How many patients should a case manager be responsible for.

  1. 0 I just started working at a for-profit hospice agency in Houston Texas. I am per-diem and shocked at how many patients the full time case managers carry. 15 to 20 or more patients. The standard of care at this agency is just one visit from the RN case manager each week. If the patient needs more visits, an LVN or the per-diem RN (myself) can help.
    We have IDG (or some call it IDT) meetings every other week and case managers have to prepare and present each of their patients to the MD at that meeting. It takes hours to prepare for and the meeting itself takes one to two hours at the hospice office. And of course the case managers are putting over a 100 miles on their car each week.

    Seriously, who can give dying patients the care they need and support the families when you have 5 to 7 patient visits to make each day spread out all over town.
    And the trend in Houston is for all the agencies to work their nurses like this.
    Is it like this every where
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  3. Visit  katie'sangel profile page

    About katie'sangel

    From 'houston texas'; 59 Years Old; Joined Nov '05; Posts: 19; Likes: 7.

    18 Comments so far...

  4. Visit  TootieCutie profile page
    Hi Katie, I've been a hospice nurse for 13 years. The national average number of patients that a case mgr should carry is 12. This would be in a perfect world. I can't remember the last time that I actually had 12 patients. I usually carry 15-17. This is far too many, and in my opinion, unsafe practice. With everything involved there is no way that I can remember all that I need to when my case load is that high, and I am unable to see my patients as often as I would like, and as often as they deserve. if I have 2 or 3 imminent patients at the same time it is really difficult to manage 15 patients. As you said, they are all over, sometimes an hour or more apart. I just have to be super organized and efficient.
  5. Visit  katie'sangel profile page
    I'm beginning to think organizations like NHPCO could help. But the hospice agency has to belong to NHPCO first, then the employees, nurses, can join.
    I'm looking for some protection from the co-oprate greed that pushes the needs of the nurses and patient down to increase their profits$$$ each quarter
    The Center for Medicare/Medicaid Services is just this year starting to require hospice agencies to perform and report quality assessment information. But the regulations, as I understand them, have little "teeth". The agencies are asked to police themselves and the results of their quality reports will not be readily available to the public.

    Patients are health care consumers. They and a potential hospice employee need a way to evaluate a hospice agency before signing up with an agency.
  6. Visit  MomRN0913 profile page
    Thank you for this info. I'm about to go over 20 patients and plan on saying something tomorrow, because I just can't handle it anymore.
    toomuchbaloney likes this.
  7. Visit  tewdles profile page
    The number of patients that a FTE RN CM can handle depend a great deal upon the rural vs. urban nature of your practice, the presence of patients in ALFs or SNFs, the experience of the RN CM, the acuity and median LOS.

    NHPCO gives us guidelines for staffing.

    20 patients is a lot unless they are concentrated in ALF/SNF environments, and you are working with another nurse (LPN) to accomplish all of the visits and care, IMHO.
  8. Visit  MomRN0913 profile page
    None of the above. I have a mix of hospice and home are palliative patients, all in the home and very complicated patients, most indigent which are really difficult. My time is spent trying to fix a bunch of problems. It's more than I can truly handle. And no support.
    I'm just told it is what it is. It's time to leave for me.
  9. Visit  tewdles profile page
    Quote from MomRN0913
    None of the above. I have a mix of hospice and home are palliative patients, all in the home and very complicated patients, most indigent which are really difficult. My time is spent trying to fix a bunch of problems. It's more than I can truly handle. And no support.
    I'm just told it is what it is. It's time to leave for me.
    Please tell me that you at least have MSW and CV support so that you do not have to manage the psychosocial and spiritual needs as well.
  10. Visit  MomRN0913 profile page
    Yes I do have those. But I tend to get very involved in that portion too it's been. Very stressful week with a huge cse old, actively dying, hard to control symptom wise patients, indigent home care and me getting in trouble for pushing visit free a very very hectic dy with too many co plotted patients no getting done very let without seeing that last patient. I give up.
    tewdles likes this.
  11. Visit  tewdles profile page
    Your saving grace will developing strong boundaries. As case manager you do NOT have to own the responsibilities of CV and MSW. You must keep you feelings within the professional boundaries to preserve yourself.

    It sounds like you need a break. I would want my staff to talk with me if they felt this overwhelmed...
  12. Visit  Mercy65 profile page
    I haven't had less than 18 pt's for 6 months, the most I have had is 23!! We can't seem to get fully staffed which is the main issue. I work for a good company with great benefits but it is hard to find hospice nurses with experience in las vegas. I work a lot of over time which is paying for my pool which I need to relax with this case load!
    NurseDiva08 likes this.
  13. Visit  mhamilt profile page
    I have a question ( ok a couple lol)- with the high caseloads you all manage, do you have a 40 hour/ full time week? Do you take on call? Do admits? Have a nurse working under you to do repeat visits? Are you utilizing your team ? I am really wondering also, is your agency for or non profit?
  14. Visit  adreamdeferred profile page
    Wow, these were really good questions. Wish there was someone to answer them.
    -Home Health RN Hopeful
  15. Visit  toomuchbaloney profile page
    case manage 20 patients?
    Maybe for a spell but not as a regular thing.
    Some agencies have nurses that they call case managers who do not visit the patients as a general rule.
    They do all of the prep and presentation for IDT meetings, etc. They are administrative nurses who insure that supplies and equipment are appropriate and available, that the medication POC is up to date and in compliance with internal and external regulations, that the documentation is on time and complete according to JC or CHAP and CMS, etc.

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