Considering Home Health but not buying their story . . .

You don't need AOL to do a PM on allnurses.com. I don't use AOL either. At the top of the message where I replied to you, you'll see a little icon that looks like a pencil and paper (just under the red flag after my user name). Click that to send me a PM.

Agencies that only do Medicaid don't pay their nurses or aides very well, sadly. Agencies that do Medicare in addition to Medicaid generally manage to generate a little bit of revenue through the Medicare cases and take a loss or break even on the Medicaid. At the time that I did Medicaid visits, most of the nurses used it for a second job and not their primary source of income. Still, I was never at a loss for visits, since so many people qualify for the Medicaid program and it doesn't require the kind of documentation for recert that Medicare does. It really is often a program for life, since you're dealing with people who have chronic healthcare issues that need to be addressed. Some of the patients that I dealt with, for example, were quads who lived at home with family, a MR/DD teenager with CP, and a quad who required a hoyer lift for transfers. Most of my patients were younger, certainly below the Medicare age. Keep in mind that Medicaid is administered by individual states and may be different outside of MO.

Smitty, if you want to give it a try, ask if they can use you as a slim-PRN, maybe a couple of visits a week or some weekend visits. The agency I was with was always hurting for weekend nurses. That way, you can try it out and see if you like it. Money isn't everything, as you said, and that kind of nursing has always been very rewarding for me--keeping people at home rather than institutionalizing them when they really just need a little bit of help. Either way, good luck!

Oh, forgot to add that 15 years ago, I was routinely bringing home $750-$900/q2w only for mileage, and if I remember, it was reimbursed at $.33 per mile. Something like that. I would drive--in one day, mind you--from Springfield to ten miles past Bruner, to Republic, and then back to Springfield. Other days, I would drive from Springfield to Mt. Vernon, then Humansville, Bolivar, and back to Springfield. I often spent more time in the car than in the homes. But I loved it. So much freedom and autonomy!

My previous employer provided aides for personal care assistance funded by state medicaid monies.
Supervisory visits were required every 14 days in patients home: 1 visit in person with aide, other visit with just client to confirm no issues pt was too afraid to discuss with aide present.

Visit included:
a. Review of care plan in the chart matched careplan on refrigerator--- or did that care plan grow legs and missing again. Did care plan need to be adjusted due to change in pts health status?
b. Did aides notes match care plan?
c. Was aide showing up and staying for entire time interval supposed to be in home?
d. Was aide abusive to patient?
e. Did patient look well cared for, home reasonably clean and neat, food in refrigerator, current meds in home?
f. Any decline in patients health or unmet health needs that showed need for skilled visits?
g. Provide monthly verbal report to office of aging case manager.
h. Monthly medication prefills needed for some patients -but was considered skilled care under another program.
i. Provided monthly inservice topic to aides and was able to give them 1 hr credit.


I sometimes had 10 patients in one senior highrise ---could be in and out of patients home within 15-20 minutes and see all 10 regulars in one day. Other days, patients all lived in outlying territory and may drive 125 miles roundtrip and only see 5 paitents. Calling clients 2 days before visit to make sure would be home + reconfirming expected visit time afternoon before helped to eliminate missed visits.

I'd found pts in roach infested homes as aide didn;t show up for days and uneaten food from MOW delivery piled up next to couch.... forgetful souls signing blank forms and aide in and out in 30 min but wrote down 2 hrs.... wonderful aides who kept wc/bedbound paitents alive as only person patient saw as family abandoned them and aides did everything to keep them in their home and out of nursing home.

It was one of the most rewarding positions I had as able to make great impact on individual lives---taught me community resources that I was totally unaware of and added to my bag of tricks today.

Our agency pays approx. $30/visit for LVN's. Mileage is 0.50cents/mile, and yes it can add up quickly.

It sounds like the agency you're talking to provides Medicaid waiver services. These are services that are not skilled. Basically it is mostly aides helping give showers, light cleaning around the house. On top of that the patients get visits from a nurse for routine monitoring of the patients' conditions. (I should say that this is from what I understand. I work for a Medicare certified home health agency in MI and we refer a substantial number to the local Medicaid waiver program.) Good luck!

I have to tell you that I think you are not getting a competitive offer. I realize that rates of pay do vary depending on the region. However, your offer seems really low. My advice would be to conduct a salary survey. Go to salary.com and find out the rate of pay for your area. That websight isn't always correct but it will let you know if they are even close to what you should be paid.