Is this s agood offer? New to Home health...

HmarieD · Mar 2, 2010

It sounds like a good offer, although the PTO does seem a little low, as you noted. Would you be working per diem or as a FT employee? I'm guessing if you are getting benes you would be full time.

Six visits can be a pretty heavy workload depending on the acuity of the pts, travel distance and time, etc. I would find out if they "weight" the visits, in other words does an admission count for two of those six visits or just one? Probably the most common complaint in HH is the amount of paperwork that people end up doing at home, off the clock. With six pts a day, I doubt you will have to worry about going home before 5:00.

As far as pay rates, that would be excellent in my area, but we have a low cost of living. Pay will vary from area to area, and it's hard to compare from one to the other and determine what's better or worse.

Is there a case manager or other office nurse to assist you in following up on MD orders, labs, coordinating care, etc? Are you responsible for scheduling pt visits or do they have a scheduler?

With several small children (kudos to your DH BTW), HH might be a good choice because of the flexibility many staff enjoy. You may be able to take a couple of hours in the afternoon to go see that school play, and complete your day's work afterwards, or drop off and pick up your kids from school, for instance.

Personally, I love HH and will never go back to the hospital. But, if you are the primary breadwinner, I know there are many factors you have to consider.

You are not the first person to have asked this kind of question here - it would be a good idea to look through some older threads that may answer some of your questions. I think sometimes we get weary of answering similar questions again and again, so you may not get a ton of responses, but a look back would help. Good luck to you!

Fancifulmist · Mar 2, 2010

Hi HMarieD,

Thank you for your response. I will be working full-time at this agency. We reside in western Cook county here in Chicago, so our cost-of-living is very high. Also, we have the dubious distinction of having the highest tax rates in the country. I really would like to try home health, as I've always been interested in this field. Patient care and my assessments are where I shine. I could be very happy in this specialty, but some of the threads I've read frankly scare me. Some I've read talk about people not getting to bed until 12:30 am and 1 am and then having to get up in the AM and start all over again. I would love to have the flexibility and autonomy that I feel this could offer me, but I don't want to be entering into a situation where I'm worse off than the hospital unit I'll be leaving for this job! Since I've had to return to straight nights for the past 2 years at my hospital and the constant stress of the acuity levels and low-staffing, I'm constantly ill! The stress is killing me, literally.

I will be switching to home health, but I don't want to make a bad choice by choosing a subpar agency. Just trying to make sure that I'm getting overly screwed over by the agency before I accept this position!! :)

KateRN1 · Mar 3, 2010

Another consideration is what happens when census is low? If you don't get the visits, you don't make the money. Will you be able to survive if you only get 20 visits that week? I made the decision that I will never again work on a pay-per-visit basis. Salaried positions have their own drawbacks, but not being able to make the rent isn't one of them. My gut feeling is that you can do better, but it may take some digging. On the other hand, once you have some home health experience under your belt, you have a great bargaining tool and may find those premium HH gigs a bit easier. Good luck, whatever you decide.

caliotter3 · Mar 3, 2010

Another consideration is what happens when census is low? If you don't get the visits, you don't make the money. Will you be able to survive if you only get 20 visits that week? I made the decision that I will never again work on a pay-per-visit basis. Salaried positions have their own drawbacks, but not being able to make the rent isn't one of them. My gut feeling is that you can do better, but it may take some digging. On the other hand, once you have some home health experience under your belt, you have a great bargaining tool and may find those premium HH gigs a bit easier. Good luck, whatever you decide.

This is what I would advise you. And the major reason why I do extended care instead of intermittent visits. Although RNs who do extended care usually do not earn as high an hourly wage, because most continuous care is at the "LPN level", at least you are assured of a steady paycheck to go along with a steady work schedule.

ItsTheDude · Mar 4, 2010

pay per visit = you're gonna have slow weeks/months (less $$$ to pay your bills with, oops) and you're gonna have heavy weeks/months (gonna work your butt off (ot, but u don't get paid for ot) and it's gonna mess up your personal/family time).

lamazeteacher · Mar 4, 2010

I have worked for 6-8 HH agencies in the past 20 years, and having more than one agency at a time ensured that I'd have work whenever I wanted it. The beauty of working in HH by the visit, is that you can turn cases down (although I wouldn't do that too often) and when things are slow at one agency, they may not be that way at the other one. Also you would get a sense of which agency is preferable, according to expectations, supervisory staff personalities, etc. The scourage of that, is that regular salaried HH nurses will leave their most hated cases for PTers. Often I got those leftovers in the worst areas of town, or the most resistent to teaching, etc. They tell you an area is secure, no need for security personnel (I've never gotten them); and then you find yourself scared out of youir wits......

Hopefully the computer program used by your agency will cut down the time you spend charting. That is a very good thing. Repeatedly handwriting the patients' names, addresses, case #s, etc. on each page used to drive me up walls...... If the referrals can be printed from the program, and messages sent physicians, all the better!

Actually the PTO sounds terrific to me - I never got any of that at any agency.

I also have never been offered a car, which my husband coujld drive. The latter sounds like somewhat of a drawback, since they may want you to cover the auto insurance yourself, in addition to the $60/month (? rental ?).

The most important aspect of the health insurance you've been offered, is the cap on the coverage. Before accepting their coverage, which from the description you gave seems incredible, look carefully at what is covered. BC/BS is the worst of the worst insurance carriers in existance (and the most utilised). It's only now that their fraudulent ways are being prosecuted. In their haste to "make hay while the sun shines", hiking their rates up 39%, in anticipation of their demise, they could have ammended formerly presentable policies, to cut off expensive parts, like what surgery and medication is covered, whether you'd have HH if you were ill, if PT and OT are included, etc.

The same should be found out with the dental and visual program. Will they cover X-rays more than once a year? Are endodontists and other specialties covered? For how much? What about orthodonture for the children when they're of an age to need that......... It's worth the time and effort to look into those things ahead of time. Luckily I asked an agency that offered health insurance to PT employees for $325/month, and after weeks of not being told what it was, found that the yearly cap on payout for care was $1,350! That included hospitalization(s)! I was furious!

In the past couple of decades, insurance companies have been so powerful that they thought they could be as ourageously expensive, for very little coverage, as they wanted to be. Now they know they dug their own graves, as when the Reform of Health Care bill goes through, their profits will be curtailed dramatically. They've been as bad as banks, giving bonuses to top executives, etc. at the average person's expense!

I wish you good fortune and can't recommend HH highly enough. I've loved becoming close to patients and their families, furthering prevention of complications and illness for all of them and teaching self care. You can't beat the satisfaction from the work!

Fancifulmist · Mar 6, 2010

Hello All,

Thank you for all of your advice! I did accept the position with the HH agency today and am excited to finally be leaving the hospital. I did make an error in the cost of the "lease" of the vehicle. It is actually $90/week, which sounded pretty steep at first, until my DH and I sat down and figured out home much we spend on gas/insurance/maintenance on our own vehicle. After that, it seems like a pretty good deal. The insurance is provided by my agency and covers both my hubby and I (the car can be used for both business as well as personal needs). I've submitted my resignation to my current supervisor. My orientation at the agency will last for 4 weeks and I'll be salaried during that time period. Wish me luck and I'll keep you posted about how things are at this agency.

KateRN1 · Mar 6, 2010

Best of luck to you! And make sure you come back here and visit often!

ItsTheDude · Mar 7, 2010

congrats, company cars are generally a very nice bene.

AnnemRN · Mar 7, 2010

Hopefully the computer program used by your agency will cut down the time you spend charting. That is a very good thing. Repeatedly handwriting the patients' names, addresses, case #s, etc. on each page used to drive me up walls...... If the referrals can be printed from the program, and messages sent physicians, all the better!

Honestly, I'm currently working home health intermittent visits solely computerized and it is no faster (sometimes actually slower) than the paper systems I've done in the past.

The programs are overly detailed and ask for so much information that there is no speed to the documentation. Also, many times the program gets hung up and in those cases I have to shut down the computer and start all over again.

I wonder how other home health nurses feel about their computerized programs?

caliotter3 · Mar 7, 2010

I have avoided agencies that say in their employment ads that they use computers. I don't care to use them in my work. I am just fine with doing paperwork by hand.

OP, just wanted to congratulate you on accepting the job offer. Hope your new job turns out to be a good experience for you.