New to Home Health- Making no money!

[shinyhappy1]

I've been working in home health since February and we are paid per visit. First of all, I feel like I have a very small caseload- sometimes, only 2 people a day. My supervisor says that's normal until I build a caseload and do more SOCs so that I have patients in my pipeline. She also says that, since I've never done HH, they want to make sure that I'm comfortable with OASIS and other documentation. We do mostly medicare patients, which she says can be very picky. I can kind of understand that; however, my first check was around $400, my second was around $900. and my latest check was around $600. I can't believe that other HH nurses are making this kind of money. I love, love, love my job. My only wish is that I could do it for more hours in the day, because I can't afford to stay at this job if it if the pay will remain this low.

Has anyone else had to deal with this ramping up period in home health? Is this normal? How long should I expect it to last?

[SaraTayRN]

Hello, I am new to home health as well. I have also been working since February and am in a building up period, but thankfully we have such a high census that I have been just shy of full-time points since I started. I do experience lulls when I have a bunch of discharges, but I just make sure to let the office know that I am at a low patient load and what days I have openings for SOCs. It will take time, but you can really make some great money with the PPV model.

[shinyhappy1, BSN]

Thank you! It's helpful to know that others are going through this as well. I applied for a job as an infusion nurse part time (so there's not conflict of interest). I figure I can do both to see if that gets me closer to my income requirements.

[inthecosmos, BSN, MSN, RN, APRN]

I worked in Hospice and we were salaried. Pay per visit seems to be a bit of a scam IMO.

[shinyhappy1, BSN]

inthecosmos:

I've heard some people say PPV is better, because of the almost unlimited potential, and I've heard others say that salary is better. It seems to depend on how busy your agency is and how close together your patients are. But, at this point, I'm inclined to agree with you.

[inthecosmos, BSN, MSN, RN, APRN]

inthecosmos:

I've heard some people say PPV is better, because of the almost unlimited potential, and I've heard others say that salary is better. It seems to depend on how busy your agency is and how close together your patients are. But, at this point, I'm inclined to agree with you.

I guess my fear is never having enough patients. With hospice, and I can assume other HH, census fluctuates. I cannot imagine not knowing what my paycheck may be. I guess that's why I feel it to be "scammy."

[Jedrnurse, BSN, RN]

I've heard that salary can be problematic as well, particularly when the agency overloads you with too many cases...

[Libby1987]

I've worked under all payment structures for 3 different varied companies over a span of 30 years and have friends who've worked PPV for another reputable large health care system. I've been treated fairly and made a commensurate RN income throughout my career.

Current company is hourly for field staff and provides 90 day orientation including competencies with a preceptor. RN case mgrs don't manage a full load until they reach 90 days, with extensions if needed. Productivity expectations are fair and reasonable. Outstanding benefits and competitive wages.

It's the company, not the payment structure.

[shinyhappy1, BSN]

I've worked under all payment structures for 3 different varied companies over a span of 30 years and have friends who've worked PPV for another reputable large health care system. I've been treated fairly and made a commensurate RN income throughout my career.

Current company is hourly for field staff and provides 90 day orientation including competencies with a preceptor. RN case mgrs don't manage a full load until they reach 90 days, with extensions if needed. Productivity expectations are fair and reasonable. Outstanding benefits and competitive wages.

It's the company, not the payment structure.

That sounds really reasonable to me, but how is one to know the pay structure before you accept the job when it's recommended that you don't ask about pay until you've accepted the job. By then, you've gone to a couple to interviews and everything, which is a huge waste of time, if the pay isn't worth it.

Basically, I'm asking: is there a way to tell which companies are going to compensate their nurses fairly before I get into this situation again?

[Kaisu]

I am paid by the hour (and it is a great rate) but I would make way more if I was PPV. I'm happy with my hourly rate tho. I can spend all the time I want with a patient and no one from the agency has complained about my productivity. I am in the process of transitioning from home health to hospice. If I wasn't doing that I would go to PPV.

[Libby1987]

That sounds really reasonable to me, but how is one to know the pay structure before you accept the job when it's recommended that you don't ask about pay until you've accepted the job. By then, you've gone to a couple to interviews and everything, which is a huge waste of time, if the pay isn't worth it.

Basically, I'm asking: is there a way to tell which companies are going to compensate their nurses fairly before I get into this situation again?

Who recommends that you don't ask about the pay structure? Of course you ask! Along with questions such as productivity expectations, caseload expectations, how census fluctuations are handled, overtime, how are unplanned visits assigned, territory, nursing/care model, how are patients assigned/scheduled, weekend and on call requirements, orientation and any oasis education, supervisory responsibilities, PTO, health benefits.. there is more but not enough caffeine yet.

Go into an interview with knowledge of the business, ask relevant questions, demonstrate your knowledge of disease management and documentation for compliance and reimbursement and what you bring to the company. If you have a warm enthusiastic personality to go with it, I'd fall over myself to hire you.

[CarterHolly, RN]

It has been my full time job for 10 years. I make VERY good money and am salaried. I make far more than i would in the hospital. 🤔🤔🤔🤔

[CarterHolly, RN]

This is why I would never consider home health a viable employment option. I believe all the home health agencies in my area are pay per visit. I know a few nurses that like it as a second income. I also know a few nurses that left it to return to LTC because they had no guaranteed income. If your patient is discharged for any reason, there goes that income along with the patient.

That sounds more like private duty than home health. Home health is pretty much guaranteed. There's always gonna be sick pts. I've been with my company for 10 years and I'm a single mom and make far more salaried than I would at the hospital. Trust me, it's not just a job for a little extra spending money.