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