HH Case Manager job offer - would like feedback

[Peachpit]

I have been offered a FT M-F Case Manager position with an agency that is hospital based. Patient census around 340 for HH.

 I am not new to HH but would be new to a FT M-F Case Manager position. I'd like some feedback as I'm just not sure about the offer but can't put my finger on why.

The position is salaried, so no overtime pay for documentation outside of the normal work day or if the day runs past 5.  Productivity is 30 pts/week. Call is rotated among Case Managers with one taking call a night (it would be about every 4th night right now) plus one weekend of call that is also rotated. Call is paid but it's like $5/hour unless a visit is made then the rate is hourly plus $5. 

They provide all car stock/supplies, tablet for documenting but no cell phone. They will reimburse $25/month toward cell phone bill. Mileage is paid at IRA allowance. Uniform stipend is provided ($50/yr) and there is a specific color that has to be worn. Benefits are standard.

Scheduling is done by someone in the office, not the Case Manager. If a change needs to be made to the schedule it goes through this person and the scheduler can also add patients if the Case Manager has a cancelation for the day or isn't on track for productivity for the week. This person is non clinical. I was told they try to keep Case Managers in specific counties as much as they can for efficiency but that is not guaranteed.

There is a large bonus paid out over 24 months with this position. They are needing to hire another Case Manager and possibly a 3rd one as it sounds like one is leaving soon.  These positions have been open for several months. In the interview they said they are 14 days out in being able to complete admissions due to staffing shortage and need to fill the open positions asap. There is no admission nurse/team.

Everyone was very nice, welcoming, professional. Several nurses are moving into office based jobs or going part time or PRN - they said that is one reason they have the open positions.

I have no problem working and working hard nor having to spend some time documenting outside of normal business hours on my own time but I don't want this to be an everyday occurrence of documenting for hours at home.

 I am not sure why I am hesitant to accept the position. Maybe it's just nervousness over stepping into a FT Case Manager role versus a non-CM one. 

Thanks for reading ?

 

 

 

[guest1143647]

Do you happen to be in NJ? Your situation sounds like a FT position I just accepted with the EXACT same scenario.

[Peachpit]

Georgia. And I ended up retracting my offer late yesterday. I do want and need to work but I have zero interest in a job being the central part of my life. Fortunately I am already employed so I'm not desperate and having to take just anything.

I know too it's not a good idea to retract on an offer but at the same time, unlike other positions, my "gut" instinct just kept telling me this was not a good move for me.  It would've been a disservice to the agency and to myself to move forward.

I realized too there had to be a reason these positions were open for months, with such high bonuses attached (10K), fast hire process and so many nurses who currently work there are out on FMLA (2 and questionable if they were returning) and others wanting to move to part time/PRN or weekends (6). Admissions, they told me, are 10 days out because staff isn't able to handle their cases and admits (there is no admission nurse and no plans to have one).

I don't think at all it's the leadership there or other nurses not being supportive,  just the expectation on a consistent basis about working outside of business hours/days off being "normal" to meet the requirements and manage the case loads.  It would be a perfect fit for someone who like to do nothing but work and doesn't mind working over 40 hrs consistently a week but not getting paid for the time.

Good luck - I hope it turns out well for you.

 

 

[guest1143647]

What does the admissions team do?

I am not familiar to Home health visits,but I always thought one nurse opens the case and does the care plan,and then another nurse performs the interventions and evals.

[Peachpit]

If an agency has an admissions nurse/team that is all they do is the actual admit visit. Then the patient is assigned to a case manager to take over.

A nurse in home health that is a case manager does ALL of the work for the patient, the visit (teaching, IV, wound care or whatever the reason is for being in the home), the documentation, care plans, medication management, interdisciplinary group meeting, admit (if there is no admit nurse), recerts, discharges, doctors notes, documentation related to the visit, OASIS, resumptions of care, lab draws and connecting patient to social work or PT if needed. 

Most agencies require nurses to take call as well. Visits may have to be made outside of normal hours, on weekends or holidays.

Most agencies assign the nurse to a certain territory but that does not mean the nurse won't go outside of it depending on if the nurse has met their productivity for the week or an extra visit is needed for some reason. 

HH is a LOT of work and nurses either love it or they don't. But in most cases it is NOT a M-F 8-5 only job.  

[NRSKarenRN, BSN, RN]

Agency should NOT be accepting patients if SOC not able to be completed within 2-3days post initial start date. Medicare requires Home Health SOC within 48hrs.  I managed Central intake for large urban/suburban  agency with 100+ referrals per day. Once I knew branch was hitting 3 day window, turned down outside referral sources; fact patients weren't being seen for 14 days is a RED flag to RUN away as  too severe staff shortage.

[Peachpit]

What's interesting is I have received two emails from the Director and 3 from the recruiter since I declined to move forward with the position asking me to reconsider. I did notice the positions that have been listed for months still are open. 

A lot of the nurses who work there have been there for years, it is a hospital based HH so there would be other opportunities to move around in the system after some time. Everyone, like I said previously, was really nice and professional but working M-F  Case Managing plus call during the week every week and rotating weekends would be too much of a work life for me...though the money would be good. 

Nursing has changed so much I just don't know where I fit in the nursing world anymore, if anywhere at all. But not working isn't an option so hopefully I can find some balance really soon.

[guest1143647]

On 4/1/2021 at 7:28 PM, NRSKarenRN said:

Agency should NOT be accepting patients if SOC not able to be completed within 2-3days post initial start date. Medicare requires Home Health SOC within 48hrs.  I managed Central intake for large urban/suburban  agency with 100+ referrals per day. Once I knew branch was hitting 3 day window, turned down outside referral sources; fact patients weren't being seen for 14 days is a RED flag to RUN away as  too severe staff shortage.

 

Oh wow. My agency has 13 day delays. According to the clinical liasons  most HHA around here have those long delays.There is a shortage of Home health skilled nurses in my area. I see why though. It is not safe to have 6 patients a day. How can I educate patients in that short a time span of 30 minutes?

[NRSKarenRN, BSN, RN]

Admissions/resumption of care/recerts took 1 1/2-2 hrs in the home; 1-2hrs complete paperwork afterwards.  Most of my patient visits were 30-45 minutes for routine home care education re HTN, Diabetes, PVD, COPD, CHF, Sarcoidosis, simple wound care, disease case management.  Palliative Care, Complex/multiple wounds might be 1 -1/2hrs max.  So easy to see 6 patients per day-- with 15-20 min drive between patients.  

IV infusions are provided by infusion company in my area. When I did those years ago  could be a simple chemo disconnect of established patient taking 15 min,  new TPN  teach 2-3hrs, to 4hrs IVIG or 8hr hydration.

 

[Wishinonastar, BSN]

I was so happy in hospital-based home care. It was a very demanding job though, with a lot of overtime. Home health did take up my life. I miss it so much. I tried a for-profit and it was awful, though maybe not for the staff. I was in a management position then. That is one reason I left home care. I think the things you are listing sound typical for the interviews I have had, but the only agencies left around me are large multi-county agencies that require you to take call for nine or so counties and it is just too much for me at my age. I cannot imagine going that far on a snowy night for a foley that came out.

I would look at the area where you would operate for one thing. The hospital-based that I worked at did basically a 30 mile radius area. A larger one might go further. Every 4th night on call seems pretty heavy to me. 30 cases a week is pretty typical. That depends on the distance in between also. Do they keep you in a certain town for the most part? One agency I worked at did that. Another one had you traveling 100-150 miles a day. But I will say every agency I ever worked at- three hospital based and two private agencies involved working long hours. I could go home, eat, do some documentation, then chill. Or work until I finished then relax. Every day was different. I never minded working at home. It was not as draining as working in the office. Sometimes I finished things the next day. I had some flexibility and that I did love.

I wish the hospital-based agencies were still around in my area. I would probably still be in home health. I have interviewed with all the large agencies but the working conditions are just too poor. No wonder they are always hiring. Good luck with whatever you decide.

[Peachpit]

I ended up declining the hospital based position. Though I would've been assigned (mostly) to one county and the money would've been good, the assigned county was 45 min one way from where I live and with the expectation of seeing 6-7 patients daily plus call it would've ended up turning into a lot more time after normal work hours than I was willing to do on a consistent basis. 

I agree with you nursemarion, BSN and others who post about HH agencies that are large and constantly hiring, it is because of poor work conditions. This is why so many have such high turn over, offer bonuses that lure nurses in and then many find the expectations are not reasonable. More nurses are starting to push back against dedicating 90% of their lives to work which I personally think is a good thing because eventually, employers will have to readjust/respond. 

I ended up accepting a weekend HH position with a smaller, nation wide company. I will work Fri/Sat/Sun with the productivity of 24, mileage, cell phone reimbursement, no call, salaried with over time if I work outside of those days or take call which will be only by my choice. My area will cover the county I live in and one that is right next to where I live. 

I am really burned out on nursing overall but am hoping with  working just the 3 days it will give me a better work/life balance and maybe spark the enthusiasm I once had for being a nurse again.

[Wishinonastar, BSN]

That sounds pretty good!! I had a weekend home health job when my son was young. Two 12 hour shifts and I could work extra if I wanted- holidays and things to get that time and a half. If you do not need weekends off it can be pretty sweet. I hear you about burnout. I want to maybe retire from nursing at some point and keep working only doing something else less stressful.