How can we see patients in 8 hours???

  1. Hi,
    I am a new case mgr for home health. I live in Northern Ca.
    I have 5 credits/day. I travel an average of 15 miles per pt.
    We are supposed to see pt's within 8 hours and when I break this down, it's nearly impossible. I get paid 20/hr and .35 per mile.

    Admit- 3-4 hours (2 credits)
    3 other patients: 1 credit each
    30 minutes in home, 40 minutes for paperwork, 15 minutes to travel.

    Not to mention in the morning we have case conf. for 1/2 hr and many phone calls to answer.

    I need at least 3 hours in office in morning, then I see my pt's.

    I have about 10 hours (2 overtime) everyday and I told my supervisor that I need this much time to get everything done.

    It sounds like you all may have it worse, so what would you suggest? Please tell me how you all are managing? How many pt's do you see per day? How long does it take per pt. (including assessment, paperwork and driving)?

    I love seeing my pt's but this OASIS/paperwork stress is about burning me out already.

    thanks, Wendy
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  2. 4 Comments

  3. by   GreytNurse
    I did home health a few years ago......boy, if I got paid what your getting, I'de still be there! Some days I had up to 13 pts to see, got paid $6 per visit and 26cents a mile. No overtime. My days usually lasted 10-12 hours and then had tons of paperwork when I did get home. I saw pts. in a 65 mile radius and drove 68k miles in one year.
    I wish you luck. All nursing fields right now are crunched. I would say to let your manager/supervisor know your feelings and hopefully they will understand that this can effect pt. care.
    Good luck!!
  4. by   Brownms46
    When I did Home Health visits in 1988 to 1992, I drove 70 miles from my home in a rural area, where I had brought to get my kids away from the NY gangs. I drive round trip 140 miles QD 5-7 X's QW depending on when I did weekends. I made 15/visit weekdays, and 20/visit weekends...with 28cent for mileage. I saw on an average of 5-7 pt per day...in a 200 mile radius! It also used to be in Medicare if the pt. saw the MD that day you didn't need to make the visit. So sometimes depending on the week...I could have as little as 3-4 visits a day. I think that has changed now.

    Here is how I did it. My office was in the middle of the City so to speak...and my territory was at the cities edge on my way to my office. So I would make my visits as I came into my office...making a circle. Meaning at the end of the day...I was closer to my home than my office. First I would check out any supplies I may need for the next day...and get those before leaving the office...which was usually around lunch time...and when it was less crowded in the office...and quieter. I would make whatever labs/MD calls needed during this time...as I would have already visited the pts...I most needed to see before coming into the office...and have dropped thier specimens off before going on to my next pts. I also would call my pts. before even leaving my home sometimes to make sure they were hydrating themselves, and or had their arms wrapped in a warm towel for the difficult sticks. It made the visits go a lot faster...and I was usually in and out at the alloted 30 mins time required for medicare visits. I tired to adhere to the "circle" as much as possible. I would ALWAYS try to be a far away from the office as possible at the end of the day.

    As for paperwork....I tired never to leave a home...with paperwork unfinished! When I left the home...paperwork was completed if at all possible. Yes...I realize that Admit packets take a lot of time...but why bring it home...when your're right there were all the information is?? While working home health I was hit by a unlicensed teenager...and I was made the team leader for my team for the year that I was unable to work in the field...and I did QA on a lot of admission packets. Too many times this was the down fall of many nurses....who would procrasinate about getting the paperwork done. But those who didn't procrasinate...and really familiarized themselves with the paperwork...could whip those admit packet together in no time. I think you just have to make a plan to organize yourself...and you get better with time. Home health was the longest perm job except the military/gov...that I have ever held...and I think I would have stayed in it longer...except...I hate to DRIVE! If I hadn't brought my house in a rural area...I still would probably being doing visits. I know a lot of LPN were thrilled doing visits!

  5. by   hoolahan
    I replied to your post in home health forum.
  6. by   grouchy
    I disagree with the poster who thinks you just need to get organized. I think the problem is the situation, not you. I worked per diem for 2 different home care agencies in Connecticut for 2 years. I was also briefly a part-time case manager. Nurses at both agencies had case loads and territories similar to yours. Both agencies paid case managers salaries with no overtime. At both agencies, ALL the case managers were putting in signifigant amounts of unpaid overtime. At the agency where I was briefly a case manager, about 2 hours a day of unpaid overtime was the norm. I once spent an entire 8-hr UNPAID day in the office and was still behind on my paperwork. When I left in 10/00, it looked like home care was going to become more difficult, as we would have more responsibility to teach reluctant/unwilling patients and family members wound care and diabetes care,etc.(when we previously would have been able to continue seeing them, with the nurse performing wound care,etc}, allowing us to discharge patients much sooner. Obviously this would require longer visits, and even more paperwork documenting our efforts if they still couldn't or wouldn't learn, and thus, even more overtime.

    Can you obtain insurance through a spouse and work per diem? This increases the pay and decreases the workload. I worked per diem because of my family responsibilities, and paid dearly for the privilege. First, I exhausted my COBRA coverage, which cost about $2500/year. Then I obtained catastrophic medical coverage via Fortis Insurance with a $1000 deductible for approx $500/year.

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How can we see patients in 8 hours???