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Considering Home Health but not buying their story . . .

Posted

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

Hi! I am new to this website and it seems like a wonderful place to get advice. I am getting ready to return to work after staying home with my kids for a year and I am nervous about choosing the right position. Most of my experience is LTC and Clinic, I'd say an even 50/50 split. I have no desire to return to LTC due to the hours and terrible work load so a clinic job was my first consideration. I have been offered a home health job doing visits and it sounds very intriguing but it also makes me very nervous. I would totally be able to work around my kids' schedules :yeah:, but the pay is not good and there are no benefits to speak of. The agency is part of a churched based non-profit community outreach group so there is no room for negotiation on pay and likely no chance for future raises. They pay $13.50 per visit and claim that I'd make $500 a month in mileage . . . Can that be right? Do you experinced HH nurses make that much in mileage? I would have one day of country travel to several small towns, about 125 miles in one day. They also gaurantee that it's sooooo much fun, can a nursing job really be sooooooo much fun?

And, how does HH LPN visits compare to skilled nursing as a charge nurse in LTC? Sounds similar but also a little scary. I have some hospital experience but not a ton (like I said, mostly skilled LTC)and I just hope I could make all the right judgement calls when I/m alone in the field. I've also been offered a clinic job with good pay and great benefits, but as always I'm sure it would get monatonuos and boring :yawn: VS after VS after VS :yawn:. I'd also have to rely on a lot of daycare for the kids. I'd love to get some opinions from other nurses out there, especially HH LPN's that do visits. Could I love it as much as everyone says or should I play it safe and go abck to clinic nursing?

There are nursing assistants that make $16 to $18 an hour, don't get taken in for $13.50 a visit. Standard visit pay for an LPN runs from $25 to $38 a visit, excluding mileage. Personally, I would go back to the clinic job. Once you are reestablished, go to another home health agency and ask for shift work for one or two shifts a week to supplement your clinic job. You can control your home health shifts to what you can handle easily, and you can work your way to a full time job in home health if you want.

SmittyLPN

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

Caliotter3,

Thanks for the reply. Do you know if there is a difference between pay for visits when the client has regular insurance vs. medicare? This agency only takes clients on Medicare. They are seniors and occasionally younger patients with MH issues. I was told that the majority of the visits would be pre-filling meds, filling insulin syringes, some wound care, PT/INRs, and monthly assessments. 15- 20 visits per week. The part-time hours are fine, I don't want to work full-time right now, and the pay is only $2/hr less than the clinic. It just seems like the pay is so much less than everything I've read on these threads. And for the responsibility of the position the pay seems too low.

The woman I interviewed with said that pay is low because the companies funds have to pay for the food bank, the meals on wheels program, and all the other community services they provide. The organization is entirely church funded and supported. She says the mileage makes up the difference, but isn't mileage paid for a reason? And I find it hard to believe that I could drive enough miles in three days to make $500/month in mileage. I just don't want to end up working for free after all is said and done. We live in a small town about 2 hours outside of Kansas City so good jobs are hard to come by and most LPN jobs in the area do not pay more than $15.00 an hour unless you work the hours no on else wants (every weekend and holiday). Been there, done that, and I'm not doing it again. Everyone in the office says the job is so much fun and so rewarding. And I get the whole community service thing, but I'm not working for fun, I need a paycheck. Perhaps the idea that I could work and still have time to spend with my kids, and to workout, and to take care of my house etc, etc, is too good to be true.

Edited by SmittyLPN

In a nutshell, it is too good to be true. Mileage is paid for a reason, like you said, not to "make up" for a poor wage for services rendered. They pay low because they can get someone to work for low wages, not because of low reimbursement rates. Almost all home health agencies use this excuse. If you can put on 125 miles a day on your vehicle, do you think they will buy you a new car or pay for repairs when your car starts to fall apart? When my car died, due mostly to home health miles, nobody bought me a car. I just didn't work with no transportation. The home health agencies gave the work to nurses who had running cars. I'm sorry you live in an area that does not pay well. Many people who live in better paying areas can't get work too, so everyone is in the same boat. I would still take the clinic job. You will have guaranteed hours and pay and won't be slowly demolishing your car over time. And you won't be doing paperwork on your own time for no pay. You can do a home health shift on an occasional basis for extra pay. This is what most nurses do.

SmittyLPN

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

Well, your basically confirming what i was afraid of. I'm just glad I have another option. Thanks again for your responses.

I'd still love to hear from anyone else out there that has some insight. I have until Tuesday to make a decision.

hi, i will add my "two cents"

first 13.50/visit---NO WAY!!!! some visits can take an hour or more depending on what you are doing. like it was said CNA's make more.

--is this agency medicare certified? which, i believe they have to be to accept medicare for payment, but i could be wrong on that one.

---i cover a rather large geographic area driving anywhere from 80 miles on a good day to 150, at 0.35/mile

---in the 20 plus years of doing HH, no one has ever cared that i put 30,000 miles/year on my car, it is my choice, so i dont do it "for the mileage money" that keeps me afloat.

--the flexibility is not what is was when i started HH, back in the 80's when we did "simple" visits it sure was, now the visits are complex and you cant leave in the middle of a visit to tend to your childs needs,,,,now some agencies i am sure are more flexible than others, and if the visit you are stuck at is 40 miles from home it makes it difficult

--i would either take the clinic job or look futher at HH agencies in your area.

best of luck!

Edited by berube
used can instead of can"t

SmittyLPN

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

Thanks berube! Perhaps I'll go back and try to ask for higher pay. If they refuse then I can walk away knowing that I tried. The visits sound like they would be relatively simple. Sounds like they don't take vent patients or anything too complicated. You guys have got me thinking though and playing the interview over and over in my head and I do remember her sneaking the word housekeeping in here and there, perhaps I should ask about that to b/c I am not a housekeeper. There are only a few home health agencies in our town and they very rarely have an opening. That's the only reason I am considering this one. I applied at the other big agency in town and he said openings are rare.

Housekeeping is not skilled nursing.

how about taking the clinic job and getting in at the other agency on weekend, everyone is always looking for weekend help, that way you get your foot in the door and will hear about opening

Do not do it! For that pay? Please. For one you cannot trust these for first telling you that this will be fun. Since when is going to people's filthy smelly houses fun (their houses are like being around people who smoke, you end up with those smells on your clothes), changing nasty wound dressing that patients don't take of is not fun, staying 1-3 hrs admitting a client (RN's only), educating them, filing med boxes, dressing a wound, getting a history, listening to their stories, trying to get out of there, make it to the next client's house, then finally make it home to complete your paperwork from your visits is not fun! Then they tell you you can make $500 in mileage! Where in the world are they sending you because trust me you will not be able to see all those clients in a week if you are spending all your time driving to their homes?! You do the math at 0.35/mile, that's ~286 mi/day in a wk! Then on top of that you have to spend your time at home working some more completing your paperwork and you don't get paid for that.

They will get paid ~$135.00 per visit from Medicare and more if they see that client more than 9 times, and only pay you $13.50 for all your time and knowledge. You are worth more than that. They will tell you anything to get you in and work you to death. Remember also that LPN's get the left over visits from the RN's. RN's do the start of cares and choose whether to continue to see that client or not or whether to share any visits with you or not. Your schedule will depend on your RN on a daily basis because if that RN's client load is low they are not going to share because they don't get paid.

Another thing is to get everything in writing when start somewhere, like pay, hrs and especially a no weekend clause if do not want to work weekends. You get in then they change to every other weekend stuff, and don't forget your territory which will also be hard considering you are an LPN bc if you are low on clients they will send you anywhere.

Do not go in there blinded and ignorant, see what the turnover rate is and why. The agency I worked for (Gentiva) could not keep their nurses because they treated them bad and now they have no full time RN's.

Hope this helped.

Edited by rngonnab

SmittyLPN

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

Ok so there seems to be one thing that I definitely need to clarify. I do not want to work full-time so if I only have 15-20 visits a week that's fine. I do not want anymore than that. My full-time job is being a mom and any job I get at this point is just for extra spending cash. As for the other stuff, we are out in the country so 200+ miles a week is entirely possible going to all the small towns in the area. I would be the "traveler" in the office so the out of town visits would be mostly mine. This is a very small office with only 4 nurses including the supervisor/manager and I met all of the staff and all have been the a long time. Some 20+ years. The nurse I would be replacing has been there 25 years and is retiring. I did call around to the other agencies in town and none of them paid more th $18/ visit and the ones that paid $16 or more did not pay any mileage. I know it sucks but thats the way this town is, trust me I wouldn't live here if it weren't for my husbands job. We'd be back in Texas :). I have left a message with the office to clarify things about job duties, paperwork, mileage, and to ask for more money but no call back as of yet. I do know for sure that the office is closed on weekends and holidays so there are no nurse visits on those days.

rngonnab - Do you work in home health? Sounds like you just don't like it? Most of what I've heard/read about it does not sound any worse that being couped up in a nursing home all day/night. I have been taken advantage off and walked all over at nursing homes so what would be the difference?

SmittyLPN

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

Ok I got a call back from the office. I was wrong. They are not medicare patients they are Medicaid. And they are basically well patients that just need someone to set up their weekly meds, may be draw labs, diabetic nail care, and weight checks. There's usually no wound care, there's no piccs, no trachs, not even tube feeders. Souds very basic and I thought for a second that maybe she thought I was an aid or a CMT, but she said she needs a nurse because they do weekly/monthly assessments. Basically we're there to make sure the patients do what their PCP wants them to do. These patients are with the agency long-term, usually until they need a nursing home or pass away. Paperwork amounts to a nurses note and a small checklist of no more than one page. Assessments are also a checklist. Sounds very easy and the workload seems to justify the lower pay. It's more like assisted living than skilled nursing. Guess I could do it for the extra cash and maybe go back to school.

I'm confused. med pre-fill, lab draws, diabetic nail care, and weight checks... none of these are skilled needs in and of themselves. Medicaid differs from state to state so maybe in your state, but definitely not in IL....

SmittyLPN

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

HmarieD (and anybody else who may know),

I am also confused, but then I don't know much about home health, medicare or medicaid. Which why I started this thread to begin with. Is there some other kind of home care other than "home health" that nurses provide? When I spoke to the RN that manages the office where I interviewed she actually made the statement "we're not Home health" :uhoh3: so what are they? They take only medicaid patients/clients that are "stable" and here's the exact description of their medical services off their website " Nurse visits offer skilled maintenance and preventive nursing services to clients with stable chronic conditions. Services include filling insulin for diabetics, setting up oral medications, monitoring skin conditions, providing diabetic nail care, and now, new medication management services." Please keep in mind that I am not an RN so I don't expect to be doing hospital type care in the home. But I don't want to end up doing HHA work either, and I am not a babysitter.

Really it sounds like most of the visits fall into the above description and the rest are medicaid required assessments occurring either monthly or q6months. And I'd totally settle for that description but eveyone keeps telling me not to fall for it. Perhaps I just don't know enough about the medicaid programs that Missouri offers to know what is going on. I did find out that they actually do offer benefits incuding PTO and 401k, so now the only truly "bad" thing is the low pay. Aside from that this job sounds like what I've been looking for since nursing school 7 years ago, just wish I could figure out exactly what I'd be getting into skill-wise :icon_roll.

Some people use the phrase "home health" to refer to intermittent visits of short duration as opposed to "continuous care" or "shift work", which consists of routine nursing care for stable patients in the home setting. Shift work usually consists of a minimum of four hours and that is what the client is billed for, a minimum of four hours. Intermittent visits average 45 minutes to one hour in length. These are the type of visits that occur for a short time after a hospital stay and have a limited time frame, e.g. for 8 weeks following surgery. Shift work goes on forever, as long as the client can't do for themselves. It prevents them from having to exist in a long term care facility. Another term commonly used for shift work is "private duty", although technically private duty refers to when the patient hires and fires their private caregivers and pays out of pocket, i.e. "private pay". HTH

SmittyLPN

Specializes in Pediatrics, Clinic, Long-term Care. Has 9 years experience.

Caliotter3,

Thanks for the explanation, it helps. Although according to your description it sounds like this agency has taken "continuous care" hours and spread them over the course of a month to allow for visits.? Each client has a HHA and the LPN's do 20-60 minute visits. Patients are not usually fresh out of the hospital, but instead are referred by thier PCP. Once the patients are referred to the agency they are a patient "long-term", usually until they can no longer be cared for in the home or pass away. There is no set time frame for completion of care. The goal is apparently to keep these seniors out of a nursing home as long as possible and keep "costs" of care down. I think I am starting to get the idea pf how this works and where it falls into "home-health" and "community outreach", so we'll see . . .

I agree with you that this agency has taken a minimal number of authorized hours and spread them out throughout the month. I once had a client who periodically lost hours because agencies could not get nurses to work the case. It was almost at the point you describe. One more decrease in hours and she would have been without outside care at all.

KateRN1

Specializes in COS-C, Risk Management. Has 20 years experience.

Smitty, years ago I did Title XX (Medicaid) visits (in MO) and this sounds just like that. Yes, the pay is low because Medicaid reimburses at an amazingly low rate. These are state-funded hours that the patient qualifies for through the Division of Aging (state), not Medicare (federal). Each pt has a certain number of hours that are approved by the Div of Aging and those are divided up by week. Usually these patients are not eligible for Medicare-funded home health, but have chronic conditions and are indigent, so they qualify for Medicaid. The rationale behind this is that it's cheaper for Medicaid to provide in-home services rather than foot the bill for a skilled nursing facility or group home (I had several MR/DD pts).

You won't be doing Aide work, usually they have a HHA assigned to them as well who does the baths and that sort of thing. You will be doing just what you described above, assessments (documentation for continued need for care for the DoA), foot care, possibly sup visits of the aides. It's kind of like doing home visits for the type of patients that you often wonder why they're in the nursing home, ya know?

Anyway, I really enjoyed it (mostly) when I did it. It was reasonably easy work and allowed me to go to school at the same time without killing myself. Feel free to PM me for more details.

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