Name your hourly wages! / 1:1 private duty pay

Home Health Columnist / Guide · May 19, 2023

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How is it the agency gets more than 50.% for their overhead ?!

I've been involved in startup of a for profit home health care and home care agency along with a large multistate established home health agency.

Most private duty 1:1 home health care , especially pediatrics is covered by Medicaid plans who negotiate with an agency a set hourly rate, getting an increase in hourly payment is extremely difficult often taking several years as each states legislature determines payment for Medicaid services --often with budget cuts requested.

Starting a Home Care Agency can cost $80K and Home Health $350K

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Much of the cost is incurred around licensing issues and regulations requiring licensed personnel, computer software and hardware, patient care costs that are paid out of the owner's pocket and are not recoverable, commercial space for the office and the length of time the state is out until initial review or survey. Additionally, many states now require that all Medicare start up agencies go through an Accreditation organization, which also adds cost, and time to the start up phase.

The day to day costs include software subscriptions, disposable materials like gloves and masks, utilities, rent, bonding office employees, business liability + fire insurance, office equipment + supplies: desks, phone and answering service, billing forms + envelopes, pens, binders, copier paper, stamps; marketing and advertising, mileage payment, performing license and sanction checks, management staff salaries, etc --costs not billable to insurance like visits are billed but added to field staff salaries in calculating hourly/per visit pay contracted with each insurance company that they will pay to an agency ---along with denials of payment (where agency still has to pay staff for care already provided).

Medicare requires 10 patients to be admitted and care provided prior to revieing agency for compliance with Medicare regulations and granting a Medicare provider number -- with no payment for services rendered.

These are reasons private duty home health nurses have lower salaries and infrequent raises.

In PA, RN hourly rate $32-36 noted in employment ads.

How to a ask for a raise? Quality home health agencies provide a yearly evaluation, often near anniversary date of hire or on yearly prior to end of budget year (as former HH Manager, I had to complete 32 staff evals by May 31st yearly). Staff were notified prior month evals being performed so they could discuss during meeting their accomplishments and goals for following year. Employees having perormance issues would be counseled at time of occurence/throughout year with improvement plans developed so no one surprised during eval.

So gather one's thoughts about your work performance for eval and use as justification for a raise:

Time and attendence: % arrived on time; # call outs, # shifts missed along with # extra shifts picked-up/ stayed late to cover care
Nursing care provided: Did you serve as team lead, responsible for Q60-90 day plan of care orders review and incorporating verbal orders into chart? Do you perform Quality Assurance(QA) chart review + # charts reviewed? Great communication / conflict resolution skills - smooth out miscommunication between providers/staff/client/parents? Hospitalization prevented due to prompt action? New skills learned: trach/vent care
Nursing Career investment: in-services or conference attended outside work requirements, nursing certifications, additional education/degrees, articles written/published online or for nursing journals, involvement in nursing organizations: ANA, NLN, Academy of Medical-Surgical Nurses (AMSN) , Society of Pediatric Nurses, etc. Journals read like Home Healthcare Now, Nursing2023, American Nurse Today and CE courses beyond work/license requirements.

Amount $$ raise to request: look at employment ads to gain idea of salary offers in your area; Zip Recruiter and Indeed.com often has 1:1 home health LPN/RN postion's posted. What's the economy like -- job glut or scarcity/ability of your agency to staff private duty case? Use prior year raise to gauge % to request for raise. Historically 3% used as base for increase in my Philly area. Underpaid --request $1.00 + more.

Stand up for yourself: nothing ventured, nothing gained.

Take advantage of any 401K or 403b plans saving MAX amount *especially if work matches $$ invested ( often as high as .50 cents/ every dollar you save) as comes out PRETAXED and will need for retirement in years ahead. One can learn to live on lower initial take home WHEN you consider will have monies later in life.

Hope these ides help!

Boppityboop · Oct 30, 2023

Thanks for your input.

Yes I get that there is overhead that the home health agencies have to pay for. But if one agency on the same case pays let's say 34 an hour, and another agency sharing the case paid the nurse 47 an hour, using the same insurance from the patient, then clearly there is some money being pocketed by the agency offering poorer rates . They want us to believe it's all about poor government reimbursement rates , but I'd say follow the money .... places always have a desire to maximize profits .... it's human nature .