"Fee Basis" Exemption for Home Health Nurses

Specialties Home Health

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I've been a home health nurse now for about five years. One of the biggest complaints I have has been "why am I working so much and not getting paid for my time?" I searched through the various posts on this thread and I see that other home health nurses are having the same complaint. Last night, I did some research on the Wage/Labor site and found something interesting. Evidently, in 2004 President Bush changed the overtime laws for certain segments of the workforce. If an employee is salaried or paid on a "fee-basis", then they are not entitled to overtime. What does "fee-basis" mean? It means that no matter how many hours it takes to complete the tasks involved for that fee-paid visit, a home health nurse does not get overtime. We don't get paid for the ridiculous drive times, calling our patients to set up the appointments, all of the doctor calls, faxes and follow-ups. Most good home health nurses will agree that they put (on average) ten hours/day into their jobs. Most agencies require 6 visits/day. That is approximately 4 hours of work not being paid to the nurse.

Now that I "have seen the light" in this matter, I am at a cunundrume (???? spelling) about what can be done to change this situation other than to leave home health entirely. Most, if not all, home health agencies are skirting the overtime issue by taking up this "fee-basis" paid-per-visit (bullpuckey). For starters, I have written a letter to President Obama this morning. Are there any other suggestions other than just plain leaving home health? My personal opinion on this "fee-basis" overtime exemption is that it may have been geared to employees or contract personnel who are obviously getting paid an exhorbitantly higher fee for their services than the run-of-the-mill home health nurse. What are your thoughts?

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Thank you for providing the answer to how this baloney started. Yep..we were told we were not exempt...no overtime.

I argree to do only 6 schedule visits a day. No more. Unless I'm on call and I have to do an on call.

Does it bite into my pay?? Yeppers.. but I figure they aren't going to get any more of my life than I have to give. as close to 8 hrs as I can manage.

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I have decided that the way to get around the overtime problem is to not work longer than 8hours anymore. One agency only staffs at 12 hours at a time, but voila, they pay well (the only agency that pays well around here), and they say they pay overtime. Of course, this is one of the agencies that has never placed me. And I doubt they ever will. I can't understand why they bothered to hire me.

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Specializes in COS-C, Risk Management.

I will not take a per-visit position, salary only. In my last round of job-hunting, I wouldn't even interview with an agency that paid per visit and I told them that upfront. If enough nurses refuse to work per-visit, eventually companies will see the light. (Yeah, I must be smoking something.)

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No hh employer has given me the "fee-basis" line. They tell us they can't pay overtime because the reimbursement rate does not allow it. Strange. Wonder where the money that the unionized agency and the agencies who do pay overtime comes from? I maintain that if one employer can pay overtime to the external employees, all of them can.

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Specializes in NH/ HH.

OMG...well I work in texas and i just got an appt to talk to an attorney for over time pay, but i guess im SOL..lol.I read earlier in some of these blogs that some HH agencies that nurses saw 7-8 pts a day...WOW! Since i started working for this HH, some nurses would see 76-80 pts wkly, and yes we all say the same thing, how could that nurse give adequate pt care, well 5 mins isnt adequate pt care, but yes its true..I would even see 14-15 pts daily and start at 7 and end my day at 8:30 sometimes 9 and than still come home and work on my paper work..but now my pt load is 40-42 pts per week and let me tell u..man i love it..i get to come home early, cook or read with my kid, which i now see is much more important than killing myself and not having a life cuz i realize im never gonna get rich this way so i might as well pay off what i owe a little at a time and be home with my family that actually appreciates me for what i can do not for how rich i can make them. So ive come to a conclusion that i might have to find a different career or find an 8-5 nursing job that will keep me sane at least until my kid goes off to college, but for now I tell my fellow collegues to take the time to smell the fresh air and spend the time with family and friends while we still have them cuz money isnt everything and wont make us happy unless we hit the lotto..lol..good luck to all the nurses that wk for unappreaciative and greedy employers..Take a stand to promote safety and adequate pt care!

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It is easy to refuse to work per visit home health and to work extended care cases instead. Then, if your shift is eight hours long, you get paid for eight hours. You complete your paperwork during your eight hour shift and don't have to waste time doing work at home. This is one of the major reasons that I work in extended care rather than intermittent visits.

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The pay per visit plan is currently being challenged in court. In Ohio a judge has stated there is enough evidence to okay a filing. Also in Georgia, a class action suit involving a VERY well known national HH company is in progress. In friendly chitchat to an upper management person I had mentioned these proceedings, remarking " Oh I'm sure the upper brass is aware of the possible illegality of pay per visit, aren't they?" Her eyes got BIG, and this "Oh .... " look appeared on her face.

Currently Im just watching and waiting........

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all the agencies in my area are Pay Per Visit, only salary positions are the office ones.

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The salary positions I've seen expect the nurse to see 15+ patients per day!

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I recently read something about the "fee basis" exemption as well, I was trying to research what other HHA's were paying. Apparently, some agencies have a base weekly rate and then pay per visit on top of that and bonuses if paperwork is completed within a certain time frame.

Where I work we are pay per visit, we don't get paid for office/case management time but anything over 40 hrs/wk we get overtime, but our overtime rate varies. It depends on how many visits or units we did that week and how many hours, so it could be as low as $7-12/hr which is the average. It seems like it's not even worth it to keep track of our hours. With our pay per visit rates and the average time our nurses spend case managing outside of the home we average about $14/hr which is absolutely not worth it! I was making more than that before I even went to nursing school, so what's the point?

Also, we don't get paid for mandatory meetings unless we have more than 1/wk which has never happened. So, for example, we serve 9 counties so we have 2 offices and we had a meeting today in a central location for everyone which is about a 30 minute drive (minimum). The meeting goes from 12-2pm and usually always goes beyond that. I got all my visits done by 11:15 and drove to the mtg. If all I did was see my pts I would have averaged about $33/hr but including my drive time, the mtg, and then some office time afterwards, my average goes down to about $11/hr.

I understand one view point is that if we are paid hourly then nurses could drag out the paperwork and milk their timesheets, but pay per visit seems to be the HHA way of screwing the nurses out getting paid for their work. There have been slow times when I've only had 2-3 pts a day and then there have been times when I've worked from 8am to midnight straight through with no break, being on call!

It's crazy!

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Yes, the pay per visit is a means to cheat nurses out of their rightfully due pay. The agency I worked for changed from hourly to pay per visit with the bold remark they were doing it 'so we dont have to pay overtime".

Two very large national HHA have a class action suit filed against them for such ploys, Ameysis and Gentiva. There is a possibility a third company will be added to the list. It will be interesting to watch how HH will try to cover the backside when those cases get to court.

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