LTC or home health?

Nurses General Nursing

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Hello all,

I will be graduating in May of this year, and only two fields of nursing interest me. LTC and home health. I got into nursing to specifically work as a LTC or home health nurse. Since doing clinicals at hospitals, OB/Ped floors, psych halls, etc, I still maintain that LTC or home health are the only two areas I want to be in.

I am somewhat worried about LTC though. Many nurses that have worked in LTC have expressed that it's a less than ideal field to work in. The nurse to patient ratio is apparently...bad in these facilities. I love and adore the elderly, I just don't know if I can afford to skip lunches every day, with no breaks, and not much time to use the bathroom. I suffer from migraines, and hunger is one of my biggest triggers. In order to better care for my patients, I will need to set aside some time to take care of myself during the day. Any LTC nurses here that have had a better experience? Is there such thing of a nursing home with a decent nurse to patient ratio?

Home health interests me because you can somewhat set your own hours. However, I don't know how well I'd do with being on call much of the time. Home health nurses, what are the pros and cons of this area of nursing?

Thank you all in advance.

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The good news is that your preferred fields are among the easiest to break into due to the often unfair stigma associated with them leading to reduced competition.

I can't speak much on Home Care, but I can tell you that you shouldn't get too hanged up by LTC nurse/pt ratio that scares so many. Nursing school and the NCLEX focus on acute care, very nearly to the exclusion of all other settings. This leads to students thinking that all bedside nurses must perform full assessments on each of their patients every shift and that safe care cannot possibly be given to any group of patients once that ratio starts creeping around 10:1 and above.

The fact is, in LTC settings, the facility is the residents' HOME. It would be both intrusive and unnecessary to try to perform a full assessment on each resident every shift. Ongoing assessments are performed on residents known to have something going on, and focused assessments are performed as needed as observant nurses/aides notice changes in condition in the rest.

Not that many facilities don't have unsafe ratios.... many do. Just saying that many schools and/or hospital nurses only look at things in terms of acute care standards, which is a frankly stupid thing to do when considering long term care.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I love and adore the elderly, I just don't know if I can afford to skip lunches every day, with no breaks, and not much time to use the bathroom.
I worked in LTC for six years and always took my lunch breaks and used the bathroom without feeling rushed. However, my time management was decent because I realized that the residents were my patients, not my personal friends with whom I could chat for hours.

The nurses who take pride in running around with a full bladder and bowel all shift seriously need to reevaluate their priorities.

Home health is not for me. I simply do not like entering homes where the patient is blowing cigarette smoke in my face and has pet poop all over the carpet.

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Thank you both for your helpful responses. It is good to be reminded that you don't do full head to toe assessments q shift on all the residents. I've done clinicals at three different nursing homes, and two of the three nursing homes, the RN or LPN was running around busy all shift. The other nursing home, things seemed to be a bit more calm, and the nurse was able to take a 30 minute lunch. What I gather is the experience of the nurse plays a big part in how the day goes. The more experienced nurse has learned better time management and is able to take lunch most days.

Another question related to LTC... Do nursing homes typically hire more RN's or LPN's? I've seen more LPN's on the floor than RN's. Will it be more difficult to find a job in a nursing home because I will be an RN?

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No, a RN should be able to find a job in a nursing home just as easily as a LPN. Sometimes more easily, as some LTC facilities like to be able to use high RN-to-LPN ratios as a marketing gimmick.

What your role as a RN will be, as compared to your LPN coworkers, will vary by facility.

At some places, like my current place of employment, you will be placed in more of a supervisory position with LPNs passing meds and doing treatments. At other facilities you will work side by side, with virtually no distinction between the two roles. I *believe* the latter scenario is the more common of the two across the US.

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No, a RN should be able to find a job in a nursing home just as easily as a LPN. Sometimes more easily, as some LTC facilities like to be able to use high RN-to-LPN ratios as a marketing gimmick.

What your role as a RN will be, as compared to your LPN coworkers, will vary by facility. At some places, like my current place of employment, you will be placed in more of a supervisory position with LPNs passing meds and doing treatments. At other facilities you will work side by side, with virtually no distinction between the two roles.

Thing is, I don't want to work as a supervisor. I want to do patient care. Because LPNs and RNs have the virtually the same duties in a nursing home, is there much difference in the pay scale?

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Thing is, I don't want to work as a supervisor. I want to do patient care. Because LPNs and RNs have the virtually the same duties in a nursing home, is there much difference in the pay scale?

Well, as I said, I do believe most nursing homes put new RNs on the floor doing bedside care along side the LPNs. My facility is one of the exceptions where the bulk of the day-to-day bedside care is strictly a LPN duty. The RNs are there mostly to supervise, audit charts, process admissions, run interference with families, stuff like that.

But if you want to work the floor in LTC as a RN, I am confident you will find such a job relatively easily, provided you have a well written resume and interview well. :)

And, yes, at the vast majority of homes, RNs make more than their LPN colleagues, even when their roles are nearly interchangeable. In my area RNs in LTC can expect to start out about $5 an hour higher than LPNs in the same field.

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Well I love home health. It's been a great career for me. Not all agencies are the same. I'm sure I out earn any LTC nurse in my area and I have an amazing amount of job satisfaction.

I think a big difference between what I do and much of what I read on this forum, I may work hard but I go home feeling good about what I accomplished on a daily basis. I may go home tired but I never go home feeling like crap. Imagine a job where patients and family are thanking your all day long, drs' offices that return calls with a positive team attitude, relationships with wound clinics, DME's, infusion companies, labs..

That with a good income and treated with respect by everyone makes the hard work worth it (and honestly it doesn't feel that hard to me though I may eat my words one day)

I wouldn't want to discourage anyone with a big heart and good energy from going into LTC but home health has been so good to me.

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I have the opportunity now to try Home Health as an LPN now that the LTC facility I worked in for 15 years is closing. Just hoping I have made the right decision to decline being transferred to another facility and try something different.

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Specializes in retired LTC.

New employee jitters are common, but I'll wager you will do fine. You have years of approp experience which should really help you along.

Good luck looking forward.

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