Pay per visit VS hourly

Yourhomehealthnurse · Feb 1

I do per visit and prefer it over hourly. I can usually see two patients in a hour if they live close by, so I wouldn't get paid as much doing hourly. If you are going to be covering a large territory and patients are like 30+ minutes apart I would do hourly. I only cover my home city and few surrounding cities so my patients are a max of 15 minutes apart. Today I had 4 patients and finished in 3 hours. Most regular visits take 30-45 minutes. Start of cares (SOC's) usually take an hour.

jnb1740, BSN · Feb 4

JS-RN said:

Hello, I'm an ED/ICU RN leaving the bedside and going into home health. I have 2 job offers and I'm not sure which to take. One is pay per visit and the other is hourly.

Job #1- $68/hr with 1 on-call shift per week. This is job is a 4 day work week

Job #2- SOC-$120, ROC-$114, f/u eval-$65, sign on bonus of $2500, and travel time pay $15.50. This is a 3 day work week

My concern is that I'm new and there will be a learning curve, therefore I'm not sure which would be best for me. Both are willing to train me and both companies have solid reputations.

Help I don't know which one to take. Thank you :)

Wow those are great pay-per-visit rates, but so is the hourly. Maybe start the hourly IF they will let you switch to the pay-per-visit, if you do the math and it seems as though you'd make more money doing it that way. It all depends on how far away the visits are from each other. What State are you in if you don't mind me asking?

CosmoRN · Feb 4

What state are you in? I prefer pay per visit vs hourly because if you do hourly they pressure you to get all charting done from 8-5 so they don't have to pay you OT and the truth is if you seeing 5 patients/day or doing 2 SOC's you will end up charting at home for a few hrs every night. In California the state has deemed pay per visit is violating the Labor Dept rules because they are not paying for the hrs worked at home (they consider it as part of the pay per visit) and not giving the required 2- 10 minute breaks or 1/2 lunch & most are not paying travel time. 2 large HH companies in CA have been sued successfully by former employees and huge awards were paid to the HH nurses, because the state gets involved. If you work hourly you will have to see less patients per day 3-4 to get all the charting done by 5:00 PM. You can also work for a salary usually $80,000-95,000 for a HH RN & that is legal according to the State Labor Board. In CA the pay per visit is usually $130 per SOC, $100 for Recerts, $80 for a revisit and mileage is paid. Nurses that only do SOC's, get $165-200/SOC. Hourly wages in CA are usually $50-55:hr. Unless its a Union, everything is negotiable. Whichever one you decide to do ask for the maximum amount as they will try to get you to work for the least amount. Also ask for 2 hrs case management time per week. That is the time you will spend on the phone trying to get orders from MD's. A SOC takes an hour just in the patients house but then you will spend another 1-3 hrs at home putting in all the meds, Interventions, goals and summary.Hope this helps you.

JS-RN · Feb 4

This is in Southern California

vampiregirl, BSN, RN · Feb 6

You've gotten some great suggestions and perspectives from other posters...

Additional information that might help your decision:

How long a typical SOC takes at each agency (different charting programs and different processes at different agencies can both influence the time involved).
How many patients are typically scheduled to a nurse each day.
Regarding call - geographical area covered, agency census, typical number of calls/ visits per call shift.
Another poster recommended asking for a specific number of case management hours a week. An alternative questions might be inquiring about the wage for case management. Some cases have a lot of follow-up/ coordination of care or education/ support via phone is necessary outside of visits. When I worked HH, I found this to be vary variable. Unless the agency is set up with a phone nurse who handles all of this and an established process to ensure communication is in place to facilitate this.

Home health can be a great place to use your experience and knowledge from the ICU/ER. It's a challenging area of nursing at time with some of the same frustrations I'm sure you're accustomed such a non-compliance and frequent flyers. It also can be so rewarding to see patients gain health literacy that allows them to better manage their conditions or improve through hard work.

JS-RN · Feb 6

CoolHHRN said:

What state are you in? I prefer pay per visit vs hourly because if you do hourly they pressure you to get all charting done from 8-5 so they don't have to pay you OT and the truth is if you seeing 5 patients/day or doing 2 SOC's you will end up charting at home for a few hrs every night. In California the state has deemed pay per visit is violating the Labor Dept rules because they are not paying for the hrs worked at home (they consider it as part of the pay per visit) and not giving the required 2- 10 minute breaks or 1/2 lunch & most are not paying travel time. 2 large HH companies in CA have been sued successfully by former employees and huge awards were paid to the HH nurses, because the state gets involved. If you work hourly you will have to see less patients per day 3-4 to get all the charting done by 5:00 PM. You can also work for a salary usually $80,000-95,000 for a HH RN & that is legal according to the State Labor Board. In CA the pay per visit is usually $130 per SOC, $100 for Recerts, $80 for a revisit and mileage is paid. Nurses that only do SOC's, get $165-200/SOC. Hourly wages in CA are usually $50-55:hr. Unless its a Union, everything is negotiable. Whichever one you decide to do ask for the maximum amount as they will try to get you to work for the least amount. Also ask for 2 hrs case management time per week. That is the time you will spend on the phone trying to get orders from MD's. A SOC takes an hour just in the patients house but then you will spend another 1-3 hrs at home putting in all the meds, Interventions, goals and summary.Hope this helps you.

Thank you, this does help

JS-RN · Feb 7

JS-RN said:

Thank you, this does help

Yes, this helps very much. Thank you. FYI- I'm in California

JS-RN · Feb 7

jnb1740 said:

Wow those are great pay-per-visit rates, but so is the hourly. Maybe start the hourly IF they will let you switch to the pay-per-visit, if you do the math and it seems as though you'd make more money doing it that way. It all depends on how far away the visits are from each other. What State are you in if you don't mind me asking?

This is in South California