Home Care vs Private Duty

[deefizzle]

I have a phone interview tomorrow with a home care company, and am really excited. From what I understand, I would see approx 30 patients per week and get paid per visit. For those of you who do home health, how long do you usually spend in each patient's home? Do you get your charting done while in the home? What kind of duties do you perform?

Also, is home care different than private duty? From what I have researched, private duty is more of a long shift spent in one patient's home, while home care is more of a "visit". Is this correct?

[Elektra6, ASN, BSN, RN]

Yes, you are correct. Private duty is usually for medically complex patients. They receive care for years or forever. I care for a quadriplegic patient who has a tracheostomy and another patient on a ventilator. Home health nursing, visits, are usually temporary often after discharge from the hospital.

[BBP42]

My typical visit lasts between 30 minutes and one hour depending on complexity of wound care or if a change in condition has occurred since last visit. Most of the time you can do the majority of the charting in the home. I do a lot of wound care, many of our patients have chronic diabetic ulcers or a wound vac that require several visits a week. We also have a lot of patients that are post-ortho procedures like hip or knee replacement, that are usually only on services for a couple of weeks until staples come out and they transition to regular outpatient therapy. I see a good number of people who are post cardiac procedures who we teach about managing their new diagnosis of CHF or their new coumadin therapy for Afib while we monitor their incision sites. We also have patients who come home from the hospital with a new ostomy and we teach them to care for their skin and change the appliance independently. It is rewarding work, you get to follow your efforts through and see lots of positive outcomes. It is unpredictable work and there are days where every visit is a crisis in progress and you straggle home at 530pm when you thought it would be 4. I would never go back to an understaffed, stressful facility job!

[KelRN215, BSN, RN]

When I worked in home care (pediatrics) visits could be as short as 15 minutes if it was one of our straight forward subq injection patients whose parents were incompetent to learn to administer or an hr/hr and a half when you walked into a disaster. More than once, someone should have brought their child to the ER or the clinic but waited because "the nurse was coming" and then I had to send the child out in an ambulance. Typical visits were usually around 1/2 hr though. Most of my patients when I did it were oncology patients so I was usually changing central line dressings, drawing labs, accessing ports and/or pushing chemo.

30 visits per week is a lot, in my opinion. I think seeing 6 patients/day regularly is pushing the limit. I found 5 to be generally manageable but more than that it was iffy.

Private duty is when nurses work a shift in a patient's home. Usually these are technology dependent patients who need continuous skilled nursing hours because of home vents, trachs, TPN and occasionally people qualify for just G-tubes. I haven't really figured out how they qualify these people- in my last few jobs I have found that children on TPN seem to automatically qualify (even though once it's hooked up, the home pump does everything 100% on its own and there is nothing for the nurse to do) yet my best friend's kid was screened out over the phone because CPAP and continuous O2 sat monitoring overnight wasn't complicated enough to qualify her.