Caseload for a Full time Case Manager

[jyhn]

Would like responses regarding Hospice nurses visiting patients at home. What is your average Case Load? How many visits do you do in a day? If you do an Admission, how many visits do you do that day? Do your Agencies understand that mileage is a factor in how many patients you see? We have dedicated On Call nurses who are salaried positions, making a substantial and well deserved salary. When they are off or sick Case Managers who possibly worked all that day and will have to work the next are expected to do the same job as their dedicated staff for $2.75 an hour. If called out to a home they are paid time and a half for the time spent. How do your Agencies handle On Call?

Thanks in advanced for any and all responses,

Judy

[Renae Hale]

Hello Judy, my nurses carrying a caseload of 8 to 12 patients. We request they see 4-5 pts a day and this depends on meetings and admissions. Admissions are concidered like two visits and meetings are concidered one visit. We try and keep the nurses in one location but if they travel more than 40 minutes that could be concidered two patients, depends on the patient.

When it comes to on call, my nurses and myself do the call. We try and tuck our patients in by the end of the day but things do come up and we use our prn staff or the person on call goes. I do have two LPN's I use for call and this has been a great thing.

We are currently attempting to go pay per visit and wasnt sure if you or anyone else has some advice, pay scales or anything to share??? The company I work for is pushing for it and my staff are a bit resistive and I have some reserve. My RN's have been with me awhile and their productivity has become a big problem. Any advice or information would be greatly appreciated!! Renae

[Hospice Nurse LPN, BSN, RN]

Hello Judy!

Mon & Thurs I see 3 pts. They live about 45 minutes or so apart. Tues & Fri I see 7 pts (6 in one facility). Our DON does all admits and recerts. As far as call goes, I split it with another LPN --one week on & one week off. Of course, our DON is available 24/7 if we do get a call, we call her immediately, if needed. We're paid $2.75/hr and rarely get any call outs. If we do, we are paid $30 for the visit plus our hourly (weekday) rates plus 50 cents/mile. Hope this helps.

[sas15]

We have 2 on call RNs to cover weekends, and an oncall nurse for Mon-Thurs nights after 5pm. We do have to take back up call during the week at night, but alternate between the 7 of us. We get paid $15/shift to carry the pager and then pd $30/visit if called out or $60/admission. Our census is currently around 100 patients. We see anywhere from 6-8 patients daily. Our typical case load is 12-15 patients to case manage. Our coverage area is very large and when we are on call, we have a tremendous area to cover. I had 4 patients this past Monday (holiday) and drove 114 miles.

[missninaRN]

I averaged 12 patients when I was working at my last agency.

The agency did not consider travel time when scheduling my visits. I had patients up to 1 3/4 hours away from me that required daily visits and often drove over 200 miles daily. I was required to do an admission on a Saturday-though the patient's condition didn't warrant it, but the marketer had promised that I would. The patient was 1 1/2 hours from me and I was paid around $20 for it because I was salaried. It came out to about $4 an hour.

I will never work at a for-profit hospice again.

[okielpn75, ASN, RN]

In our hospice our RN's see no patients daily and do admissions as they come.. Average about 1 a week.

[deanalyn76]

the hospice i work for we average 12-18 case loads, are required to see pt's once weekly unless symptoms require more visits, but there is an LPN to help out in some instances. Our on call is only $3/hr but you get $80/visit plus 50cents a mile and we offer an additional bonus for primary on call that will pay $225 per night that you take the primary position (which you also have 3 other nurses on with you at all times on call). i'm very happy with our company, very supportive from the top down or from the bottow up, whichever way you look at it. Everyone communicates really well with each other. Everyone helps each other out, even the Executive Director will take your calls anytime anyday, it's all about our patients and what we can do to best serve them and their families while they go through what will be remembered for the rest of their life. I've been w/ my company for about a year and believe me, i have my breakdowns (especially when you have 5-10 crisis happening at once) but at the end of the day I know i'm making a difference in someones life. Reading some of these other posts I'm realizing we might have it pretty good with our organization

[curiousauntie]

I averaged 12 patients when I was working at my last agency.

The agency did not consider travel time when scheduling my visits. I had patients up to 1 3/4 hours away from me that required daily visits and often drove over 200 miles daily. I was required to do an admission on a Saturday-though the patient's condition didn't warrant it, but the marketer had promised that I would. The patient was 1 1/2 hours from me and I was paid around $20 for it because I was salaried. It came out to about $4 an hour.

I will never work at a for-profit hospice again.

That is not the case in our for-profit and as far as I know also not the case in my area in general. I am hourly. A case load at present of 12-14. If I need to do on-call it is $50 for the night and time and a half for any time worked, including travel, and mileage starts at my home and back. I see 3 to 4 patients a day, and although my territory is large, I set my own schedule so I can see people in an area on the same day. If there is an emergency with one of my patients, I may have to drive the hour or so to their home, but travel time is removed from our productivity so when productivity is calculated it is "patient time" vs. "office time." We have dedicated on-call staff (7 days on, 7 days off) so unless the on call is sick or on vacation, we don't do on-call.

As I said on another thread, I will never again work salaried in health care, especially when I am in a position where the hours you work may depend on the emotional health of a family member or the physical decline of your patient!

[ErinS, BSN, RN]

We average 12-18 pt's per full time case manager. We are paid per visit, $43/visit. Travel time is kind of taken into consideration- we split our area into thirds, so we are limited in how much driving we do. I have the biggest area and often drive 100-150 miles per day. I do 5-8 visits per day. We have a dedicated admit nurse, a dedicated night nurse, and a weekend nurse. We do cover their call when ill or vacations come up, although we are averaging 2-4 admits a day, so we have to use prn staff for that. We get paid 10% of our hourly (not pay per visit) wage (which is about $23/hour) per hour for on call, and get paid visit and a half for any visits while on call. Hope this helps...

[AtlantaRN, RN]

i'm a weekend nurse and i'm salaried. I do 24hr follow up visits, and take care of emergencies/med issues. I was a full time case manager for 3 yrs prior, we averaged 12-18 pts and we did 40hr/week and got time and 1/2 for over 40 hrs. Average visits are 4-6/day. if you do an admission, then they move 2 of your visits to another nurse.

no-they don't look at the time it takes you to drive-which sucks for the m-f case managers-that is one of the reasons i do weekend call now.

if i am asked to do an admit during the week, i get $100, $50 for a visit that takes less than 45 minutes, and $75 for any visit taking more than 45 minutes (like a death, or a whole lot of wound dressing changes), i prefer on call. the girls during the week run their butts off.