"Fee Basis" Exemption for Home Health Nurses

[sweetsugar]

I've been a home health nurse now for about five years. One of the biggest complaints I have has been "why am I working so much and not getting paid for my time?" I searched through the various posts on this thread and I see that other home health nurses are having the same complaint. Last night, I did some research on the Wage/Labor site and found something interesting. Evidently, in 2004 President Bush changed the overtime laws for certain segments of the workforce. If an employee is salaried or paid on a "fee-basis", then they are not entitled to overtime. What does "fee-basis" mean? It means that no matter how many hours it takes to complete the tasks involved for that fee-paid visit, a home health nurse does not get overtime. We don't get paid for the ridiculous drive times, calling our patients to set up the appointments, all of the doctor calls, faxes and follow-ups. Most good home health nurses will agree that they put (on average) ten hours/day into their jobs. Most agencies require 6 visits/day. That is approximately 4 hours of work not being paid to the nurse.

Now that I "have seen the light" in this matter, I am at a cunundrume (???? spelling) about what can be done to change this situation other than to leave home health entirely. Most, if not all, home health agencies are skirting the overtime issue by taking up this "fee-basis" paid-per-visit (bullpuckey). For starters, I have written a letter to President Obama this morning. Are there any other suggestions other than just plain leaving home health? My personal opinion on this "fee-basis" overtime exemption is that it may have been geared to employees or contract personnel who are obviously getting paid an exhorbitantly higher fee for their services than the run-of-the-mill home health nurse. What are your thoughts?

[lossforimagination]

I've been paid by the hour and then switched to PPV and it came out pretty much the same, but no overtime is involved. The pay rate can be pretty good: SOC: $120, ROC: $90.00, Recert: $80.00, SNV: $35.00. I've seen people on salary and they have to work like 12 hrs/day to get their work done.

[salvadordolly]

I have worked where I was paid by the hour and they switched to per visit. I really didn't notice any difference in my pay overall.

[RNFL1991]

I am salary and I see 6-8 patients a day. I have a productivity of 30 per week. I don't even work 40 hours. I guess I have it good compared to some people.

[KelRN215, BSN, RN]

I don't think home health nursing visits really meet the requirements of the "fee-basis" exemption as it is written. The law says:

"Administrative, professional and computer employees may be paid on a “fee basis” rather than on a salary basis. If the employee is paid an agreed sum for a single job, regardless of the time required for its completion, the employee will be considered to bepaid on a “fee basis.” A fee payment is generally paid for a unique job, rather than for a series of jobs repeated a number of times and for which identical payments repeatedly are made."

Here is the law: http://www.dol.gov/whd/regs/compliance/fairpay/fs17g_salary.pdf

And the complaint against Amedisys: http://www.cohenmilstein.com/media/pnc/0/media.1220.pdf

[AnnemRN]

I will not take a per-visit position, salary only. In my last round of job-hunting, I wouldn't even interview with an agency that paid per visit and I told them that upfront. If enough nurses refuse to work per-visit, eventually companies will see the light. (Yeah, I must be smoking something.)

I must be smoking the same thing because that's exactly how I feel. I would love for us to collectively band together and refuse to accept any position that pays per visit. In reality, I know we need to work and that's the major reason why most nurses end up working for pay per visit companies or companies that take advantage of us. It's not realistic to hold out for something better if it doesn't exist in your area.

[AnnemRN]

I don't think home health nursing visits really meet the requirements of the "fee-basis" exemption as it is written. The law says:

"Administrative, professional and computer employees may be paid on a “fee basis” rather than on a salary basis. If the employee is paid an agreed sum for a single job, regardless of the time required for its completion, the employee will be considered to bepaid on a “fee basis.” A fee payment is generally paid for a unique job, rather than for a series of jobs repeated a number of times and for which identical payments repeatedly are made."

Here is the law: http://www.dol.gov/whd/regs/compliance/fairpay/fs17g_salary.pdf

And the complaint against Amedisys: http://www.cohenmilstein.com/media/pnc/0/media.1220.pdf

Wow!! that is awesome news. I hope they win this case, that will really shake up the home health agencies that pay per visit.

It will give nurses and ancillary staff some much needed clout. Thanks for posting it.

[netglow, ASN, RN]

Yeah. It sounds more like working for a temp agency but even less legit.

[lossforimagination]

I recently interviewed with an agency that paid per hour. The interviewer let slip that they had just had an audit by the TX Labor Board regarding pay-per-visit on the weekend. She said the Labor Board said they had to pay BY THE HOUR. I know most agencies pay-per-visit so not sure what is going on.

[homecareowner]

What Bush passed into law does not apply to home health registered nurses. I just joined a class action suit yesterday against my old employer for very issue. Basically the law states that if they pay on a salary or per fee basis and use this as the exemption of overtime rule, then they can not dictate how long it takes to complete a particular task. That is where agencies have manipulated the law to fit their immediate needs. The agency I worked for mandated that all visits had to be at least 30 minutes long. You can't have that mandate on time and then think don't have to pay overtime. Nursing is a job, just like any other. For far too long nurses have been a stomping ground for big corporations who know because of our good nature we will do whatever it takes to make sure our patients are taken care of. I explained to them when I worked there that they were wrong on their overtime policies. I was told no they weren't. I knew eventually there would be a class action brought against them. Sure enough it happened. I encourage all nurses to stand up for what you deserve and work for. This job takes a lot of people, personally and professionally. I was told yesterday that not only do they have to pay overtime, but the drive time does get figured in to count towards the overtime. Also, that all the on call time counted towards overtime as well. Agencies also can not have you call clients and not allow you to document that time as well.

[Libby1987]

I've been paid by the visit since 2007 (it has so far worked out well for me, but I have a consolidated territory) and I've always been paid OT. It's calculated differently than time and a half of hourly, there's some calculation they use and it usually works out to about &24/hr for every additional hour versus 1.5 times my hourly rate.

My company also reimburses for driving time over 30 minutes and will pay additional for extended visits that are beyond my control.

[Mom2boysRN]

I get paid per visit and if I chose to see as many patients as I was required to see when I got paid hourly/full time I would make considerably more getting paid per visit.