Feel Cheated by Pay Per Visit

[homecaresurvivor]

I'm feeling a need to vent! First let me say I've been a home health RN for over 23 years; I know the field inside and out, so anything I'm feeling right now is not because I'm new and need to get used to this area of practice. It seems like in the last few years, every month brings new expectations, new responsibilities, and new things to document. Of course, none of these things replaces something old; instead it's just more stuff piled on top. Add to that the almost incessant requests from QA to correct this, or change that. It just never ends.

In my first almost 13 years in home care, I was paid hourly. So when things got really crazy, it didn't matter, for I never felt taken advantage of when it came to getting paid for my work. My current agency (where I've been almost 10 years) does pay per visit which is what all the agencies do in my area. I know some people prefer pay per visit, but I started adding up all of my time spent working and traveling lately, and frankly, I'd get paid more per hour working at a McDonald's.

For example, I'm on call this weekend. One of my scheduled visits today was for a patient who does not speak English. I was given the number of a relative who did speak English, and I left a voicemail informing her of my planned visit time today. I had been assured by the primary nurse that this patient was always there and to just go to the patient's home. Of course, after driving an hour, I arrived at his door only to find out he'd gone somewhere. Wonderful. For a little over an hour of driving, the 10 minutes or so of phone calls, and the aggravation, I'm going to get paid for my mileage. That's it. It's like I just donated my time. Of course, going there meant my drive to my next patient was longer than it would have been otherwise, so that added even more time added to my day.

It's getting where I no longer feel I'm ever completely detached from work. There are always things I need to do in the evening. There's no way my per visit rate is covering all of these extra hours. More and more, I'm feeling cheated. Anyway, thanks for letting me vent!!

[Haddoa]

We are having this same convo as a group in our agency right now. We are also ppv and any time over 40 hours you get payed at half time. So they figure out what you averaged pay wise and then devide that by 2 so basically as an RN I get 13-17 an hour for OT. Insulting. Luckily in your situation today our DOO would allow us to put in for admin time or hourly pay. So you would atleast get your mileage plus like 32 bucks. Still annoying. On the weeks I get all my stuff done without working a ton of hours pay is fantastic. It's the long weeks that seem hardly worth it.

[Libby1987]

I would have you claim hourly time on your time sheet. I never want our staff to feel taken advantage of.

However 23 years in, you know it's a risk to drive out to an unconfirmed visit and that verifying with your supervisor prior to driving an hour out with no phone confirmation was needed if you want to be paid for it. I woukd have asked if you tried to contact the patient and made a decision whether making a cold call was warranted.

That said, I'd advise you to take some time off and regroup, then go in and speak with your director/adminstrator. If you are organized, kept up on reimbursement/regulations and a true low maintaince asset, they're not going to let you go. However, if you're burnt and have been resistant to evolve and change old habits/poor routine that doesn't work in today's home health climate, I would put it back on you. If you are a strong asset and your company hasn't evolved, then I'd take your very marketable knowledge and experience and negotiate elsewhere.

Home health is hard work, but it doesn't need to be miserable and underpaid. I'd jump at opportunities to hire experienced home health nurses, they're rare as can be.

[homecaresurvivor]

I rarely go out to a house without a phone confirmation. This gentleman was getting daily visits, this had never happened before, and he knew someone was coming this weekend, as we had the previous 2 weekends. If I hadn't shown up, and he had been there, what would you as a supervisor have thought? Frankly, I haven't survived in home care all of these years without "evolving." I've been with this particular company over 10 years. They haven't kept me on because I'm "high maintenance." (Is that really how you refer to your staff?) Frankly, I'm the one they'll call when there's a difficult case, because they know they can count on me. Why would you automatically assume this is because I have bad habits or a poor routine? I was simply stating that I believe hourly reimbursement more fairly pays nurses who do home care. If this had happened in the years I was paid hourly, I would have been compensated for my time. In a pay-per-visit scenario, I get nothing but mileage. If I had actually spoken with the patient and scheduled the visit, then shown up to an empty house, the result is the same: no pay. (It's happened to me more than once.) It just makes no sense to me that an RN who drives 100 miles during the course of her day gets no more reimbursement (except for mileage) than someone who drives 10, with the same number of patients seen. Thinking this is unfair doesn't make me a bad employee. The company for which I work is a pretty decent place, but this is their policy. (There are a dozen different reasons why I'll stay with an employer; pay is only one of those aspects.)

[Libby1987]

I rarely go out to a house without a phone confirmation. This gentleman was getting daily visits, this had never happened before, and he knew someone was coming this weekend, as we had the previous 2 weekends. If I hadn't shown up, and he had been there, what would you as a supervisor have thought? Frankly, I haven't survived in home care all of these years without "evolving." I've been with this particular company over 10 years. They haven't kept me on because I'm "high maintenance." (Is that really how you refer to your staff?) Frankly, I'm the one they'll call when there's a difficult case, because they know they can count on me. Why would you automatically assume this is because I have bad habits or a poor routine? I was simply stating that I believe hourly reimbursement more fairly pays nurses who do home care. If this had happened in the years I was paid hourly, I would have been compensated for my time. In a pay-per-visit scenario, I get nothing but mileage. If I had actually spoken with the patient and scheduled the visit, then shown up to an empty house, the result is the same: no pay. (It's happened to me more than once.) It just makes no sense to me that an RN who drives 100 miles during the course of her day gets no more reimbursement (except for mileage) than someone who drives 10, with the same number of patients seen. Thinking this is unfair doesn't make me a bad employee. The company for which I work is a pretty decent place, but this is their policy. (There are a dozen different reasons why I'll stay with an employer; pay is only one of those aspects.)

I wasn't assuming anything, I don't know either way. I gave different scenarios, and you very well could fit the other description I also offered.

I didn't intend to offend you. I'm the unpopular type that tends to see and respond from a neutral problem solving perspective versus the take it at face value supportive type. Re-reading your post you made it clear that you were venting and not asking for reasoned feedback. But as I've already dug myself in I'd like to further clarify.

The reason I gave two different scenarios is because I have dealt with both kinds of staff, those who are consistently reliable to follow protocols and irreplaceable and those who have patterns of disorganization and inconsistencies. I'm sure you've seen both. I suggested you speak with your director. If you were my nurse, I would listen and make sure you were and remain fairly compensated, both because it's the right thing to do and I wouldn't want to lose you.

I would have have paid you for your time, we often pay hourly for excessive time outside of the per visit rate. We also reimburse for any travel time over 30 minutes. And on a case by case basis we reimburse for a variety of situations to keep it fair.

As a former field nurse, I would have confirmed that I'd be reimbursed for my good faith effort. As an admin, I would have paid you but asked you going forward to discuss with me beforehand.