I know I replied a long time ago to this thread.. but I figured after re-reading what I wrote, I'd re-reply with something more constructive.
I'm getting the impression from this thread that many who are replying are direct carestar employees and not independent providers? I'm probably wrong, I can't exactly tell.. but that's a moot point
anyways..I will describe how my experiences have been..My friends were/are IP's before they forced the Lpn's to have RN supervisors. When I started in April of 04, I had a problem even getting started.I requested my paperwork, by phone, which took forever for them to send to me.After I completed the stack and returned it, to, where I was told, the county in which I was getting a case in, not the county I live in.. It, once again, took forever to get a response.There was a problem with my fingerprints (BCI) I went and got a money order, went to the sherrifs dept and had it done.. and since they are only good for 30 days.. whoever was responsible for moving my paperwork along.. the paperwork didn't get "moved" in time and the BCI was no longer good. I attempted, and this was a 3 month period, to call the person "in charge" several times, with no return call.
For some reason, I thought to call the center in charge of the region in which I lived. I spoke to a WONDERFUL woman, explained my situation. Now this gal, sent me a NEW packet within a matter of 2-3 days.. I remailed it, AGAIN.. had to pay to have another BCI done.. did that.. and had my number within a few days.So I had a number. Then I had to call around and figure out who was going to process my billing.. Oy, yes yes, I might only have to bill for services 4-5 times a month, but the min. for billing was 40 billings a month, so I had to pay the flat rate fee...
Half of the companies listed as contacts for IP billing assistance, either had NO idea what I was talking about, or did not provide billing for IP's.. THAT was a HOOT! (enter sarcasm!) Funny as I got those contact numbers from the state!So it was 25 bucks a month to have my billing processed.Next comes an RN supervisor! Well, I've come to learn that everyone in the IP "business" knows one another.. They also know cases. Apparently the case I was to be working on, everyone knew about.. Nobody wanted to be in the home, nor be the Rn supervisor. I finally found someone willing to do it, and that came at a cost of 55 a month! While I might add that I think she was WONDERFUL and deserved every penny... That was just another "thing" that came with this territory!
Next we move on to the client... How odd it is to have nurses coming in for "hour" visits (I'm sorry, try more like 15 minute visits, but we get paid for that 55 loader hour so Yippee!) and then having nurses coming in for shifts! Well I was just getting the hang of the whole medicaid deal.. and I know that nursing notes had to remain in the home.. but apparently nobody wanted to leave their notes in the home... Talk about wonderful continuation of care...
On to the family.... This is what I truly took away with me from working as an IP.For me, when something MAJOR happens with a client/resident.. I call the doctor and get an order and get the ball rolling.. Every mm of your bodies nursing judgement tells you that there is a problem, you have a process to follow and that's how it should be... What I learned from being an IP Home provider? What nursing judgement? The FAMILY is "holier" then the doctor, "holier" then your nursing judgement. You "can't" call the doctor unless you have permission from the family. If they have a PRN order from the doctor for something, you can't do it/give it unless you have family permission..and I'm not talking about pediatrics here.
If they DON'T need something, like say, a breathing treatment, because they are having NO difficulty breathing, no congestion and an apical pulse of 130.. The family is going to pitch a fit and argue with you until you do as they say... THEY'VE been taking care of their "loved" one, they've been "trained" they know "what they are doing"... To them, (ok, I only have my experiences and the conversations I've had with other IP's, I'm sure not ALL cases are similar, so please don't assume I'm generalizing here) you're just free help coming in to take the "burden" off of them for a short time. Doesn't matter how much experience you have as a nurse, they know best.
On to the case manager... When I tried to address issues with my case manager, I was blown off. The FAMILY contacts the case manager, and the consumer is always right! The RN supervisior attempts to address concerns with the case manager and the consumer is always right. We could not attempt to "make waves".. That was bad, very bad, even when everyone, except for the case manager and the family, felt morally and ethically obligated to resolve issues... they did not get resolved.. The family is always right, and that was the support given from Carestar.
You have to contact the case manager and let them know your schedule, and if another nurse calls you and you have to go in and work, you have to call and let them know.. You're only alloted so much time, and if they don't put your time in, when you attempt to process your billing, it gets rejected and you don't get paid.
You're paid directly from the state auditor.. so no taxes are taken out. You either have to pay to have an accountant figure out all your taxes and how much you have to put away from each and every check, or you have to guess.. Taxes are due to be paid quarterly.. Good luck trying to figure that one out... I had no support with that department.. and no idea where to go to even find help.. Every IP I knew just paid to have an accountant do it all.
There's more expense.again, I'm not trying to generalize here.. I know a lot of people who are IP who love every minute of it... I noticed the last time I checked for open consumers... it was mostly aide openings, and not nurses..
Many nursing positions are just "visits" I haven't come across too many that are actually shifts.. Another problem I noticed is when there is more then one nurse in the home, the RN supervisor issue becomes and issue too.. Sometimes they only want 1 supervisor in the home, and if they don't know you, they don't want to be your supervisor...but they don't want another RN in there...
I preferred, and still prefer, working my part time staff job and my part time agency work. I didn't have to mess with Rn supervisors, taking out my taxes, paying a billing entity, dealing with "know everything" families, putting up with unsupportive caseworkers, arguing with other nurses in the home about schedules or care provided or not provided.. Sure I have a patient load...but I feel much more comfortable in a setting where I can use my nursing judgement and the doctor is a phone call away.. not having to convince a family member to let me call them. And I found that the pay was just not that great. I made more money, took home more money, dealing with my hourly rate and my taxes taken out, then working as IP.
Just my 2 cents