nurses although make a visit everytime they get a call if possible. Even if it only takes 15 minutes its still $25.

Originally Posted by aimeee

I'm not clear on your compensation....when you say you get Visit pay of $25 in town, are you saying that you get a stipend of $25 for being on call on a weekday and then if you go on a vist (which happens to be in town) you get another $25 for the visit regardless of how long it takes you, but no hourly pay (because you are salaried, right?) and then you get no additional reimbursement for travel time? And do you get reimbursed for mileage? And if you get $50 for an admission visit, does that mean you get no additional compensation for documentation time?

[lantanaRN]

I work for one of the largest not-for-profit hospices in the country and love it. Pay rate is good, I'm a case mgr, salaried, 30.00/hr with plenty of overtime if I want it. Am seeing a pattern of not hospice apppropriate admissions over the last year too..families use up the SN in home health and want the same from us. Case load should be 12-15 optimally, however our team has been carrying 78 patients for months, which gives us a caseload of 15-18, which can be quite demanding at times. Burden was lifted as of the first of this month, with the addition of a new team and the spreading out of the caseloads, however, it will soon be "season" and our census will continue to climb. Fortunately I feel very priveleged to be doing what I do on a daily basis, so when this happens, I just kick it into high gear, and take PTO when the emotional overload becomes too much.

[req_read]

It is both fascinating & appalling to read what goes on in some (many?) hospices. But you (nurses) are not entirely helpless.

Some hospices are examined by JCAHO. But all, I think, are monitored by the State (whatever State it might be.)

Typically, when a State investigator comes around, the agency’s management team works very hard at instilling a morbid fear in their staff and drills them on what to say… and not say. In reality, however, those people (investigators) can be your best friend.

You can tell your manager or administrator that you do not think a particular pt is hospice appropriate and in all likelihood you will be ignored, or perhaps even reprimanded. However, if you tell an investigator for the State that you think a particular pt is not hospice appropriate and they, in turn, confront your administration about it, trust me, they won’t be ignored or reprimanded.

Similarly, when the State comes around to see how your agency is doing and you (while riding around in your car engaged in PRIVATE conversation with that investigator) explain that your caseload is too high for you to provide good care, “stuff” will happen.

Nurses in general get dumped on… which has a lot to do with why there is a shortage of nurses… but nurses work within a system that has certain checks & balances. Those checks & balances are designed to help protect pts and nurses. Use them.

Also, while State investigators may not come around very often, I think that most State regulatory agencies have a hotline. In other words, agencies are visited on a schedule, but if someone files a complaint, it can trigger an immediate investigation. If a pt’s family makes a silly complaint; e.g. their dying loved one (dying of Ca) was not dialyzed, that’s one thing. But when a nurse working for an agency makes a legitimate complaint, that is something else again.

Michael

[KJB_65]

I know this thread is a little old but thought I 'd answer anyway.

I work for a not-for-profit Hospice agency. I make $52,800/yr salaried as a Case Manager. I have 21 patients which is way too many but I am told I must have 23 patients to get an LPN with me to form a team. I work 50-60 hours a week which when divided by my salary doesn't equal much of an hourly wage. We are on call 2-3 days a month with one of them being a weekend day. We have triage nurses that try to take care of what they can without sending us out. We make $70 visit for 0-3 hours and $90 for anything over that. That includes regular visits and admissions. We have a weekend nurse that is on call from Friday at 5pm until Mon at 8am. When we work a weekend day we are her back up and must be available 8-5. We make $50 for being on call + paid for each visit we make. During the week we get $25 for call. We get 44.5 cents per mile. We cover 5 counties when we are on call but your driving time is just counted as mileage not time working. During the week I start my day at 8am and finish when I finish at night. I never see patients and get my paperwork done in an 8 hour time. I always bring work home with me. We chart on computer and laptops are provided. It doesn't speed things up as I was hoping it would. It's MORE time consuming if anything.

[acesdaughter2]

I have worked for for profit at $22./hour with $.35 per mile, horrible insurance we totally paid for. No over time, take comp. time they said. Weekend call $50/day, after hours visit $45. Sucked!
I now work for non profit at $23/hour, $.47 per mile, insurance is paid 80%, $50 on call pay, no weekends call. We have dedicated LVN's that take front line call and we back up one day a week. LVN's rotate weekends with RN who works weekends only and we have LVN that takes call M-TH front line only. So that is all better. I did take a $6/hour cut in pay after leaving a hospital job. So, the pay comparably isn't so good, but we seem to be better taken care of. And our patients are high priority. Our director knows and follows the rules and P&P! And expects us to as well.

[curiousauntie]

Hi.
Have been working hospice for about a year. Started at $29/hr, NOT salaried, hourly. Get overtime for anything over 40. On-call pay is $50 a day, Mon-Fri, 5:00pm-8:30am, and $100 for Sat or Sun, (24 hours each day). Holiday on-call is $125. We have one "on-call" nurse who works Mon 5:00pm to Mon 8:30am, then is off for 7 days. The case managers (me, who works 5 days a week and 2 other RNs who work 4 days a week) take call on the week the on-call nurse is off. We set the on-call schedule and try to work it that we are never on-call 2 days in a row and rotate the weekend days to have a full weekend off every 3 or 4 rotations. (that means 3 weekends in a row every 7 or 8 weeks). We are paid mileage at 44 cents a mile, which is below the IRS rate, but you can figure that into your unreimbursed work expenses with your taxes. The on-call is expected to do admissions, weekend visits etc on top of covering for emergencies and deaths...Fine for the 4 day a week nurses, but I end up working 6 days a week when I am on call. BUT...I was able to save more money in 10 months then I ever have before, and then spent it on a new truck!!! My last job in long term care was $6 more an hour, but was salaried. I bring home $200-$400 more a week in this job making less per hour. My case load is around 14-16. For a month I only had 12, we had a rash of deaths and few admissions. We should make 4-6 visits a day, and since I have 4 patients on the same dementia unit in an AL facility, that day is the 6 visit day. If I want to take a day off when I have worked 10 or 12 hours on a Sunday, it usually is not a problem, I just rearrange my schedule to allow it. I love hospice nursing, more like the nursing I was taught 24 years ago in nursing school, and as far as I am concerned, a natural extension of the 22 years of long term care I have done...with the added perk of not being stuck in a building all day, never to see the sun. I also have never had such a high percentage of my families truly thankful and grateful for my work, caring and services. In long term care there is so much guilt that the families tend to be a bit snippy and you need to be so on your toes about everything to head off complaint calls the the state that you forget how wonderful it is to do your job to the best of your ability and have people see that. Of course there are the exceptions, but all in all I have not had any real "bad" families, or if they were, they were able to get past it to a good place for them and the patient.
Reading this board I have seen many posts about the changing that is happening in hospice, but at this moment I am so thrilled with my work that I think I can go with the flow. Especially as long term care, for an RN that usually mean front line management, is SO stressful and rules your life so much that I cannot ever fathom going back to it.

[NurseKatLVN]

I have had my license for a little over a year; been working at a SNF/LTC facility in Orange County, California for 11 months making $21/hr. Just accepted a Part Time/per diem position with a hospice company. Hourly rate will be $25/hr if I do continuous care. If I go out to visit patients, it's $30/visit. I'm new to hospice, but I wonder if I'm getting ripped off: it would take me 6 visits/day to earn the same amount I would for a day of work at the SNF.

[finn11707]

Wow!--I am fortunate. I make 52/hr as hospice casemanager--a caseload of 10---4 visit per day expectation -paid cell and mileage reimbursement at government standard soon (58 cents per mile) We have minimal colabrative support from management, but an in office advice nurse is available much of the time if something can't go to voicemail and wait. and we have a few nurses devoted to weekend and after hour work so we only occasionally are approached to pitch in there. We kinda get harrassed for claiming any overtime or reporting no lunch/breaks-- commonly missed. Still, sound cushy by comparison to all the responses.

[curiousauntie]

Originally Posted by finn11707

Wow!--I am fortunate. I make 52/hr as hospice casemanager--a caseload of 10---4 visit per day expectation -paid cell and mileage reimbursement at government standard soon (58 cents per mile) We have minimal colabrative support from management, but an in office advice nurse is available much of the time if something can't go to voicemail and wait. and we have a few nurses devoted to weekend and after hour work so we only occasionally are approached to pitch in there. We kinda get harrassed for claiming any overtime or reporting no lunch/breaks-- commonly missed. Still, sound cushy by comparison to all the responses.

Oh my God, what state are you in and are there any openings?????????
My case load right now is 19, soon to be 20. I make 31.50 an hour. I usually make 6-8 visits a day, and never feel that I can give the patient or the family the time they need. We have been understaffed (RN-wise) for the past 3 months. I have been working up to 60 hours a week, when the on-call is factored in (the time I have to be out actually on a visit, not the time on-call), 50-55 hours when no on-call visits, and our mileage is only 46 cents a mile. We do have a paid cell.

The only reason I am still there after this last 3 months of hell is that I love the other 2 nurses I work with and would never abandon ship at their expense. Thankfully, another case manager was just hired, but she will need about a month of orientation as she is not hospice experienced. AND we just found out that a second on-call nurse was hired to start in 2 weeks, so no more on call. I can handle the 19 or so patients, but it is the on-call that has been killing me.

So, now, once the new case manager is ready to start, I should see my case load go down to about 15, and am expected to do at least 5 visits a day. It will make the job a whole lot nicer and even more easy to love.

ps. Just read the post from December that I have a couple of posts above this one...see what a few months and a big jump in census will do?

[finn11707]

The philosophy of Hospice is very differnt from the home care philosophy. I don't see how an agency can use the same nurses and change the payor source and expect the nursing care to go from home care to Hospice. Perhaps I ramble too much but do you see these types of things?

Where I work now, I was driven crazy at first. The Hospice admission philosophy and guideline was so loose. Sometimes the patient had actually been told by the MD to sign into Hospice just for the help covering DME, meds and to have nurses checking in. Nothing about progression of disease and appropriateness given the 6 mos or less criteria! Of course it is a big HMO and the other was pure hospice. I have, however, grown to see the value of the broader qualifying referral criteria. People who are really really far along in progression of their disease get support and staff who understand and can, with gentlness, and honesty offer the truth. I once received a ESRD patient still on dialysis. I cried out in dismay "how do I do hospice nursing with someone attached to life support????" It was a really beautiful journey and death soon after. A big leaning for me. (But very intense work, for sure) I guess I used to want them to come 'preped' for my work...now I can trust the process and what Hospice offers.