How to chose a hospice to work at?

tewdles, RN · Dec 30, 2009

I will try to be concise and to the point...

You do not want to work for a "for-profit" hospice...period.

Make sure to ask them about how they handle admissions, after hours calls, and on call. Ask about weekend obligations. Do they have an admission nurse or team? Do they require the case managers to take call on the weekends or during the night? If so, how many hours per week/month, how is it compensated, and do they give you some time to recoup if you are out all night? Ask about their expected case load for a case manager? Do they expect you to manage more than 12-15 patients in the field? What support do they offer the case nurses? What case load does the MSW carry? Do they have contingent RNs? What is the management plan for case manager illness or vacation? Ask them why they are currently hiring...what is their turnover trend for the past 18 months? Certainly you need to ask about the wage and mileage reimbursement.

Good luck.

Flutteryby · Dec 30, 2009

Wow, good questions to ask. What is the typical case load for in the field? How many pt's do you visit per day? At what point is it so many that you can not provide good care? What do you do if you are on a call and you plan for it to take 30 minutes and it ends up taking 90 minutes?

Thanks for your help.

tewdles, RN · Dec 30, 2009

Wow, good questions to ask. What is the typical case load for in the field? How many pt's do you visit per day? At what point is it so many that you can not provide good care? What do you do if you are on a call and you plan for it to take 30 minutes and it ends up taking 90 minutes?
Thanks for your help.

The case load varies by area and agency. I know hospice case nurses who manage 18-24 pts routinely. The comfortable standard is 12-15, with a mix of private residence and LTC patients. I generally complete 4-6 visits per day...my friends who case manage 18+ pts often see 6+ pts/day. I rarely have a patient who I would assume would require only 30 minutes of my time. I plan on 60 min for most of my visits. Sometimes you plan on 60 and spend 120...you have to call the office and get some assistance with your other visits on those days. I generally have at least one visit each day which is a once weekly visit...I try not to see them first and they are the ones that I will bump to the next day if needed. I try to establish that level of flexibility early in that relationship with the patient and family. In my practice, it is not really a question of too many visits to provide good care...it is more a mechanism of too many to get home before 7 pm. Sometimes a day can get extemely hectic with information coming at you from all directions...many phone calls while driving, lots of changing orders (while driving), changing POCs, etc...I delegate as much to the office support staff as I can during those days. Otherwise, I try to accomplish most aspects of the case management of each patient while I am with them...MD consult, new med orders, POC revision, referrals, equipment orders, etc. This (I think) helps the patient and family to feel that they are well informed and involved in the POC.

Good luck.

Flutteryby · Dec 30, 2009

Thank you so much! Truly helpful information.

nadinekRN · Jan 3, 2010

Why not "for-profit" hospice?

tewdles, RN · Jan 3, 2010

By their very nature, for profit hospices will put profit above all else. Whereas a not for profit hospice is likely to attempt to meet the bottom line (pay salaries, rent, utilities, etc...) and the remainder is not profit but funds for patient care. There are no share holders or owners to make happy with cash flow above and beyond expenses.

In my mind, the pursuit of profit in hospice can be a very serious conflict of interest and most people cannot get their own financial interests out of the way of the patient's interests.

Ginapixi, BSN, RN · Jan 4, 2010

nadine: i worked for a for profit - for a year

I left because they literally, physically drained the life out of me! i was on salary, however expected to work more than 40 hrs; they also paid lower mileage reimbursement; as mentioned in the other posts: they want to make a profit; since the basic care is regulated by medicare (in terms of what a hospice has to provide to the patient) they make a lot of their profit off their employees....