Job offer..salary to start then point based pay..need feedback please

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I was offered a Baylor position (Fri/Sat/Sun) for a large HH agency. The offer letter states (and the recruiter and Administrator confirmed in the interview) this is a FT position.

During the orientation period (about 2 months) I will be salaried then pay will be based on "points" depending on visit type (SOC, Recert, etc). Mileage is paid from office to all visits and back to office. No call is involved and there is a small stipend for cell phone. The Administrator during the interview stated weekends were "steady" especially Fridays but wasn't specific other than stating "some weekends there are more admissions that others but there are routine visits and recerts, ROC and unexpected visits."

What I don't understand, and am not able to get a direct answer about, is what happens if there are no visits for the weekend or only a couple of visits? Does this mean I don't get paid at all? The point visit rate is based on my hourly rate times whatever the point value is assigned to the visit. If I understand it correctly, even though it's FT, if there are no visits for a weekend then there would be no pay even though technically I am "working" or if there were only couple of visits then I would only be paid for those few visits for the weekend. I don't understand how this translates into a FT position or how I would have consistent FT income.

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My take on this is that you are going to transition into a non FT situation similar to how people get paid "on commission". No calls, no work, no pay. Few calls, only paid for that type of visit. In other words, this job is not a reliable source of consistent income. Imagine applying to rent a home or get a new credit card, and you can't even figure out what to put on the application because some weeks you get nothing and some weeks, perhaps $120 and other weeks perhaps $440 or whatever. If you don't need a consistent salary, (your partner's income covers expenses), then take the job if you want to. But if you need a consistent check, if it were me, I would look elsewhere.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Worked for 2nds largest HHA in PA. Baylor F/S/S 12hr FTE position required that one needed to meet point system to maintain FT = 30 points

examples: 3 admits/day ; 2 admits/resumption care +3 revisits; 8 revisits/day

Admit/Recert/Resumption = 2 pts. RV=1 pt. No show 1/2pt.

As Central Intake Mgr, majority of our daily homecare referrals arrived Thursday and Friday (100 admits +25-50 resumption of care) so had bountiful visits for weekend staff with many overflowed to Monday. Since you state large agency, should be OK.

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22 hours ago, caliotter3 said:

My take on this is that you are going to transition into a non FT situation similar to how people get paid "on commission". No calls, no work, no pay. Few calls, only paid for that type of visit. In other words, this job is not a reliable source of consistent income. Imagine applying to rent a home or get a new credit card, and you can't even figure out what to put on the application because some weeks you get nothing and some weeks, perhaps $120 and other weeks perhaps $440 or whatever. If you don't need a consistent salary, (your partner's income covers expenses), then take the job if you want to. But if you need a consistent check, if it were me, I would look elsewhere.

Yes, that is what my gut is telling me as well. I am the only income for my household so not having one that isn't consistent isn't doable. Thank you for replying.

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13 hours ago, NRSKarenRN said:

Worked for 2nds largest HHA in PA. Baylor F/S/S 12hr FTE position required that one needed to meet point system to maintain FT = 30 points

examples: 3 admits/day ; 2 admits/resumption care +3 revisits; 8 revisits/day

Admit/Recert/Resumption = 2 pts. RV=1 pt. No show 1/2pt.

As Central Intake Mgr, majority of our daily homecare referrals arrived Thursday and Friday (100 admits/25-50 resumption of care) so had bountiful visits for weekend staff with many overflowed to Monday. Since you state large agency, should be OK.

This company is nation wide so I know it's a stable company. They have multiple offices in each state so this particular office only covers one county which also concerned me as the county isn't that large.

My other concern is I am the only income for my household and it seems like being paid only based on points would mean my checks would be inconsistent and census/referral dependent. No visits/low visits, no pay/low pay.

What strange is the hospice side of this company salaries it's nurses so I'm not sure why that isn't done for the HH side as well but then again, it's been a long time since I worked HH so I know much as far as reimbursement etc has changed.

Thank you for replying.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Ask how often points reviewed and salary adjusted. Points were reviewed on a weekly basis ( how many not home not found-- followed up with referral source, # deaths) monthly reviewed for total average; then quarterly FTE status looked at if not meeting point system performance improvement plan (PIP) instituted. Would be asked to change to part time or termed when performance improvement plan not met.

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4 hours ago, NRSKarenRN said:

Ask how often points reviewed and salary adjusted. Points were reviewed on a weekly basis ( how many not home not found-- followed up with referral source, # deaths) monthly reviewed for total average; then quarterly FTE status looked at if not meeting point system performance improvement plan (PIP) instituted. Would be asked to change to part time or termed when performance improvement plan not met.

I can't see going through this just to have a job. Visit work is fine when there is an abundance of available work but when one gets one visit in a day and it is so far away that one has to pay out of pocket to gas their car to get there only to be paid for one "occurrence", just not worth it. Not even looking at the aggravation of PIPs because somebody wants to say that one is not working hard enough. I go to my 8 hour shift 5 times a week and everybody is satisfied after 40 hours and I get my paycheck. Better for me and my bank account. JMO

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Compensation System in Home Health has good explanation of models pros and cons. Point based productivity balances time efficiency with cost of service - minimizes non-productive + poor performers.

https://www.nahc.org/wp-content/uploads/2017/10/AM14-310.pdf

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On 8/23/2020 at 5:08 PM, NRSKarenRN said:

Compensation System in Home Health has good explanation of models pros and cons. Point based productivity balances time efficiency with cost of service - minimizes non-productive + poor performers.

https://www.nahc.org/wp-content/uploads/2017/10/AM14-310.pdf

Thank you for this. I am moving forward with the position after (finally) speaking to the Nurse Recruiter and the Administrator again to get some clarification. The reason they are hiring specifically for Baylor is because, like your experience in PA, the volume is such they are either having to roll visits into the next week or turn away admissions because they don't have the weekend staff to support taking them on. They tell me they care confident there will be no issue with my getting visits & if I want I can pick up more during the week. Hopefully they are telling the truth. So for the foreseeable future this will work. I don't know about long term, time will tell, but there are other opportunities within the company so that is also a plus. Fingers crossed!

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Hope the position works out for you!

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Update: unfortunately it ended up not working out as so many of the patients canceled on the weekends, didn't want HH due to covid but mostly because the M-F CM's had to pick up extra visits on the weekend to meet their salaried productivity so I ended up with little to no paycheck one too many times so I resigned.

I was just offered a M-F salaried position at another HH agency that is hospital based but am hesitant based on my experience thus far and other posts on here about the amount of out of normal business hours HH nurses end up working - paid or not. I am not opposed to doing that sometime but not all the time. Paying my bills is important certainly but so is doing more than just working all the time too. 

Nurses are so dispensable to companies now. It's such a shame.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Thanks for your update.  My colleagues report same issue since COVID -refusing homecare visits for 2/3 past year, seeing a decrease in refusals now as more understand the disease and vaccines being given.

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