What Does Your Agency Do?

Hi Jenny. i work for a hha in Iowa. we cover 7 counties. our current censes is 74 clients. we have facility adm who is an RN, a clinical supervisor who is an RN and myself RN case manager. we have 2 part time visits nurses and 2 part time hourly (private duty) RNs we also have one LPN and 60 aides/homemakers. we do MCD, MCR, all Waivers, private pay, insurances. currently RN visits avg 3 per day mainly because travel time between each can be up to 1.5 hours. the full time aides avg 8 hours worth of visits/homemaker hours per day, their travel time is less than 15 minutes. we pay mileage only after 21 miles is deducted, the avg person commutes 21 miles and doesn't get paid to commute so our company takes 21 miles off non-professional staff. i avg 125miles per day to cover my clients. some times it is a little higher because i'm the psych nurse for our agency and i may have to travel the extremes of our area. we just did a study on our admissions and for the past year we averaged 7 admits per month, these are just new clients, we have to dicharge and re-admit several long term clients several times a year. do not have a lot of overtime for aides except i really bad weather, snow storms etc. some staff will drive anywhere any time others are scared of rain. we don not get alot of MCR clients do dur extreme competition in our area and previous adm. lack of advertising VNA is just down the street. we tend to get the calls about pts no body wants and this has increased due PPS. we send gifts (candy, balloon thank yous etc) to MDs social workers etc to keep referrals coming. i also have a very good working relationship with the local child health specialty nurse who sends us MCD/waiver referrals

1. How many visits per day for RN's, Aides?
RN's 4-5 revisits and 1 new, LPN's 7 revisits, aides 5-6
2. Average number of miles traveled per day?
We cover one county, and it is big, but we have several teams broken into smaller geophrahical areas, a few zip codes each, I myself average 25-40 miles per day. Can't imagine 150 miles between visits. Books on tape must be great!
3. Average amt of admissions per month?
Not sure I heard it was around 60, in January we had 90
4. Average amt of overtime per pay period?
I don't know, but I get an hour or two each week. Some nurses are afraid to put in for it!
5. Have you noticed a decrease in visits with PPS in place?
Yes, most definitely. PT cuts off right at 10 visits usually. I wish I had a dollar every time I got a VM from PT saying "we did our ten", never used to be like that.
6. Tips on improving relationships with area physicians to keep the referrals coming in????
We don't have to worry about it. There are 2 other agencies in my county. One is very small, so they turn down a lot, the other is very hoity toity, so they refuse inner city visits or homes w/o air conditioning, so we take everything else. Sometimes I think we acept too many ridiculous referrals. MD's send us out to anyone who needs labs, even if they are not homebound. They don't mind having their friends take them to Atlantic city to gamble, but wouldn't impose on them to take them to the lab. Frankly, I wish some physicians would be banned from referrals for totally inappropriate reasons for referral. Our intake dept is not at all supportive OR efficient, so we always get a surprise when we get MD office referrals. Today I admited a man, no allergies sent and he has no idea what his allergies are, but he knows he has some serious ones! Now, don't you think the doc and office staff would know he is a poor historian and give us some useful info, like a med list?? We get a RX from a RX pad saying VNA, and our agency takes that! Don't get me started on our intake dept. There is a position open there now, and I would take it, but to work w the other total nasty B who is already there, I think I would lock her in a supply cabinet on a Monday and not let her out til Friday 4pm!!

we are supposed to be getting an intake "person" that i s going to handle the referrals for all offices (5) in the whole state. sounds like it is going to be a blast. rural home health has a very interesting set of challenges that city home health doesn't (and vice versa i'm sure)

I work for Managed Services Organization (MSO) that Manages 2 PA (opposite ends of state) and 1 NJ homecare agencies; I'm situated at largest one-City/Suburban covers 5 county Phila area

1. How many visits per day for RN's, Aides?
Aides are given clients to fill 8 hr day.
RN's: 7 pts/8 hrs; 1 admit =2 pts; WE 12 hr RNS get 10-11 pts
2. Average number of miles traveled per day?
25-50 miles ( My previous job I did ALL 5 counties at times in 1 day~125 mi/day)
3. Average amt of admissions per month?
Main office- 750+/mo with ~50 additional readmits
4. Average amt of overtime per pay period?
Dont know; guess 2hrs/wk
5. Have you noticed a decrease in visits with PPS in place?
No. WE have a mix of short term and long term here.
Previous agency managed Office of aging clients, so mostly long term there.
6. Tips on improving relationships with area physicians to keep the referrals coming in????
a. Get to know your main docs office patterns: which days and times are heaviest and avoid calling/visiting at those times. Write down name of office manager/RN and use that person to channel paperwork thru/important calls. Get backline tele # in case of serious problems--I would call that line 5 min prior office hrs starting with all of my grouped pt concerns/admit from previous day.

b. Think proactively first visit to avoid multiple calls to Dr.
Look in their medicine cabinet area/bag to get idea of ALL meds taken-include OTC meds on POT like pain meds eg tylenol. 75 % over age 60 have bowel problems. Instead of asking if they have problems with constipation ( many will deny as embarrased), I ask them how frequently are bowel movements, what medicines do they take to keep moving, and the impotance of fiber/fluids/ regularity to PREVENT problems.

If client alone/frail/ repeat admits--- I "Check refrigerator temp as recent patients sick from spoiled food" to see if any food present, outdated milk etc. Will recheck next visit to see if items moved or will discuss MOW outright "til stronger" and MSW Eval for county office of aging referrals for Options/Wavier services
"You know there are wait lists in the county and when YOU MIGHT need help, you'll be at the top". If they need help but decline aide and I suspect will change mind, still place HHA services on POT.

ALL of these concerns I discuss with DR on first call if not on intake/dc plans; if I can't reach DR discuss with office RN/Manager or leave on office voice mail with cell phone # for call back.

c. If patient came from large teaching hospital, I ALWAYS make contact with referring DR to make sure he will sign orders for POT, otherwise contact PCP, summerize problems and send POT to PCP.

d. Send note with clients main problems, requested chages along with blank drs order sheet with patient to drs appoint if known--avoids sending VO in mail.

e. 2 DRs won't sign POT/ VO unless hand delivered. I'd gather all outstanding orders of theirs from Medical records, call to find out what time to stop in; can be 5 min to 1 hr---bring in notes/update OAsis to start to avoid wasting time. I ACCEPTED won't be able to change these docs habits so don''t dwell on negative.

f. "Thank you gift" -former liason had this great idea: fresh breads. One of the local bakery's made different types fresh breads. She'd buy bags and colored tissue paper at dollar store, insert thick plastic knife in bag, maybe tub margerine or jam to offices every two weeks-month when dropping off plans of treatment---could get 5-8 gifts like this on her $25.00/month alotment. Her gift stood out.

g. Liason would also inquire if dr having any repeat pts/difficult ones that just might benefit from home care eval to fine tooth med administration. If PT referrals low, would tell office mgrs that we had openings for PT in their area that could do safety evals-- any patients in for fall assessment?? That might generate a referral or two.

Hope these ideas help.