Home Health agencies paying nurses per visit - page 2

I was wondering how many home health nurses are hearing that agencies are leaning towards paying per visit instead of hourly in order to save money. I definitely prefer an hourly rate, but all the... Read More

  1. by   ALHHRN
    We are paid by the hour with no mention yet about getting paid by the visit. I have worked 3 years at this agency. Before I worked 12 years at another agency that kept changing names and got worse each time. If you work for a for profit agency you will donate a lot of your time to their fat profits. It sounds good for an agency to say they will pay you $30-40 a visit and a visit can usually be done in 45 minutes. What you don't realize is that this may include you travel time too and if you are working for one of those Walmart type home health agencies that are trying to buy out all the small agencies and monopolize the business, they will send you 60 -70 miles for a visit. They will not pay you for scheduling time, follow-ups, or any other office time you will have except maybe for mandatory meetings. In the early days, pay by the visit from a non-profit agency was wonderful. But since BBA, the visits are further apart. Also there is much more documentation and audit trails to complete now. Be careful with agencies that pay per visit.
  2. by   teaka
    I have been working as a per diem nurse getting paid per visit. The money sounds good but when you add the wear and tear on car and time spent at home finishing paperwork I'm not sure it's better. Plus, at the agency I currently work for (for a few more days) per diem nurses get no benefits. I am getting ready to start working for a hospital based HH as a regular part-time employee. The pay overall is better and the milage is almost $0.10 more/mile. And, I'm pretty much guaranteed hours plus I'll have benefits. As a per diem nurse I don't always get enough work. Also, if you work and get paid per visit, those days you are the one driving 100+ miles and only see 3-4 patients, it's not worth it. Been there done that. That's why I am going to an hourly position. I would rather be paid for my long drive times. That's probaly why in a previous post the nurse was saying the per visit staff only worked locally - maybe the per visit staff won't drive the distances. Although, it would actually be more cost effective for the company if they did.
  3. by   Nurseonwheels
    Paying per visit rather then per hour will generate more income, at least it does in Canada. I would never make as much money working in the hospital, no way. Your experiance and ability to do things quickly will allow you to take on more patients and thus make more money. In canada, hourly rate usually equals that of one visit. If you are paid per visit, you can often see 2 patients in one hour. Your hourly rate has just doubled. The beauty of home care. But don't count on it happening all the time. Some patients are easy while others can be heavy. Overall, beats hospital pay.
  4. by   indigo girl
    Quote from Nurseonwheels
    Paying per visit rather then per hour will generate more income, at least it does in Canada. I would never make as much money working in the hospital, no way. Your experiance and ability to do things quickly will allow you to take on more patients and thus make more money. In canada, hourly rate usually equals that of one visit. If you are paid per visit, you can often see 2 patients in one hour. Your hourly rate has just doubled. The beauty of home care. But don't count on it happening all the time. Some patients are easy while others can be heavy. Overall, beats hospital pay.
    I left homecare in 1997 due to an out of state move. My homecare experience was in a city, and I was paid by the visit at first. My choice was to work almost every day although I scheduled fewer visits on weekends. I was single and loved my work. Because this was in a city, many patients were clustered in the same areas. My travel time was decreased. As you say, sometimes you can see see more than one patient per hour, depending on what was needed. I hired someone to type my notes. Life was good. I made very, very good money.

    The agency was sold to a group. Corporate nurses appeared, and made changes. They switched us to an hourly rate, and limited the number of visits we could make per day. My income decreased markedly.
    I took on a second agency that paid by the visit to compensate.

    I loved homecare better than any other type of nursing. It is a pleasure to help people to recover from illness at home. I love to enable people thru teaching changes in lifestyle, and explaining illness and the reason for meds. I think that it is the redundant paperwork and the distance between patients that keeps me from going back to that environment. Now, if I was in a city again, I would seriously consider doing this.
    Last edit by indigo girl on Mar 12, '07
  5. by   PCUSheryl
    From reading the posts in this thread, I can see there are so many differences in home health agencies! Just thought I'd log in how it's done where I work.

    Full-time RN's are paid salaried, depending on experience, and according to a grid. I had been a nurse for 2.5 years when I came to work here, so relatively new nurse with no HH experience, my pay was the same as in the hospital. I am satisfied with that. Although, actually took a large cut in vacation time. The hospital paid over 4 weeks per yr in PTO that accrued every pay period. Here, it's a little more than 2 weeks PTO.

    I'm on call every 5-6 wks on weekends only. There's an RN who takes call every weeknight for us (LOVE it!). So we're paid $50 per day when on call, plus per visit for any visits. Any Oasis visit is $65, that includes DC and RC! Routine visits are $35. And then mileage is $0.395/mi. On weekends, there's an RN and LVN on call. LVN's do all the routine visits unless she can't for some reason, then the RN does it. It's only happened to me 1x in 7 months. The only thing is when you're on call, you can just expect to be working. I have 4 Oasis to do this weekend. I can do them all today or spread them out over 2 days. Also, one of the visits is a "pre-assessment", not even an Oasis, just someone who is not happy with their current HH and wanting to talk to an RN about our agency, and be assessed. I am paid $65 for this visit, which probably won't take an hour to do.

    Right now, we are one RN short, and so we're working pretty hard, it's a challenging pace, although, it's not anything close to the stress and fast pace of the hospital. The agency is flexible with the nurse to a certain degree, as much as they can afford to be. I am pretty happy where I'm at. I hope it stays this way!

    Well, I hope that my post shows you that there are some good agencies out there, just keep looking.
  6. by   PCUSheryl
    I forgot some things:

    During the weekdays, I usually am scheduled to see anywhere from 2-5 pts per day. Although if it's 5, they're usually maybe only a recert and the rest routine/aide sup visits. On days when it's 2 visits, usually both are Oasis, but not necessarily, sometimes it's 1 Oasis and an aid sup. It's not too bad in my opinion. The area we cover is within a 50-60 mi radius of the office. Those days when I have to see someone 50 miles away, the scheduler gives us fewer visits. My daily mileage is anywhere from 30-140 miles (a heavy day). Although usually around 60-80 miles.

    A typical day is I call my patients for the day, then finish up Oasis/charts until around noon. Eat a quick lunch at my desk, then go see pts. Usually finish up between 4:00 and 5:30.

    All in all, I am feeling good about my job most of the time.
  7. by   DutchgirlRN
    Quote from AnnemRN
    That way, no matter how much time it actually takes the nurse the agency only has to pay one flat rate.
    AND.....They don't have to pay any overtime!!! I never got any anyway because I'm quick but for those nurses who are slow at visits and slow at charting they were really wracking up (abusing the system) the overtime. I don't like being punished, going per visit, because of those who abuse the hourly system. I bet they'll speed up now or quit. I hope they quit.
  8. by   DutchgirlRN
    Quote from AmPmRnoncall
    My agency payes all of us nurses by the hour. I make 25.00/ hour with a 0.43$/mile. I am responsible for up to 3 counties but if I am oncall, I'm responsible for up to 10 counties. I get 25$/ night week night for carrying pager and get my hourly rate if I get called out. I get 50$/ day on the weekend for carrying pager plus my hourly rate if I need to go out. If I take charge nurse, I get 50$/weekday night and 75$/ weekend. I can really rack up the bucks with call. I work 32 hours per week and expected to do about 20 visits/ week. I also get paided for all my paperwork time. I try to organized myself, so I'm not spending all my time on my paperwork.
    I used to have that sweet deal and I never abused it or lied about my time or mileage. I have to be able to sleep at night. We also got time and a half for any visits after 5p or on weekends, including the mileage from the time we left home until the time we returned. Time and a half for charting those off hour visits as well.

    I am really angry about going per visit. Not because of the change so much, because it's come about because of all the overtime being paid out to nurses who do stretch out visits and charting time to make more money. Greedy will get them nowhere in the end.

    We still get full benefits, mileage and cell phone. $15.00 bonus for any visit over 24 miles one way. I think in a difficult situation at least they are being fair. They broke the news on Wednesday. We start it tomorrow. One branch had all the nurses walk, another lost about half the staff, in my branch everyone but me and another called in sick on Thursday. I really didn't feel good that day (headache, cramps) but did want to call in with what all was going on. I'm going to give it a fair shake. I just can't physically or emotionally go back to 12 hour shifts. I'm not the major bread winner for our family so I'll be fine.
    Last edit by DutchgirlRN on Apr 1, '07
  9. by   pjs91n
    I am an LPN working in NJ and I do one home case a week it takes me one hour per day I make $30.00 dollars/hr. Sometimes they will call me to pick up another visit. This works well for me because I also do agency and per diem work. My visit money is my pocket money.
  10. by   CapeCodMermaid
    Several agencies around here pay per visit. The one I work for pays hourly. We are expected to have 5-6 visits/day. As you know, some visits take half and hour and some take an hour and a half.
    I don't think I'd do this if they changed to per visit pay.
  11. by   DutchgirlRN
    i was so angry! today. it's not so much about the change to pay per visit, it's more about how it was just sprung on us, no warning, they didn't have any of the details worked out at the time. everything we asked, "i don't know". now i hear the owner, an rn, wants to talk to all the nurses. i won't be there, it's a little late for that now.

    one branch had all their nurses quit on friday, the main branch had several nurses quit on friday, i don't know about the other 6 branches. the other branches weren't even told about the change until friday and it was effective this morning!

    so....this morning i go in at 8:30, we were told that when we got there our schedules would be complete, our wound care supplies, venipuncture supplies, lab slips would be filled out and our clinical summaries and mapquest would be waiting for us to we could get there and leave right away. not only was nothing ready, another rn was refusing her assignment so i got stuck with it. 4 regulars and 1 admit in nashville (146 miles round trip) driving time no longer being paid. i had to hang around for 2 hours while they got the clinical summaries and the intake from the nashville office. i was livid. i wasn't getting a dime at this point. i threw a fit and demanded to get paid for those 2 hours, that was ok'd by the don.

    finally, i get the paperwork. i start reviewing.....ok, 5 patients i've never seen, lots of info missing, first off no mapquests. i go into my computer. the patients were never entered after being admitted over the weekend. i had no diagnoses, no med lists, no orders, no intake on the new admit, nothing. i pitched the papers on the don's test. "i'm going home, this is ridiculous, i need a mental health day, i cannot do this".our faithful care manager had called in sick as well as two other nurses. the don said "who will see these patients", panic on her face, "um, you know what? i really don't care". fine & dandy the nashville office needs help, can they not even finish their admissions from the weekend? gees. she said "well they may have to help us out someday" yeah, like that would ever happen.

    i ended up doing the visits but not before she agreed to an additional 4 hours pay for the day. tomorrow's schedule looks ok. if they dare change it due to call in's or whatever i vow to not work. i'm not touring middle tn again tomorrow. this situation is just too much. so poorly handled by administration. i hope alot more nurses quit, i bet they will and i may be one of them!

    thanks guys for letting me vent.
  12. by   runrn
    Quote from AmPmRnoncall
    My agency payes all of us nurses by the hour. I make 25.00/ hour with a 0.43$/mile. I am responsible for up to 3 counties but if I am oncall, I'm responsible for up to 10 counties.

    I am wondering: with having to cover 10 counties...how does that work with the 50 mile radius limit that is imposed on most agencies.....in louisiana, our rules say 50 miles because they dont feel you can effectively manage to take care of patients needs if they are more than 50 miles away...not sure what your rules are just curious.
  13. by   floridanurse65
    Quote from DutchgirlRN
    Thanks guys for letting me vent.
    I can't make it better for you but I do understand. The agency I had worked for previously also gave us no warning that we were going per visit. Everyone was angry about the change though no one quit because we were the last agency in town that had remained salaried. I never spent a minute more in that office than I had to after that. They weren't paying for my office time any longer. I eventually resigned due to a pathetic census. I went from an average of 35-40 visits a week to maybe 15-20. I couldn't pay my bills. I send you best wishes for whatever you decide.

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