please outline for me, a "good" home health agency

Libby1987 · Apr 28, 2014

Wow!

I'm paid by the visit.

My wages are comparable to straight time in acute care.

I work Mon - Fri with a rare, as in maybe once a year, weekend when our weekend nurses need a weekend off.

We take turns rotating through a week of night call with only making visits on cath patients with retention. And I give my call away usually to a part time nurse that likes the extra money so haven't actually taken call in 1 1/2 yrs.

I haven't worked a Xmas since I've been there, going on 7 years.

I live in my territory and start clocking time and mileage at my first patient.

I have no problem maintaining my benefits.

I work in a supportive mgmt environment.

I don't work 8-5, I set my schedule and work the hours as I want as long as my patients' needs are met.

Our turnover is slower. We have nurses that have celebrated their 25th anniversaries.

My company is smaller, mid size maybe.

jhdoublin · Apr 29, 2014

And this is the way it should be in hh. These jobs should be sought after, but the norm is probably not. My company is poorly ran, and if it weren't that I love hh and being a cm that sees pts with the flexibility.... I would quit. I'm never "off" my patients call me and so does the office on my days off. I feel responsible for my pts every need, which is not right. But its the price I pay right now for flexibility since I have small child.

Libby what area are you in?

Libby1987 · Apr 29, 2014

I'm in Northern California.

I'm unusual in my office in that my patients have my cell number, but I work remotely from my home some days and I'd rather have vm on my cell then to have to drive into the office to pick up messages. In 7 yrs, I haven't had a patient abuse having my number and I really don't look at it as any different than my office number since it isn't my land line. It helps me get my messages timely, often it's info I'm requesting, and helps my time mgmt and efficiency.

While my patients potentially have access to me during waking hours (on call nurse for NOC hours) I have noted that they call less due to reduced anxiety from knowing they have a contact person. Plus I get my patients as independent as possible as early as possible. I teach them how to make decisions and navigate the healthcare system appropriately.

allnurses Guide · Apr 29, 2014

It doesn't seem like I really have the option to get my patients independent; my company keeps them as long as possible and we have little to no real input as to who to keep and who to ask for discharge orders on.

allnurses Guide · Apr 29, 2014

I have no real flexibility. I'm expected in the office at 8am sharp every day. I'd like to find a better company but don't know where to look.

Libby1987 · Apr 29, 2014

That's really different from our focus, which is more of a rehab perspective. Unless they require a nurse for observation of an unstable condition or a complex woundor something that's obviously medically necessary we work on getting them competent, stable and discharged.

I would look for a different home health environment and in the meantime get that experience on record so that you are more marketable.

outside_child · Mar 29, 2015

Wow!
I'm paid by the visit.
My wages are comparable to straight time in acute care.
I work Mon - Fri with a rare, as in maybe once a year, weekend when our weekend nurses need a weekend off.
We take turns rotating through a week of night call with only making visits on cath patients with retention. And I give my call away usually to a part time nurse that likes the extra money so haven't actually taken call in 1 1/2 yrs.
I haven't worked a Xmas since I've been there, going on 7 years.
I live in my territory and start clocking time and mileage at my first patient.
I have no problem maintaining my benefits.
I work in a supportive mgmt environment.
I don't work 8-5, I set my schedule and work the hours as I want as long as my patients' needs are met.
Our turnover is slower. We have nurses that have celebrated their 25th anniversaries.
My company is smaller, mid size maybe.

OMG Libby you have the perfect HH job!

JustMeRN · Mar 29, 2015

The more I read the more I appreciate my agency.

I work per diem, I am paid hourly and have mileage reimbursement. I don't qualify for benefits, but the agency has decent benefits for full and part timers.

I provide my availability calendar on a monthly basis, I am required to work 1 weekend a month and 2 holidays a year (this year I have Presidents' Day and thanksgiving).

Since i I am per diem I usually only case manage 2-3, then work as a care partner with 3 other full time nurses. I cover their visits scheduled on their days off, or when they have too many visits. The attempt is to keep me in my home area, and generally I am within a 5 mile radius of my house. On occasion I get an assignment far away. Last week I did a visit that was 40 miles away. But I am paid for my drive time and mileage so it's fine with me.

Most days I don't even go to the office. I have an agency provided laptop and blackberry and work primarily from my kitchen table. I work 6 hour days, then I am home to get my kids off the bus. I try to do most of my charting at point of care, and usually spend less than an hour finishing up once home.

If I finish early or someone cancels I easily email scheduling and they assign me another visit or tell me to check in with other nurses in my area to see if they need help.

I meet with with my team supervisor twice a month to go over any issues, questions, or patient concerns. We have interdisciplinary team meeting once a week to discuss clients getting multiple services (pt, OT, st, hha, social work). There is always an emphasis on independence and discharging to self care if it is an option.

Our agency has a nurse and administrator on call for 24 hours a day. Full timers rotate call. I am never expected to field a phone call after my regular work hours, and doing so is discouraged. I have a few times, but since I have an agency provided phone clients abusing my personal phone is not an issue.

For or comparison I work for a nonprofit full service agency that employs roughly 65 nurses. I do notice turnover is on the higher side, but I'm thinking it's less too do with the agency itself and more to do with how different home health nursing is. There is what I would call decent staff support, though not great clinical support. The education department is seriously lacking. If you don't know your stuff you will sink with this agency

OP it sounds like your agency is very likely abusing medicare by continuing to provide unecessary care. That would be a red flag for me. If you are looking for a new agency I would start by looking for an agency that places emphasis on independence, and also on staff support. Ask lots of questions if you interview with an agency. Good luck!

anh06005, MSN, APRN, NP · Mar 29, 2015

As PP's have said I'd be leery to keep with that agency for more than I had to. My agency isn't (well, wasn't since I graduated and moved on) as awesome as Libby's but was similar to hers.

We got paid per hour. I kind of preferred that because then I felt okay to take my time to truly help/educate the patient's who needed it without worrying. Since we got paid hourly if we were full time we got full benefits no problem.

Most of us were case managers who had a set of 15-20 patients we saw as their primary nurse. They were assigned based on territory and diagnosis (some of us had background in cardiac while other nurses weren't as comfortable with it). We rotated weekends. 2 nurses per weekend so we wound up working every 5-ish weekends. If it was slow we had an easy one but we were often busy. They recently hired weekend option nurse who is sometimes the only one who works now. It has eased up on the regular field nurses. We also had a few nurses who mostly went to do eval's and maybe took a few patients as case managers.

The thing that got me was the office nurses would often accept more referrals than we could handle so the field nurses would wind up with constant OT while they all got to go home at 4:30 M-F and they never took call or did weekends. Many of the field nurses felt as if they were on a pedestal while we were worked to the bone with time taken away from our families and homes. The addition of a weekend option worker helped a bit of that as it was often on weekends when everyone got discharged and we were asked to work extra...again....after our week where we often already had OT.

We rotated major and minor holidays. We worked a Thanksgiving or Christmas every 5 years or so (we would draw a name of one's who hadn't worked the last 5 years).

Anyway we also discharged many many patients because there was no skilled need. Our office trusted us to believe our gut feelings about patient's. If we had a feeling they needed a little more time and we could swing it paperwork wise we'd do it. If we went on an eval and really didn't think they needed us we wouldn't pick them up but leave our number if anything changed. I was glad they realized we were the one in the homes and saw the entire picture. Not just the OASIS.

Libby1987 · Mar 29, 2015

As PP's have said I'd be leery to keep with that agency for more than I had to. My agency isn't (well, wasn't since I graduated and moved on) as awesome as Libby's but was similar to hers.
We got paid per hour. I kind of preferred that because then I felt okay to take my time to truly help/educate the patient's who needed it without worrying. Since we got paid hourly if we were full time we got full benefits no problem.
Most of us were case managers who had a set of 15-20 patients we saw as their primary nurse. They were assigned based on territory and diagnosis (some of us had background in cardiac while other nurses weren't as comfortable with it). We rotated weekends. 2 nurses per weekend so we wound up working every 5-ish weekends. If it was slow we had an easy one but we were often busy. They recently hired weekend option nurse who is sometimes the only one who works now. It has eased up on the regular field nurses. We also had a few nurses who mostly went to do eval's and maybe took a few patients as case managers.
The thing that got me was the office nurses would often accept more referrals than we could handle so the field nurses would wind up with constant OT while they all got to go home at 4:30 M-F and they never took call or did weekends. Many of the field nurses felt as if they were on a pedestal while we were worked to the bone with time taken away from our families and homes. The addition of a weekend option worker helped a bit of that as it was often on weekends when everyone got discharged and we were asked to work extra...again....after our week where we often already had OT.
We rotated major and minor holidays. We worked a Thanksgiving or Christmas every 5 years or so (we would draw a name of one's who hadn't worked the last 5 years).
Anyway we also discharged many many patients because there was no skilled need. Our office trusted us to believe our gut feelings about patient's. If we had a feeling they needed a little more time and we could swing it paperwork wise we'd do it. If we went on an eval and really didn't think they needed us we wouldn't pick them up but leave our number if anything changed. I was glad they realized we were the one in the homes and saw the entire picture. Not just the OASIS.

This is why I prefer PPV. It's much easier to set the number of visits you can handle given the current average acuity without push back. I'm either working a perfect 6 patient/ 8 hr day, a 7-8 patient very well paid day, or a 2-4 patient day and going home early/catching up after a run of busy days.

I never get the quota thing amd I like the variety in workload, it's easier to get through a tough run when I know there will be those short days when I have less patients or I can take advantage of help available. Also at PPV there is a different motivation for taking in those extra referrals to keep census up. It can feel like they're doing it for me versus me working my butt off for them*.

I prefer an average of 6/day, others prefer 5. At hourly we would be expected to maintain 5 and the average is informally tracked, at salary there aren't those bonus short days where you can get out of town early or just go do your personal thing.

*tangent..if we don't accept referrals from our good referral sources, they will go somewhere else. I don't want to lose those post ops and only get the "dumps". We've been there before when we've tried to set too tight of limits and it takes a lot of marketing and consistency to get them back. From a PPV a perspective, the type of patients I have make a big difference in my productivity, all high acuity with dysfuntion takes so much time and energy and we need a mix to keep it feasible. If on hourly/salary your agency accepted you managing a lower number of patients/visits per day, then all high acuity would be fine but I believe they ultimately have a quota in mind.

anh06005, MSN, APRN, NP · Mar 30, 2015

This is why I prefer PPV. It's much easier to set the number of visits you can handle given the current average acuity without push back. I'm either working a perfect 6 patient/ 8 hr day, a 7-8 patient very well paid day, or a 2-4 patient day and going home early/catching up after a run of busy days.
I never get the quota thing amd I like the variety in workload, it's easier to get through a tough run when I know there will be those short days when I have less patients or I can take advantage of help available. Also at PPV there is a different motivation for taking in those extra referrals to keep census up. It can feel like they're doing it for me versus me working my butt off for them*.
I prefer an average of 6/day, others prefer 5. At hourly we would be expected to maintain 5 and the average is informally tracked, at salary there aren't those bonus short days where you can get out of town early or just go do your personal thing.
*tangent..if we don't accept referrals from our good referral sources, they will go somewhere else. I don't want to lose those post ops and only get the "dumps". We've been there before when we've tried to set too tight of limits and it takes a lot of marketing and consistency to get them back. From a PPV a perspective, the type of patients I have make a big difference in my productivity, all high acuity with dysfuntion takes so much time and energy and we need a mix to keep it feasible. If on hourly/salary your agency accepted you managing a lower number of patients/visits per day, then all high acuity would be fine but I believe they ultimately have a quota in mind.

Nice way to think about it (your tangent). And yeah we are associated with a hospital and have the best scores around so we do well but many of the field nurses are getting so stressed and burning out at the rate they are going. It'd be nice if we could just tell them we are seeing 6 patients today or ask to get off early for a doctor's appointments but there have been instances they have asked us to change appointments that we told them about weeks ago because we are busy.

Basically our agency is great Ihc some aspects but at the sacrifice of employee satisfaction at times. If only they were all like yours! It'd be Christmas every day for me!

And I really did like your view on PPV. I hear of the nurses who see sooooooo many it's not even really possible to give good care just so they get the money.

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