Hospice Case Management question

[Marshall1]

I looked through posts but didn't see anything that answered my question..which is this:

How many days/week would be involved (on average) in case managing 7-8 hospice patients? I was offered a FT call and a small case management position but declined because I felt it would be doing two jobs for the price of one. The agency has come back to me and offered me the case management portion as there is another nurse that wants to do only call. I'm seriously considering this, for a variety of reasons, but am unsure how much time is involved. I did ask the hiring manager & he basically said 2-3 days/wk average once I get through orientation which is based on the nurse and how he/she does - there is no set orientation phase. They want an answer by the end of the week.

The agency is aware that for now, at least, I do not want a FT position but do need something that is part time/consistent & he tells me a case load of this size (compared to 18 average for FT nurses) would give me what I'm looking for & allow the other nurse to go to FT call. I worked hospice years ago and really enjoyed it. I just want to understand more fully what I'm getting into - my last position in hospice was only call.

Thanks for input.

[jeannepaul, BSN]

Industry standard for case load for full time case management is 12-13, not 18pt, so they are already overloading the regular full time case managers. It all depends on where these pt's are located. If you have mostly nursing home pt's, then 7-8 is easy to do a couple days a week.

I would find out what will happen if one of your pt's call on a day you are not scheduled to work? who will take care of the problem? When are your IDT meetings and will you be required to attend. They can take up to 2-3 hours. If you are required to attend, will they let you do yours first and then leave so you can go see your pt's.

Case management can be time consuming and I would find out exactly what they will expect from you on the days you say you can work. will you be required to do admissions? Will you be required to take call, or backup call?

If you take the position, make sure when you get your patient load, the families know what days you work and that if they need something on other days, they will be seeing someone else. Families can get very needy and take advantage. Do not give out your phone number and if they happen to get it off caller ID, explain that you do not always answer your phone and if you don't answer, they need to call the office.

It can work, but you will have to be firm with both the pts families and your company, because they can guilt you into going to see a pt when you are not working. I personally prefer nursing home pt's when only working a couple days a week, you can get in and out a lot faster most of the time, but it is difficult sometimes dealing with the staff if they are lazy and want to call you for every little thing.

Good luck on whatever you choose to do.

[Marshall1]

Thank you for replying...I was told I could choose my own days to work and would case manage the 7, no call is "suppose" to be involved as they have an RN who is going to take call FT. I don't mind helping w/call - just not all the time. It sounds like I can work at least a few days/wk with this case load which is what I need. I am almost certain IDT meetings will be a part of it since I will be responsible for these 7. I wouldn't mind nursing home pts.

I am going to get in touch w/the DON this a.m. & ask her about the things you pointed out. I really appreciate your feedback.

[tewdles, RN]

I am not an advocate of pairing FT oncall with PT case management, when there is a choice.

PT case management with SOCs, and shared oncall, maybe.

In my view, if a person is working FT oncall, their option should be to pick up cases to support the case managers when they are available and need to fill hours.

[Marshall1]

Thank you for replying - I am going to case manage 7 patients and as far a I know there is no call requirement. I am just not sure how much time case managing 7 patients will take. I'm assuming a few days/wk.

[tewdles, RN]

Thank you for replying - I am going to case manage 7 patients and as far a I know there is no call requirement. I am just not sure how much time case managing 7 patients will take. I'm assuming a few days/wk.

What are you referring to by posting FT call in your original post? In my experience, that is being on call from 5p to 8a everyday with some weekend coverage built in. Is that not the case with a FT call position for this agency?

[Marshall1]

FT call was going to be 5p-8a and every other weekend..they wanted this PLUS case managing 6-7 pts. and make it a salaried position. I told them no - that was too much - at least for me. So they asked me if I would case manage the 6-7 pts because other RN wanted to take only call - so the agreement was she will do all the call, there are FT RN's that are case managing 15-18 then I would case manage part time the 6-7.

[tewdles, RN]

That is doable, IMHO

[hospicern030363]

The number of pt's one can case manage depends on the patient acuity. If I have some really sick patients who take a long time, I could not case manage 7 patients. Will that hospice take that into account? How about drive time? There are so many variables out there - a number isn't a good way to look at things. I work 3.2 days per week - this includes IDT - and generally I case manage 4-6 patients. But, I often have the patients that live far away and/or have very high acuity.