The exhausting side of home care

TazziRN, RN · Oct 12, 2007

thanks, sabby! no, we don't have computers yet, admin is working on getting a system. so far they haven't found a system that everyone can agree on.

we don't officially have a cap on pt load, although i suppose if one threw a tantrum about being overworked, that might help to keep new opens away. that would also not put that person in a good light with the rest of the staff, however.........our agency's policy is that caseloads can go up to 25, which would be manageable if we delegate out, but at the moment we only have two full time lvns, one in each area of the county. both are being run ragged at the moment, and yesterday when my day was about to explode i felt guilty calling the lvn and asking if she could take one of mine for the day.

Jo Dirt · Oct 12, 2007

I did HH for 8 months and had to get out of it before I had a nervous breakdown. I was eating Tums and drinking Alka-Seltzer like crazy and on the road 7 days a week running the wheels off my car driving hundreds of miles to see if someone is having bowel movements and what their blood pressure was.

I left the job feeling kind of cynical about home health and I've learned since then that the agency shut down. If someone needs IV therapy or port-a-cath flushing or catheter changes I can justify the visits but we were being pushed to keep too many patients who needed so-called teaching and management of disease processes weekly or bi-weekly and I would leave the house wondering what was accomplished and what kind of difference it made.

I don't miss it.

TazziRN, RN · Oct 13, 2007

i did hh for 8 months and had to get out of it before i had a nervous breakdown. i was eating tums and drinking alka-seltzer like crazy and on the road 7 days a week running the wheels off my car driving hundreds of miles to see if someone is having bowel movements and what their blood pressure was.
i left the job feeling kind of cynical about home health and i've learned since then that the agency shut down. if someone needs iv therapy or port-a-cath flushing or catheter changes i can justify the visits but we were being pushed to keep too many patients who needed so-called teaching and management of disease processes weekly or bi-weekly and i would leave the house wondering what was accomplished and what kind of difference it made.
i don't miss it.

i'm sorry it wasn't for you, mm. i really enjoy it, i'm glad i made the switch. there have been pts who have made me raise my eyebrow and wonder "what am i doing here?" but most of them have been part of a rewarding experience.

fat cat · Oct 13, 2007

To TazziRN

There is a short article you may like to read tittled, "Effective Time Management" by Susan Wittenberg with a focus for certified home health agency nurses. It may offer something that could be useful to you so it may be worth reading. It provides 1 CE credit if you decide to take the test and pay $8.00. Course offering is @:

www.advanceweb.com/nurses Click on the big red apple

on the page and scan the

course listing for it.

CseMgr1, ASN, RN · Oct 13, 2007

I did HH for 8 months and had to get out of it before I had a nervous breakdown. I was eating Tums and drinking Alka-Seltzer like crazy and on the road 7 days a week running the wheels off my car driving hundreds of miles to see if someone is having bowel movements and what their blood pressure was.
I left the job feeling kind of cynical about home health and I've learned since then that the agency shut down. If someone needs IV therapy or port-a-cath flushing or catheter changes I can justify the visits but we were being pushed to keep too many patients who needed so-called teaching and management of disease processes weekly or bi-weekly and I would leave the house wondering what was accomplished and what kind of difference it made.
I don't miss it.

Yep. I knew it was just a matter of time before that agency self-imploded. All those similar agencies I worked for (with the exception of one) during the 20-plus years I worked in HH have either been sold or shut down. The days of manufacturing "skilled" visits in order to stay afloat are LONG gone.

I've since moved on to working for a home care service which brokers with the local AAA (Area Agency on Aging), to provide custodial care (Respite, Personal Care and Homemaker Aide services) to a population of very needy clients. I work from home (FINALLY!) My Manager e-mails me the referrals, I schedule the admission (or supervisory visit) with the client (or primary CG), complete the visits, travel to the office once a week to turn in my paperwork, pick up my paycheck and go home. That's it. No OASIS, no office politics and NO "manufactured" visits in order to finance the Owner's yearly sabbatical to NYC (or whatever). And, more importantly, I finally work for someone who does not hesitate to give someone who does not (for whatever reason) want to work or follow the rules the boot. Period. They are immediately terminated and replaced. My Manager does not mince any words during orientation of the field staff: either they show up for the cases they have been assigned, follow company (and our State's) policies or procedures...or get out. It's all about accountability, something which I haven't had the pleasure to see in quite some time, and I think I am here to stay...as least as long as my car holds up.

Sabby_NC · Oct 13, 2007

thanks, sabby! no, we don't have computers yet, admin is working on getting a system. so far they haven't found a system that everyone can agree on.
we don't officially have a cap on pt load, although i suppose if one threw a tantrum about being overworked, that might help to keep new opens away. that would also not put that person in a good light with the rest of the staff, however.........our agency's policy is that caseloads can go up to 25, which would be manageable if we delegate out, but at the moment we only have two full time lvns, one in each area of the county. both are being run ragged at the moment, and yesterday when my day was about to explode i felt guilty calling the lvn and asking if she could take one of mine for the day.

hi tazzi,

we us roadnotes and it is a great system.

very user friendly and that is the main thing eh? once you get used to it you can simply do what you need to do and put the note etc in before you leave.

i do my assessment as i work through each field in the computer. it is a great feeling that when i leave the home note is done and i am on to the next.

we all have cards where we can hook up using wireless and synchronize our computers (if you are in an area that will pick up) and bounce the up to date note back to the main frame.

we have had a few hospices send admin and rn's up to our organization. i have taken them out and shown them how i can do a full assessment, check med profile, do a pyschosocial visit all within 45-60 mins. all very doable let me say.

i have done 7 full assessment visits in a day and that has pushed me but 6 is a comfy ratio. hope your organization can decide soon on something that would be more efficient for you all.

so pleased hh is giving you more experience and seeing the 'other side of life'

don't you just love the autonomy though?

do you plan your day out or week out on visit needs of patients and then go from there?

love going to patients homes and being with them.

TazziRN, RN · Oct 13, 2007

I have taken them out and shown them how I can do a full assessment, check med profile, do a pyschosocial visit all within 45-60 mins. All very doable let me say.
I have done 7 full assessment visits in a day and that has pushed me but 6 is a comfy ratio. Hope your organization can decide soon on something that would be more efficient for you all.
So pleased HH is giving you more experience and seeing the 'other side of life'
Don't you just love the autonomy though?
Do you plan your day out or week out on visit needs of patients and then go from there?
Love going to patients homes and being with them.

When I get crunched and have an open to do, I'll do my visit and ask my questions as I'm touching, watching, writing, etc., and finish filling it out later. If I have the time I'll fill it out as I go. We have a caseload board with everyone's loads written on it, so the week is planned out for everyone. I try to be in the office early in the morning to sit and plan out my day, do paperwork from the day before, catchup on my inbox, etc., and then start making visits around 1000. This seems to work out the best for me.

I live about an hour from the office, so whenever there's a pt in my home area I get the assignment. I schedule that one for either first thing in the morning or last in the day. If it's first, I do my planning from home so I still get an early start.

I recently had a warm fuzzy/vindication feeling......a pt with pressure sores on her bunions got an infection in both of them and I told her she had to either see her podiatrist that very day or go to the ER. I got a call from the podi that afternoon and his whole attitude was "Yes, they're infected but I think you're making a big deal out of nothing, however I'll humor you and here's what we'll do......" When the culture came back it was a nasty strain of staph, and he called me back, rather shaken, to thank me for catching it and insisting she be seen. With her other problems she can't fight stuff off very well and infections can get a good foothold pretty quickly, and if it hadn't been caught as early as it was she could have been facing amputation. This was the first time that I felt "Okay, I do know what I'm doing here and I can do some good." A lot of the time I feel a little lost because I'm still learning things.

nurseangel47 · Oct 13, 2007

What with oncall duties where you don't get enough sleep on the week/weekends that you're "on" plus the dreaded paperwork overload, it's no wonder that my brief (less than a year) stint in home health didn't flourish.

I don't understand why the powers above in suits cannot get it thru their thick heads that they need (a) less volume of new admits per day per nurse, (b) less mileage to cover no matter what! (who pays for the newer vehicle one must purchase when one drives 100-200 miles per day on average! and © a prn nurse well practiced in home health who can be their oncall nurse and/or new admits nurse to maybe buddy up with another nurse of same ???

And those forms, paperwork volumes! Why, oh why, must one fill out in triplicate the same frikkin' information over and over and over again! Can someone say, " To heck with the OASIS forms?! Why can't the government be gobsmacked with some of it back in THEIR face to have to do and get them off our back!...it's not like we enjoy or can even get the mess to jive for them the first time it's done anyway! Geeeezzzz! Our office had a "nurse" (retirement age, slow as the dickens, lazy, felt entitled to sit in the office all day) who insisted we bring the new admits to her for "coding"...well, that meant she racked our brains, thoughts, and actions verbally in her office for as long as it frikkin' took to extract the "correct" coding for surgeries, therapies, treatments, etc. It was like, hello, who's doing the coding here? If she, for example, would've gotten out there and helped with openings, she would've KNOWN which code to look up. Another thing: she DIDN'T know which code (s) to use, she had to look it up, hmmm and haw over it, then change her mind, she'd never done codes in her life 'til then and apparently never been taught! Oh!

That lasted from February to October for me that year.

One more thing: Some nurses/cnas/pcas etc. believe that the mileage money made somehow is a magical "bonus" paycheck in and of itself. It is NOT! Figure the gas, wear/tear on all four tires, damages to vehicle in the way of exhaustion on it's body/frame/etc.

and you are IN A HOLE before you turn around! It's not just gas you have to buy to keep your car running, people! Think about it!

My hubby is a Panel Beater, or restorative body man, here in the states. He quickly educated me on the finer points of the cost of running my car into the ground versus the "extra" pay in the way of 40 cents per mile or whatever it is now. (32 to 34 cents per mile at the time I was driving the massive amount of miles in home health.)

If home health picques one's interest, I suggest trying hospice home health. It isn't nearly the miles each day, or at least it wasn't in the hospice I worked with. They tried and usually succeeded in keeping the territories based on what zip code YOU lived in! within boundaries even from the start of care of a case, plus the paperwork is not nearly the bear it is in regular home health cases. No OASIS forms AT ALL unless you take it upon yourself (optional, usually) to do a "true" home health case in and of itself thrown in with hospice diagnoses.

They also provided LPNs to do visits for us WHILE we sat in the office once or twice per month at least to complete monthly eval. forms for recertification...! I felt like I had died and gone to heaven. The only reason I ever left was, the

nurseangel47 · Oct 13, 2007

sorry....got cut off by hitting wrong button on keyboard! The end, it's near. The only reason I resigned is because of a bat out of you know where who took it upon herself to do a witch hunt within the organization for some strange reason, to prove herself on paper, I think. Turns out I was an intended target due to the friendly relationship I had with another one being targeted, who eventually resigned herself, well before me actually. She was turned into the board of nursing for xanax use while on duty illegally obtained off the street! She was primed to exit nursing as far as I was concerned in reflecting on her situation. She reentered the local Waffle House as a greasy spoon waitress, insisting she made more in tips on any given night than she'd made at the hospice as an LPN.

I have digressed from original addition to this OP, and I apologize.

It's been a healthy vent for me though and I do thank you all if you stuck thru to the end of the post!

CHEERS EVERYONE of you home health nurses who are fighting the good fight on the front...while the rest of the top staff in suits are counting their money and breathing easier, knowing THEY are not oncall that night!

Sabby_NC · Oct 13, 2007

This was the first time that I felt "Okay, I do know what I'm doing here and I can do some good." A lot of the time I feel a little lost because I'm still learning things.

Hey you did fine and I know you will learn heaps.

Hang in there and enjoy the ride.

Nothing better than being out in the field and having to use your knowledge to make a call as you did.

You Go Tazzi Home Health Extraudinaire :) :monkeydance:

CseMgr1, ASN, RN · Oct 13, 2007

sorry....got cut off by hitting wrong button on keyboard! The end, it's near. The only reason I resigned is because of a bat out of you know where who took it upon herself to do a witch hunt within the organization for some strange reason, to prove herself on paper, I think. Turns out I was an intended target due to the friendly relationship I had with another one being targeted, who eventually resigned herself, well before me actually. She was turned into the board of nursing for xanax use while on duty illegally obtained off the street! She was primed to exit nursing as far as I was concerned in reflecting on her situation. She reentered the local Waffle House as a greasy spoon waitress, insisting she made more in tips on any given night than she'd made at the hospice as an LPN.
I have digressed from original addition to this OP, and I apologize.
It's been a healthy vent for me though and I do thank you all if you stuck thru to the end of the post!
CHEERS EVERYONE of you home health nurses who are fighting the good fight on the front...while the rest of the top staff in suits are counting their money and breathing easier, knowing THEY are not oncall that night!

Don't apologize. I've been there, done that too....which is why I made the decision earlier this year to no longer be ANYONE'S target, doormat, scapegoat, whipping girl...etc. I have basically been working for myself since July 1st, and in the process have managed to regain some of the self-esteem which I had lost. My new Manager respects me both as a Professional AND as a human being, and that speaks volumes.

TazziRN, RN · Oct 14, 2007

Hey you did fine and I know you will learn heaps.
Hang in there and enjoy the ride.
Nothing better than being out in the field and having to use your knowledge to make a call as you did.
You Go Tazzi Home Health Extraudinaire :) :monkeydance:

Thank you, Sabby!