Hospice case management and physical demands

HeySis, BSN, RN · Feb 25, 2017

The type of patients on hospice can vary greatly. And some of it depends on where your hospice patients are located. Where I live most are still in their homes. In some areas they are in LTC facilities or hospice residences.

A patient can be terminal and on hospice and still be going outside and gardening, or they could be bed-ridden.

Sometimes the families are very involved and will do all the "heavy lifting" and sometimes the nurse will end up doing a dressing change on a dependent area by themselves having to hold the weight of the patient while doing it.

If you are able to make your own schedule you maybe able to make it so you cross paths for a 10 minutes with the hospice aide and get help from them with those kinds of things.

The biggest thing about home health and hospice work is the paperwork which you will be doing after the visit. Hospice is not yet as bad as home health. (Can anyone say Home Health OASIS, ugh!)

You will mostly take notes at the visits, put some numbers into your assessments and do the rest of the work later. The longer you work there (and depending on the software your company uses) the faster you'll get. Each company does it different, so you'll have to ask if your documentation time is built into the hours they are offering. If it's not, expect to spend a lot of time at home, finishing paperwork.

It use to be that you got paid by the type of visit a flat rate, starting a new case paid more then routine visits, death visits paid more the routine but less then starting a new case, it was based on the "time it took" to do the visit and documentation. So as a new to hospice nurse it took a long time and pay was not that great, as you got more efficient it took less time and the pay was more attractive and/or you could fit more visits into the same amount of time, making more money.

The federal government ruled in 2014, and it became enforceable in 2015, that pay/visit was against labor laws and the HH & H employees had to be paid hourly. I don't know if every agency has switched over. Some agency have, but pay differently for travel time, like minimum wage (they state you are not using your nursing skills to drive between appointments). They are not legally required to pay mileage.

So I would ask (not during the interview, but if you get an offer) for details related to pay.

Some hospice's will let you make your own hours, which can be very nice to work around a schedule and life.

Most hospices also require you take some on-call, so if a death or emergency happens a nurse can go to and help the patient/family.

Sorry it's so long. I love hospice, it's such a great service that is offered, and it really feels like the errand of angels when you can help people have a great end-of-life experience (from making the most of life, to the peaceful death). But there is a huge difference in the way agencies give hospice care, pay employees and the expectations of work involved.

HelloWish, ADN, BSN · Feb 25, 2017

Thank you for all the awesome info!

TheCommuter, BSN, RN · Feb 26, 2017

We have moved your thread to our Hospice Nursing forum with the goal of amassing more responses and feedback. Good luck to you.

https://allnurses.com/hospice-nursing/