How many patients should a case manager be responsible for.

[katie'sangel]

I just started working at a for-profit hospice agency in Houston Texas. I am per-diem and shocked at how many patients the full time case managers carry. 15 to 20 or more patients. The standard of care at this agency is just one visit from the RN case manager each week. If the patient needs more visits, an LVN or the per-diem RN (myself) can help.

We have IDG (or some call it IDT) meetings every other week and case managers have to prepare and present each of their patients to the MD at that meeting. It takes hours to prepare for and the meeting itself takes one to two hours at the hospice office. And of course the case managers are putting over a 100 miles on their car each week.

Seriously, who can give dying patients the care they need and support the families when you have 5 to 7 patient visits to make each day spread out all over town.

And the trend in Houston is for all the agencies to work their nurses like this.

Is it like this every where:(

[toomuchbaloney]

case manage 20 patients?

Maybe for a spell but not as a regular thing.

Some agencies have nurses that they call case managers who do not visit the patients as a general rule.

They do all of the prep and presentation for IDT meetings, etc. They are administrative nurses who insure that supplies and equipment are appropriate and available, that the medication POC is up to date and in compliance with internal and external regulations, that the documentation is on time and complete according to JC or CHAP and CMS, etc.

[hospiRN]

I have a question ( ok a couple lol)- with the high caseloads you all manage, do you have a 40 hour/ full time week? Do you take on call? Do admits? Have a nurse working under you to do repeat visits? Are you utilizing your team ? I am really wondering also, is your agency for or non profit?

I have 17...We do get some help from PRN nurses. I have yet to know a 40 hour work week...I am salary, I usually do about 50 hours a week (and yes we take call, at least once per week..we have designated weekend on call nurses). We do admits as well....

[Race Mom, ASN, RN]

I am a little spoiled, I guess. I work for such a wonderful company, for-profit, hourly. I have 11 patients right now, most was 12. I was overwhelmed when I started since I went from 3 (during training) to 12 in one day. As I became more efficient, things flow more smoothly. I always hover around 40 hrs/wk. We have great team support and I have to keep reminding myself to utilize them. My problem is that I use A LOT of critical thinking and that usually means communication with family/pt in all aspects of life. At that point, I will let my LCSW and SCP know what I found and let them work their magic. We are encouraged to have a 45 min visit or less. We don't have LPN's to visit pts. I do all the visits. Some of my pts are seen 3x week (wound care) and sometimes it's daily when at EOL. My average pt is seen 2x week. My IDT doesn't take me long to prep for as we have an IDT template that we use during an "IDT visit" every other week. We occasionally have to take call, but that is only when our dedicated on call nurses are unavailable. Some of our nurses at other offices (different cities) have upwards of 20 pts. There visits are super short. I don't get how they do it. We chart in the home and that alone can take 20 minutes! My average time is just under an hour.

[areensee]

For profit or not for profit, it doesn't really make any difference in hospice. The not for profit agencies I have had acquaintance with don't necessarily do a better job for the patient. In fact, competition tends to promote better patient care. So while I am one who wishes that health care was seen as a right rather than something to be bought and sold, our current system blurs the field and you will find not for profit groups following the same questionable business practices as some for profit groups do.

Now for your real question, the number of patients depends on the staffing model used. If you as an RN are the only nurse to routinely see your patients, then a good number is 12 to 14. It also depends on the acuity of your patients and the location. For example, if you have 10 patients in one facility, obviously you are going to save a lot of time driving. If your agency using a team model, and other nurses (RN or LPN) are making some of the visits, then obviously you can case manage more patients.

[areensee]

Probably is time to leave. Why jeopardize your license for unsafe practices?

[NonnaWick]

Hi Katie,

I have been a hospice nurse for 6 months now, after 21 years in the hospital pcu. I completely understand what you are going through. I am a very high energy, fairly organized person, with many years experience, but feel completely overwhelmed some days. I see typically four to six patients daily, and carry a team of 12 to 16. IDG usually runs from 1 to 4pm. Loongg meeting. I spend hours preparing for these meetings but still find I do not have easy access to the info I need to have all the answers to our doc's questions. A few of my patients are probably not hospice-eligible, and I find myself grasping at straws to make sure they are re-certified as our entire team has a reputation now for revocations. I have had days where I have fielded and placed over sixty phone calls. Now, we are switching from McKesson charting to HCHB, so that is a painful transition, and we have been bought out by another company so upper management is getting squeezed which is in turn squeezing us as well. Our new pharmacy is not as efficient as our old one either, and it is very frustrating when I have to make four to eight phone calls to pharmacists and patients just to get one med order placed. I love my patients and my coworkers, but our director has a vicious tongue, and has run the office through cronyism, bullying and targeting those she doesn't like for firing. I am frustrated, but I can see what a wonderful job this could be. I feel like I am in a holding pattern waiting to be fired, or waiting to quit. It's definitely better than the hospital, but it is a very different world. Just learning how to chart in hospice has been a challenge. Orientation was disorganized and completely lacking in thoroughness. I can't imagine what other kind of nursing I would want to do...and we still need a paycheck. I'm just hanging in there for now...

[toomuchbaloney]

Hi Katie,

I have been a hospice nurse for 6 months now, after 21 years in the hospital pcu. I completely understand what you are going through. I am a very high energy, fairly organized person, with many years experience, but feel completely overwhelmed some days. I see typically four to six patients daily, and carry a team of 12 to 16. IDG usually runs from 1 to 4pm. Loongg meeting. I spend hours preparing for these meetings but still find I do not have easy access to the info I need to have all the answers to our doc's questions. A few of my patients are probably not hospice-eligible, and I find myself grasping at straws to make sure they are re-certified as our entire team has a reputation now for revocations. I have had days where I have fielded and placed over sixty phone calls. Now, we are switching from McKesson charting to HCHB, so that is a painful transition, and we have been bought out by another company so upper management is getting squeezed which is in turn squeezing us as well. Our new pharmacy is not as efficient as our old one either, and it is very frustrating when I have to make four to eight phone calls to pharmacists and patients just to get one med order placed. I love my patients and my coworkers, but our director has a vicious tongue, and has run the office through cronyism, bullying and targeting those she doesn't like for firing. I am frustrated, but I can see what a wonderful job this could be. I feel like I am in a holding pattern waiting to be fired, or waiting to quit. It's definitely better than the hospital, but it is a very different world. Just learning how to chart in hospice has been a challenge. Orientation was disorganized and completely lacking in thoroughness. I can't imagine what other kind of nursing I would want to do...and we still need a paycheck. I'm just hanging in there for now...

I do not have easy access to the info I need to have all the answers to our doc's questions...wow, what sort of questions are they asking that you cannot access the info? Could you provide an example? Perhaps, if you do not have access to the info they require, they are asking the wrong person?

A few of my patients are probably not hospice-eligible, and I find myself grasping at straws to make sure they are re-certified...Just remember that it is NOT your job to make the patient look eligible, it is your job to report the facts and data of the case. The TEAM determines if recert vs. discharge is relevant.

we are switching from McKesson charting to HCHB...let us know how that works out. I did not really care for that software.

our director has a vicious tongue, and has run the office through cronyism, bullying and targeting those she doesn't like for firing. I am frustrated, but I can see what a wonderful job this could be...maybe this COULD be a good job, but not likely with management like that, IMHO.

If it were me I would be looking for another hospice provider and start marketing myself to them.