Home Health-The good, The bad, and I'm getting out.

  1. I've been working in home health now for almost 3 years as a RN case manager in southern California. I'm posting this so those of you that are thinking about home health know what to expect and I'm basically just venting why I have a love/hate relationship with this job.

    First why I love it: I love autonomy and independence and not having my boss look over my shoulder at all times. I feel like no one is really watching me most of the time unless there are random chart audits or I accidentally miss a recert oasis. I get to drive around beautiful So cal all day, which most days is absolutely stunning. If I'm having a bad day, my car is my refuge and I can blast that radio really loud. I see about 5-7 patients a day and love that my current agency does not have me drive over 100 miles per day like my old one. I drive about 60 a day on average now. My patients for the most part are really appreciative and I develop a rapport with them and their families. I still use most of my med surg skills. I do alot of PICC lines, wound care, phlebotomy, gtube, and teaching, a few trachs here and there. Mostly it's teaching which I love.

    The bad: Every agency I've worked for is a disorganized mess. My supervisor does not remember her own name half the time. She will call me at all hours, text me at 630am for report on a patient I did not see, and call me on the weekends. Calls from co-workers and patients on my days off constantly gets on my nerves. I had last Thursday off and my phone rang every 15 minutes and I did have to take some of those calls. All agencies try to milk medicare patients to the fullest extent they can. I feel like I am a part of the problem and not the solution as far as medicare overspending. I was pulling into my driveway one day last week at 445pm (I work 8-5) and I get a call from my boss.."OH I forgot to tell you that admission for tomorrow actually needs an IV dose today at 5pm oops!." So that ruined my plans for the evening and that is typical. Typical example of disorganized non-sense that I have experienced with all 3 of the agencies I have worked for. 2 of these agencies are top 500 national agencies. I feel like I am a money machine for these agencies and they do not value me as a person who has a life outside of work. Last gripe, If i refuse to admit a patient because they do not meet medicare guidelines its a huge deal and I get interrogated by multiple managers as to what my rationale is, with the constant reminder that each patient they don't admit is a $4000 loss. Its all about money.

    So I'm out of home health starting next month by miraculous devine intervention. One of my dear friends who I worked with in HH, got out about a year ago and started working in an infusion room in a local outpatient clinic associated with a big hospital here. Her manager wanted to hire a HH RN as an assistant to two specialty doctors in a clinic/hospital setting, so she recommended me and I got the job. I had about 24 hours to think about it, happened so fast. This position would require that I become wound certified and I still will be doing infusion and teaching patients. I get to round with the doctors and work closely with them in developing a POC for the patients. Sounds like a great job and I get to use my HH skills and independence to my advantage. We will see, they always say grass is greener on the other side. Good luck in home health. I may be back some day.
  2. Visit lsvalliant profile page

    About lsvalliant, RN

    Joined: Sep '07; Posts: 242; Likes: 166
    Specialty: 8 year(s) of experience in acute care then Home health


  3. by   youngheartoldhead
    I read this and couldn't help but laugh....I'm laughing to keep from crying actually........ugh.....I feel your pain. many times i have had a rough day in addition to being behind in paperwork due to having no less than 3 packets a day , with reg visits and MILES.......just when you think you're about to be home free.........you get that dreaded call. that isn't disorganized, thats just inconsiderate. and yes, managers not only want you to commit fraud, but EXPECT you to. and that really hacks me off....because the government no longer just punishes the HH agency for the fraudulent acts, but they're charging the involved nurses with felonies. when they ask me to do things like that after I've explained that they don't qualify for HH, I just lOOk at them.
  4. by   St_Claire
    Good luck to you!
  5. by   paradiseboundRN
    Very well said! I have had all of these same problems and feelings. I tried to get out too. I spent one year working at Blue Cross doing telephonic case management. I thought I would die from boredom and claustrophobia in my little cubicle. Recently, I tried Intake at a HHA. This job entailed working 50 hrs/week and getting paid for 40. Now I'm back in school full-time. I don't know what the answer is. Good luck! I hope you find what you're looking for,
  6. by   tyvin
    The grass isn't always greener as you said...be careful what you wish for and all that good stuff. Money is the bottom line for most every agency. Times are changing very fast and new policies are popping up everywhere and basically we are finally finding out what's in the ACA.

    I know you will miss your autonomy and I hope this place will have your back. You're going to have a huge adjustment as far as answering to the powers that be and other staff. I pray you have a good staff to work with; that's what makes the difference.

    Good luck to you.
  7. by   Marshall1
    Thank you for posting this..I recently accepted a position that does not require weekends and was considering applying to HH for a weekend/PRN type position so I could pick up some extra time on the weekends my spouse works. A few of the ones I contacted where I live said they did have weekend needs but call was a part of the deal or I'd need to commit to every or every other weekend - even with PRN - that was a flag to me that they either over schedule weekend visits or don't have enough staff or both. After reading your post and a few others on here I think I need to find something else to supplement our income.
  8. by   netglow
    Hospice can be just as bad or worse for all the same reasons - plus GPS on your phone, which you are required to keep with you at all times at some places - so they know if you are home and within their grip on your day off...
  9. by   St_Claire
    Quote from netglow
    Hospice can be just as bad or worse for all the same reasons - plus GPS on your phone, which you are required to keep with you at all times at some places - so they know if you are home and within their grip on your day off...
    The GPS will not work if the phone is shut down. Take the battery out if you have to.
  10. by   MomRN0913
    I'm glad you found a position to get out of HH.

    I've been in it for almost a year. A miserable year. Overworked and underpaid. I wanted a work/ life balance, instead I got a work is life situation. I will do anything to get out and have my life back. All weekend all I have done is worried about the paperwork I am behind on. But I decided to give my off time to me and my daughter this weekend.

    I appreciate this very straight forward true post about HH.
  11. by   Blackcat99
    OMG!!!! GPS on your phone so they know if you are home and within their grip on your day off!Sounds like a terrible invasion of privacy for sure. I am so glad I have a job where I am not required to have GPS. I work at LTC and on my days off, I just put my phone on the "do not disturb" mode. My friends understand why I don't answer the phone on my days off and they just leave me a message to return their calls.Thank you for telling us about the reality of home health nursing. I will certainly avoid it at all costs.
  12. by   SweettartRN
    Quote from St_Claire
    The GPS will not work if the phone is shut down. Take the battery out if you have to.
    I do homecare also and on my days off, after hours, and on weekends, the phone is shut off. Period. And I don't take calls from my personal phone from work.
  13. by   paradiseboundRN
    Quote from Blackcat99
    Thank you for telling us about the reality of home health nursing. I will certainly avoid it at all costs.
    One person's opinion is not necessarily reality. If you read the first part of the post, she also had good things to say about HH. Like any kind of nursing, it has its good and bad. I worked in HH for 11 years and when I got sick of it and tried other things, they had issues too. Unfortunately, nursing has changed and every company, hospital, agency is trying to hire less nurses but expecting more work. HH is having a particularly hard time right now because the HH industry is growing so rapidly. Good or bad, this is where the jobs are and are going to continue to be. Nurses may not be able to avoid it at all costs.
  14. by   youngheartoldhead
    the problem with home care, whether its hospice or home health, that field attracts ***** in the management position. sorry, just no other way to put that.
    Last edit by JustBeachyNurse on Mar 26, '13 : Reason: edit out veiled profanity