Home Health Nurses, how many opens and visits do you have a week?

twokidsmom,rn · Jul 30, 2011

I am not all about the money. The reason I have to see that many is my census is around 18-24. I would rather see 6-7 a day and then I would have no problem going home and finishing up my paperwork. But right now I leave the house at 0730 and don't get home till around 5pm. ANd I can not take a whole week off there is just not enough nurses to see my pts and their own. I took 2 days in June and taking 2 days this week. That is all I have taken all summer. I have also seen patients most weekend while not oncall but since the oncall had so many to see my manager has asked me every weekend to see at least 1-4 pts. I am off this Thur and Fri so I am going to see 6-7 pts on Sunday so I do not have to ask others to see as many on those days. I hate to do that but I need to get away at least for 3 days, my kids start back to school in a couple weeks. Wondering if I should try another agency, or is it all the same. Also thinking about going back to my local VA they have a opening in there nursing home. I have been always told that HH is flexible, not for me. I have had to cancel my childrens and my own doctors appts. Not so flexible to me.

abbie0 · Jul 30, 2011

I raised 2 boys while being a home health nurse, I know what it is like if you are overloaded. Some agencies I worked at tried to work me to death, so I learned to say no. I have several nurses who want to do less than 10 visits a week. I have some nurses who want every patient they can get. I let my nurses tell me what they can to do. Of course it is PPV work so they have the luxury of getting things done. We are a hospital staffing agency, and do wellness and flu clinics as well. So I have access to extra staff if I need them when my regular nurses are too busy. We even staff other home health agencies with therapists. Our nurses who want to do a full day do about 1 SOC a day, and 2-3 other visits. Most home health nurses can do that in an 8 hour day. The way I always did my work was to spend 4-5 hours seeing patients, go home pop in a movie and finish up my SOC & paperwork. Most of the time I could do it in 8 hours. I became the SOC nurse at many places that I worked, and did 2-3 SOC's a day and then had 5 hours to finish the paperwork. I like planning care. Pacifica has been a great company for me, because we all want a peaceful way of life. I try to help the nurses simplify the way they are doing things so it is less stressful, but everyone has to find their own rhythm.

abbie0 · Jul 30, 2011

They aren't doing good work if they are doing that. Don't compare yourself to workaholics.

Just do what you are comfortable with. Take care of yourself. :nurse:

MJ Marx · Jul 30, 2011

For the person who assumed that nurses are paid per visit, that is incorrect. Home Care is paid in a bundle based upon diagnosis. This creates real havoc for nurses who have been used to being paid by the visit. Medicare cuts are creating stress on all Home Care agencies. But I digress. As a new supervisor to the Home Care world, with about 12 years of Long Term Care experience. I'm struggling with what is appropriate timing for visits. I have a nurse who has been in Home Care for an extended period of time who feels that 2 hours is a normal time for a routine skilled nurse visit and wants 4 hours to do a start of Care. Unfortunately, this creates an overstaffing issue.

caliotter3 · Jul 30, 2011

One of my coworkers does as many as 14 visits in a day in addition to her full time extended care case with us. She is always dragging around, but she states that she likes the money she is making. She once said that although she is an LVN, she has done SOC assessments in the past that were signed as being done by an RN. How this happens, I don't know, and probably don't care to know. I think it is too much for my car, also too much for me. Just the thought of driving around to 14 different addresses in the local traffic gridlock tires me.

KateRN1 · Jul 30, 2011

At many agencies, the *nurses* are paid per visit. How the agency chooses to pay the nurses--whether hourly, salary, or per visit--is irrespective of the home health PPS system which pays per episode. And for the record, the diagnosis does not wholly dictate the payment, it is combined with the HHRG score + therapy to equal the HIPPS code, as well as the routine or non-routine supply payment and if it is considered an outlier, then there's the regional adjustments. A lot more than just the diagnosis.

MJ Marx · Aug 1, 2011

At many agencies, the *nurses* are paid per visit. How the agency chooses to pay the nurses--whether hourly, salary, or per visit--is irrespective of the home health PPS system which pays per episode. And for the record, the diagnosis does not wholly dictate the payment, it is combined with the HHRG score + therapy to equal the HIPPS code, as well as the routine or non-routine supply payment and if it is considered an outlier, then there's the regional adjustments. A lot more than just the diagnosis.

Kate,RN, I apologize that my newness is showing. I was unaware that the nurse themselves got paid per visit. I have only worked in rural america and a nurse being paid by the visit is unheard of out here. And I actually appreciate you explaining the PPS system, no one has been able to explain that to me here. Thank you so much for being able to share your knowledge with me.

berube · Aug 2, 2011

on a typical day i will see 8 (units),,a soc, roc and recert might be in the mix, i can handle up to 9....i think it is unfair to say that those seeing that many patients are not providing quality care! i have seen nurses see 3 in an 8 hr day and accomplish nothing! i never short change my patients, i know my patients inside and out, i can tell you their meds off the top of my head. Is there paperwork at home? of course there is. If home health is overwhelming to some with the mountains of paperwork, it is ok to seek employment elsewhere. HH is not for everyone, i have been doing HH for over 20 yrs and this is the norm, good days with 6 and bad days with 9. it comes with the territory. HH may be the hardest job we will ever hold. With all the medicare regs we can only assume that the documentation will get heavier.

shannongriffinrn · Aug 4, 2011

It's easy to get caught up in the "rat race"... trying to make productivity, earn the good money that can be made, and make everyone happy. The bottom line that nurses should be paying attention to is patient care and safety. If a nurse is seeing 40-50 patients per week, is he/she providing the care that the patient deserves (and payor sources require) in a safe and thoughtful manner? We all have to know our limits and practice within them.

AnnaRN78 · Aug 6, 2011

My supervisor does not allow any nurse to see over 7 patients a day. If you have more than that we have a PRN LPN or RN see the overflow. A busy day for me would be the Friday I just completed. I had 6 patients, 4 regular visit, 1 start, and 1 DC. If those nurses in your agency are seeing 50 patients a week then they are seeing about 10 a day. Unless they start their day at 7 and end at 7 I don't see how they are doing true case managment with those patients. Does it take an hour for each patient, well I hope not ,unless it is a start, but the time doing case management with those patients can easily take up the other 30min that you didn't spend in direct contact with the patient. I wonder what their re-hosptialization rates are. I would bet it is high. Of course every one has their own way of getting their job done...so just because one nurse takes 2 hours to do a start doesn't mean the next nurse will take that long.

Daisy369 · Jun 16, 2019

I quit a job for a seemingly shady agency after a month . As DON i was ask to do QA on over 150 patients , all recerts for about 20 and growing patients, all supervisor visits 60 day 30 day and 14 day skilled and HHA plus open all cases and visit all patients after being in acute or long term care facilities. some SOC was an hour and half drive in part on country gravel roads. I was to complete the Oasis SOC documentation in 15 minutes and no more! I was ask to backdate my documentation which I refused to do . In addition I was doing skilled visits in far away counties , up to a one hour drive , as the other nurse LPN refused to travel out of town . The day I quit I was screamed at and verbally abused and threatened on the phone to open the 6 cases that day and get all QA done etc. Then text harassment ensued and ultimately I was told to stay away from the office as cameras had been put up . At the same time demanding me to turn in my keys and documentation yet told to stay away . I actually got an attorney to discover my rights. I have never witnessed so much unprofessionalism . The owner who did the screaming is not a nurse . My orientation was promised to be thorough yet I had only a few hours of Oasis scattered training and worked without a phone or computer for 2 weeks . Told to use my personal cellphone and personal Lap top . I was snapped at if I had Oasis questions told I had my training to look at notes. Does anyone complete a SOC in 15 minutes on Oasis? Has anyone worked in such a nightmare ? Owners upbringing was in Kenya and she told me the British ran a business by yelling and being aggressively demanding, to get used to it that it was merely business no hard feelings ! I was told that since I was working in a hostile environment to file with the labor department . plus she refuses to pay me for 2 weeks pay which I worked .

IMOKAY, BSN · Jun 17, 2019

That sounds terrible Daisy369! So sorry.