Which is best type employer? Best HH websites?

  1. hi!
    which type of employer would you recommend for an experienced nurse returning,
    with refresher course, to home care? i am seeing opportunities in hh with vna, private,
    proprietary, hospital based, non-profit, etc... i am just trying to sort out the pro-cons of each.
    what should i be considering? what difference does "medicare certified" make?
    also, any suggestions for great home care websites for resources?
  2. 10 Comments

  3. by   paradiseboundRN
    I am surprised to see that no one answered you. I guess its because its a complicated question. Here is what I know from being in home care for 6 years and working at multiple agencies (often more than 1 at a time). Most of the hospitals have now opened their own agencies so that's where the patients go. Unfortunately, these agencies tend to be large, expect a high level of productivity from their nurses and they get a lot of referrals for the weekends. You will work at least 1 weekend a month, maybe more. The pay is also lower than private agencies. But at least you will have work. Here inMichigan, the smaller (profit) agencies are competing against the large hospital agencies. They are having difficulty getting referrals (patients) from the hospitals. Smaller agencies are nicer places to work (pay a little better) but you will be struggling to keep a full load. Less work= less pay. Also, the for-profit agencies are struggling to pay their bills (for the above reasons) so they may be borderline ethical just to keep the doors open. The only agencies in Michigan that are not Medicare certified are non-medical agencies. These agencies arrange for companionship/bathing etc. They use cna's. The only responsibility for the nurse is the inital assessment and supervisory visits. You will be bored with this fast. I hope I answered at least some of your question. I struggled with this problem myself when I recently went back to home care after taking a year off. I ended up at a large hospital agency. I like it but some of their process drive me crazy and cannot be changed due to "corporate". Oh well, at least I see some interesting cases. This is the best web-site that I know of for home care!
  4. by   paradiseboundRN
    I forgot to add that if you need a refresher in home care, you are better off with one of the larger agencies that will give you a preceptor and keep you on orientation for as long as you need. The smaller agencies usually do not have the resources to orientate nurses. Are you familiar with the OASIS? If not, you can find many sites that will explain it, including this one. Good Luck!
  5. by   caliotter3
    I've never been able to find another website on home care. As far as the different types of agencies, home care is home care. If you want extensive orientation, you can ask for it when you are hired, but once you have the hang of the agency documentation, that is about it.
  6. by   paradiseboundRN
    I respectfully disagree. The documentation may be the same but the training will not be. The smaller agencies have never been able to spare the time to really train me to their paperwork. They are so anxious to get an "experienced" nurse out in the field to make them money. They will tell you, "Just go see the patient and we'll answer questions as you go along". I was very surprised when I started at this hospital based agency. Even after 6 years in home care, they taught me some things I didn't know. And they are comfortable hiring nurses without home care experience, so many agencies just won't do that right now.
  7. by   RubyRN,CHPN
    I have worked at both not for profit private and hospital based home health agencies. Hospital based in my area pays 50 percent more hourly than not for profit in my area. With 50 percent more pay there is the accountability of meeting a productivity standard which probably comes more easily with experience. Paper work is pretty much all the same. At the smaller not for profit agency there was no productivity standard, no personal accountability to meet a productivity standard and the constant stress of being micromanaged by management. Would much rather see a couple more pt's. a day and keep the bosses off my back than to make squat and be harrassed all the time by the bosses. No brainer for me, I know where I want to work.
  8. by   1RRRN
    Thanks everyone for your input. Re. Michigan nurses...what do you know about
    http://www.residentialhomehealth.com/careers.php? Looks like an agency with
    alot of perks. But, it was good advise to consider volume and continued clinical
    support. I like to problem solve and am pretty good at recognizing my resources.
    I'll be doing clinical practicums at the site of my choosing. The mission statement
    is going to weigh heavily on my decision. I'd rather have a positive work environment
    than $. I also like the idea of maybe multiple agencies, once I get going. I think that
    helps to stay a bit above the fray. Thanks for responding!!!
  9. by   paradiseboundRN
    I have a friend who is one of Residentials marketers. I guess that what they call her. She writes up referrals from SNF's etc. She was the clinical director for 10 years for an agency that I worked for. In the end, the agency screwed her over and Residential scooped her up fast. She is very good at what she does and she has an awesome personality. She gets plenty of job offers, but she stays with Residential. I think she has been with them about 5 years now. She likes it a lot. I have heard only good things about Residential.
  10. by   1RRRN
    Thanks, "Paradise" for sharing your insight and knowledge. Much appreciated.
    I'll stay tuned.
  11. by   nursemarion
    I have worked for a small private for-profit agency, a large national for-profit chain, three hospital-based agencies. I will never, ever work for a for-profit agency again. Hospital-based is far, far better. Normal work conditions, all the resources you need, good inservice training, and a feeling of ownership of employees. You can transfer into the hospital and cross-train if you like. I have nothing good to say about the large for-profit agency that I worked for, except that the nurses were paid well. They treated everyone like dirt, fired people all the time, and accepted cases that were not suitable and should have been denied. I wish they would go under or lose their license. Medicare certified means they can take Medicare cases. One that is not Medicare certified would only take selective insurances. This is not a practical way to operate and I would be leery. The small for-profit agency I worked at was personalized and they treated the staff like gold, but they did not get enough referrals to make a go of it for very long, so they sold out to the hospital-based agency where I am now.
  12. by   paradiseboundRN
    I found that's the biggest problem with for-profit agency. They are so hungry for the money that will accept any case. This includes Medicare pts that are not homebound and pts that should be in a nursing home. I got tired of fighting with the owners re: Medicare Regulations. And if the patient refused services (for whatever reason) they were angry at me for not "selling it". I agree that these agencies need to be monitored better by Medicare.