Home health care?

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Specializes in Allergy/ENT, Occ Health, LTC/Skilled.

Would any home health care nurses care to share how you know if your working for reputable home health company? I am in LTC PRN right now and would like to pick another PRN job in home health care since I need more flexible and shorter shifts.

Only concern is a few things. I have never worked home health care as an LPN (did a short stint as an STNA) and there are literally SO many companies in my area. Many of them need nurses and are literally hirining on the spot and I know when that happens in LTC it usually means high turnover so not a good thing.

Is it really as flexible as it sounds? If you got out to a patient's house and they are doing poorly (not in an major distress but on the deline) do you have an RN to call (well I would like to have an RN on hand to call) at all times so you can get some input as to whether they need to be transferred to a hospital? Or would do you just call like a staff MD as we do in LTC to see what they want to do?

Totally out of the loop on this so any input is appreciated.

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Specializes in pediatrics; PICU; NICU.

Are you wanting to do visits or private duty shifts? Either way, any reputable agency will have an RN on call (even after office hours) for clinical issues. There won't be a "staff doctor" as every patient has his/her own provider. If you get to the home & the patient is having problems, you would be able to call the on call RN to run it by him/her.

I do private duty pediatric home care. If my patient isn't doing well, I usually leave the decision of whether he goes to ER up to the parents (unless it's something really dire).

I'm not sure any of this helps you but if you have more questions just ask.

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Home care is not for everybody - a lot of nurses do not realize until they actually get a job and come off orientation.

As a LPN you won't be a case manager with a case load, which will make it somewhat different from being a home care case manager with a load. In my agency that provides all services, the LPN go out for re-visits. Because they can not do any admissions, re-certifications or discharges they do straight visits.

I would recommend that you shadow a LPN in home care for half a day to get an idea what it is like in the area you live. If home care is for you you may like it because it can be flexible especially when you work per diem or per visit.

Good questions to ask if you decide to apply and get interviewed:

1.How long is orientation?

2.How can I reach a RN or supervisor?

3. What are typical re-visits for a LPN ?

4. If it is per diem will I get paid per visit or per day - if per day what is the productivity (amount of visits expected per day)?

5. How do I chart as a per diem/ per visit? Will I have a computer?

6. Is there mileage reimbursement or is it all included?

There is a high turnover in most home care agencies in my area and one reason is that home care is just not for everybody. Going to other people's home requires one to be comfortable with this set up. Driving can be time intense if you go into a high traffic area. Case manager RN tend to leave because the documentation is immense and it can be a challenge to finish it within the allotted time. Also, some people simply do not like to have the whole trunk filled with home care supplies - if I want to put groceries into my trunk I have to take all the home hospice stuff out of there first ....

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In addition to what has been posted re intermittent home health care..

Medicare site with agency ratings gives one view:

https://www.medicare.gov/homehealthcompare/About/What-Is-HHC.html

Agencies that receive regular referrals from the local hospitals tend to be known and established.

If you're going to be paid per visit, ask how big of a territory you will be expected to cover on any given day and consider driving times depending on traffic.

If you're going to be paid by the hour, ask how many patients you will be expected to see along with size of the territory.

If you're looking for benefits, ask about productivity required to be eligible.

Ask how visits will be assigned. And when could you expect to have your schedule for the day to begin organizing and planning. (An organized agency will have at least most of that the afternoon prior with final adjustments made early in the am)

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Specializes in Allergy/ENT, Occ Health, LTC/Skilled.

Thank you both, great info!! I am looking to do PRN visits through an agency, perhaps taking on actual long term assignments if it can line up with my school schedule. So no benefits needed and your right, I should shadow an LPN on a visit so I can see the deal. I imagine going to some homes can be difficult at times. Do you ever worry for your safety going to homes where you have NO idea if someone has a record, etc?

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No, I have never been concerned about my safety - but I am also already middle age and did martial arts for years ......

My agency provides some education on safety and situational awareness. In addition, I do not carry valuables and my car is old.

There are areas where I think it is best to go during the day, some places I only go if I am able to schedule a visit on the phone and they expect me. Other places I can just drop in, it really depends. My experience is that treating everybody no matter where I go with respect and genuine caring is key.

Also, it is important to listen to you inner voice. Nobody expects you to get yourself into an unsafe situation. My agency also has a code word that if you call the agency and use it they will call the police.

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I worked in pediatric home health for a while, not sure where you're located but my agencies were PSA and Loving Care. They were both good. I did private duty and got to pick my own patients and areas I wanted to work at. I never felt concerned about my safety except for one time when there were 4 very large pit Bulls roaming all over the house and the step dad ran a tattoo shop on the second floor. The patient was stationed in the living room. Needless to say, I thought the whole thing was unsafe so I called my supervisor and told her I wasn't going there again. After that I got 4 patients which I kept for 3 years and got very closed to their families and they were all great.

Rule of thumb, follow your gut feeling. If it feels unsafe or weird ask for a different assignment. I always had someone to call for assistance or advise.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

This thread has been moved to our Home Health Nursing forum with the ultimate goal of amassing more responses from other nurses who work in home health.

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Specializes in Allergy/ENT, Occ Health, LTC/Skilled.

I went to the home health interview and it was a bit unnerving. They wanted to hire me on the spot without checking references, work history, etc. They have many vent patients, which I was fine with after some training because I haven't come into contact with those in awhile, but they said I would get one 4 hour training shift and they only pay $10/hour for training because the company covers it themselves. Then they offered $17/hour pay w/ no gas mileage. So with over 5 years of LPN experience, it just wasn't worth it to me. I will stay in old LTC where I belong till I am done with school lol. Thanks for all the answers, it was very helpful!

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Good for you for sticking up for yourself. Seventeen an hour does not cut it for a vent case. For that matter it is too low for any LPN level case. If this is an extended care case, you don't normally get paid mileage. Mileage comes into play when one is doing visit work. You'll do better once you finish school.

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LPNtoRNin2016OH, can I ask if the HH agency that you interviewed at was in Columbus? It sounds a lot like a place that I interviewed with.

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