Looking for info on well run agencies

[Capco56]

I work out of a hospital based agency, have been in HH only a few months, and we've had alot of changes with personnel occupying new positions, etc. Wondering how other agencies organize their scheduling and assignments for visits and case managing. Here's how we operate and if you have some helpful tips, I would love to hear them. Currently have RN's/LPN's out in field with RN also doing the case managing on a master schedule. Supervisor makes daily assignments from this master schedule. As much as possible she attempts to keep us on our "territories", but it's not always possible. We're in a very rural, spread out area, so travelling 50-100 miles a day is not out of the question. Currently, the RN's average 5 patients (SOC=2, all else =1). Very often I find myself doing a d/c on other nurse's patients who I know nothing about, same with ROC and recerts, etc. I've noticed in a lot of posts, nurses have their own patients who they follow from beginning to end, scheduling all their visits themselves, working primarily out of their home, etc. It seems our agency is in such disarray that any help would be welcome. Would love to hear how a well-run agency manages their patients, specifically in cases where the field RN is also the case manager i.e. what responsibilities are done in the office by the supervisor, what specific responsibilities to managing a caseload do the RN's do. Thanks so much for your input. I know there has to be a better way to organize everyone's day!

[berube]

all i can say today is stay away from Gentiva,,,unless you enjoy micromanaging

[carwin]

Try an RN/LPN team. This allows the RN to make all OASIS visits while the LPN can step in an make revisits. Home care is such a separate beast compared to other hospital departments. Although hospital-based HHA often can put more money into the orientation than the free-standing HHAs, I think there is an attempt to use the hospital model for home care.

You want to minimize the number of people going into a patient's home for continuity but mostly for patient safety. This is first and foremost a patient's home. If you have patient's canceling services, it could be that they are tired of having to re-tell their story to each new nurse passing through.

Teach your RN's to case-manage. Remember this nurse will need assist because it's hard to make lots of calls from the field when one is driving, seeing patients. The supervisor can run case conferences, support field staff by ordering DME or assigning other disciplines and schedule. High mileage needs points assigned. Fifty-sixty miles should be considered a normal day of driving. Mileage policy could be translated into points, i.e. over 50 or 60 miles up to 75-85 miles = 1 point. Up to 100 mile an additional 0.5.

You have to wrap your brain around the fact that home care cannot be run just like the hospital. It is its own business. The free standing agencies "that are not into scamming medicare-caid" can help you in that department. Go to your state home health meetings. You should find help there.

Good luck!!

[RubyRN,CHPN]

I have worked for both a hospital based home health agency and a free standing agency.

The free standing agency allowed the CM's to do there own scheduling with a lead intake nurse adding an admission visit to your schedule if your schedule was light or covering for sick call. There was no productivity requirement. There was continuity with providers with some of the nurses and some of the patients who were well case managed and good case managers. However, I noticed that some of the pt's were often passed to other nurses often. There was a real disconnect with teams geographical areas. Not to mention, there was not an incentive to meet any productivity requirement. Pay and raises were lousy. From a time management perspective and cost containment perspective there was an agency wide need for improvement. Bosses were way to busy micomanaging and not focusing on real solutions to issues.

On the other hand, working for the hospital based home health agency there are actual schedulers. CM's have a weekly schedule and can pass patient's to the LPN's on their teams if needed. Teams are organized by geographical areas. There are float nurses who do OASIS-SOC-ROC-and some R/C's. There is a productivity standard which includes a provision for mileage and driving between pt's. not to mention a much better compensation package because there is an incentive to be productive-better pay!!! Managers are focused on creating systems to help their employees be better CM's. Not ineffectively micromanaging their staff. There is an office nurse to follow up on orders, take phone calls from pt's. and answer pt. questions, follow up on labs, etc.