Does anyone get paid hourly any more in home health?

[homecaresurvivor]

I'm wondering if anyone out there still gets paid by the hour in home health care any longer? (I'm referring to intermittent home care.) I got paid hourly the first 15 years I did home care, but when I moved back to my home state about 10 years ago, the only thing available was pay-per-visit, which, I know some people like, but which I detest. (I've heard some nurses say they resented others stretching out their day to get overtime pay, but frankly, I always thought that was an issue for management to address. What really bothers me is that there are some who abuse the pay-per-visit system, by spending too little time with a patient, so abuse can happen either way.) I just find it unfair, and feel like a lot of the work I put in is not really being paid for, or at least reduces the worth of my visit rate down to McDonald's wages.

Honestly, this is not a case of disorganization on my part. (I remember my first months in home care back in the 90s; I was a mess sometimes!) Obviously, I've been doing this for a while, but the amount of time I'm spending on care, driving, documentation, phone calls, etc., just seems to ever-increase, without a comparable increase in pay. In addition, there are more audits, chart reviews, etc., that we're being required to do, with no extra compensation. I got called to the office the other day to correct an "error" on a chart that was to be audited by a health insurance company. I stopped by, only to find that the only "error" was on the part of the person who supposedly found it! It may not seem like much, but that was extra time out of my work day that would have been more efficiently used if I hadn't had to have come in, especially since I had no visits near the office that day. I probably drove an extra 30 miles. I have looked around. No agency in our area pays hourly, so just getting another job really isn't an option. Besides, there are many aspects I like about the company for which I work.

I just have a hard time believing that home health agencies have, for the most part, gone to pay-per-visit for our benefit. I know that all health care settings are tightening their belts these days, but I don't like this aspect. And there's my rant for the day!!

[Libby1987]

I've never worked for anything other than PPV or salary. I preferred PPV as I could use my flexible schedule without any micro mgmt and I had the option of making extra money and/or meeting patient needs whenever the need arose without the OT issue. (I was paid OT for hours made for the agencies benefit) Worked well for me for years and I made more money than my hourly counterparts. My care was patient focused and high quality, no pay structure could ever compromise my integrity.

Most of our staff are hourly however and they are all hardworking and patient focused as well.

If the PPV staff are productive but being delayed with excessive mileage and/or difficult cases, they are compensated for it.

Honestly! I think the grass tends to be greener on those sucky days (like your unnecessary trip to the office) but that it usually balances out. In home health, as I'm sure you've learned, you have to look at the year end pay and overall job satisfaction and if it allows you the life style you want.

[caliotter3]

With my first visit agency, it did not take me long to figure out that the ppv was not turning out to be cost effective with the way the visits were turning out. I certainly never figured out how a former colleague could manage 5 or 10 minute visits to assist her in structuring an average 13 or 14 visit work day. For me, the pay rate "included" the set amount for mileage. That was the giveaway there. Did not stay long.

[MSNce1]

One of my nursing jobs involves home care and the company I work for is still paying hourly which benefits Medicaid/Medicare and other insurance in that sometimes care delivery can occur in smaller packets of time. I was pleased to see you examined how the administrative position choices for payment of the nurse affected nursing care delivery as I have not seen such posting before. Calling nurse entrepreneurs in your state to set up their own agency and change up nurse pay to hourly unless this is a state mandate.

When I train for a new case I believe the lack of client nurse interaction is from training but have heard from parents how this is not usually the reason as documentation usurps the nurse:child interaction time. As we know this also occurs in other settings like hospitals or outpatient care. I have also heard many a client complain about a docs head being focused down onto a laptop while with a client. So by what schedule method would you propose documentation be handled?

[Nursemike2010]

Not sure what state you're in, but here in New Jersey we do have hourly pay?