Are all home care agencies a disorganized mess??

Isabelle49 · Jun 1, 2013

I am new to home care and the agency that I work for is a disorganized mess. I got very little orientation. I was just thrown out there after 4 days.
My problems are I do not understand "home bound" per medicare rules. There are some patients that I have that I will not consider home bound. I feel pressured to accept everyone.
I will discharge a patient and a week or two receive another referral for the same patient.
I am finding out tidbits of information that should have been received in orientation. Which is very frustrating.
How many patients should a case manager have? I am responsible for SOC and revisits the first week or so, then the LPNS continue visits.
Is it common to have a scheduler or you schedule your own visits??

Sorry you are in this predicament. 4 days orientation for someone new to home health is not enough!

The following link explains "Homebound". I hope this helps.

http://www.medicare.gov/Publications/Pubs/pdf/10969.pdf

I am prn and about 99% retired. The agency I work for has case managers who carry a case load of 32+ patients.

It is common to have a scheduler, but clinicians can rearrange schedule to meet patient preference, patient doc visits, etc, but care needs to be taken when doing this during the week a Recert of Discharge is to occur so as not to miss the date required.

I hope this helps. I wish you much luck!

AnnemRN · Jun 1, 2013

Unfortunately, a lot of home health agencies are disorganized. A red flag should go up if a home health agency is constantly advertising for nurses,they are the agencies that give poor orientation and have high turnover rates.

Thankfully (like Isabelle) I am also prn and about 99% retired. My agency's case managers carry up to 22 patients and they schedule their own patients. I know from experience that anything over 25 patients is spreading yourself too thin. There are a lot of agencies that have the case manager seeing the patient's only once a week or once every 2 weeks and have an LVN doing the bulk of the visits. I don't agree with this practice especially if the patient is experiencing complications.

paradiseboundRN · Jun 9, 2013

oh yes, many HHA's are a mess! But thank goodness there are so many agencies out there to choice from. There is no reason to stay with a bad one. I do know changing jobs frequently takes a toll on the nurses' psyche, but its better than being used and abused.

The caseload number can be deceiving, as some of those patients may be 1/month catheter changes, so the important number is visits per week. A full time nurse in home care is expected to see 5-6 patients a day. Many agencies use a point system and a FT nurse must have between 28-30 points a week. RV=1 point, SOC= 2, Re-cert=1.5, Resume=1.5, D/c=1. It is very common to have a scheduler. Their job is to assign new patients to the nurses and other disciplines. I do know of some agencies that try to actually schedule what day and time the nurse will see the patient, but it never works!

AnnemRN · Jun 9, 2013

I can tell you from experience as a former case manager that the once a month catheter change patient's did not stay once a month for long.

I do think the caseload is extremely important as well as the acuity of your patient's. All the agency's that I've worked for require their nurses to make anywhere from 5 to 6 pt visits daily. You will see that many patient's even if your caseload drops as it's not uncommon for them to see other case manager's patients to fill in the gaps.

The agency where I work now does not have a scheduler. Each nurse is required to schedule their patient's themselves.