Two patients one client-revisited

Specialties Private Duty

Published

I get paid X dollars per hour by an agency. The home that I go to there are two clients. I care for both clients. They both required the same care basically. Originally I was told that they were both approved for 4 hrs each. So, I didn't really argue about more pay.

One patient now gets more hours approved. I am told to chart the X+ hours and that means double assessments for this one. The other one is still only X. The second patient is often home ALL DAY LONG (usually out for things during most of the day), but often I have both all day long. Parents not home and even when they are they busy fighting the good fight for the patients.

When I was told to chart X+, I filled ALL my paper work out with the new hours, including my time sheet. I was paid. Week following, pay dropped to original rate. I am being told that RN's with twins (they are not twins at all) get a flat rate. I am pretty sure it ain't my small rate.

Before I email about this and raise the roof, what IS fair? AGAIN, these are NOT twins.

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Specializes in Peds(PICU, NICU float), PDN, ICU.

I had a case with two kids. One in school during the day and walked home. I did the major care stuff for the kid at home. Then did care for the other kid when he came home. But both were home and I supervised them once the other one came home from school. Basically charting stopped for the first kid at a certain time and them started for the next kid. But kid at home all day was on tpn and it ran 18 or20 hours a day...can't remember exactly. So of course if something went wrong, I had to take care of it. I always questioned the pay too. Wish I could be of more help. But I've been there. I remember a thread about this quite a while back, maybe you can find it and it will help too.

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Yes, similar situation, but now I have to keep charting for kid (a) after kid (b) gets home from school. And, when kid (b) is out of school I have two. Mom is not usually home. I found my original thread and all answers were double kids double pay or pay + half. I just don't think I can keep charting all day for kid (a) and basically have two kids for the last four hours of the day. It's just not right.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Not a case I'm on right now, but there is a case with my agency where there are two disabled kids in the same home, and that case pays $7/hour more than the regular rate to account for the fact that you're doing more care and documentation than if you only had to care for one child.

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When I ask, should I go whole hog and ask for the increase for the case as a whole or for the half of the day that I regularly have two children? Opinions? I am putting myself in a position in which they disagree and say lump it, I will have to lump it until I get a new case for those days. Who knows how long that can take. Knowing the agency is getting paid and I am not is leaving a sour taste in my mouth.

I guess I should start with the whole hog and then I have a chance to work back to a portion.

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Specializes in Complex pedi to LTC/SA & now a manager.

My one agency policy 2 children = 2 nurses. The other case with 2 children it happens that one child is with agency A and other child has agency B. (Child #1 requires an infusion qualified RN and agency A offers that service while agency B does not. Originally Agency B had both children. Both complex enough to qualify for nursing so the case manager insisted on 2 nurses. Agency wanted to keep the case so they staffed each child separately)

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
When I ask, should I go whole hog and ask for the increase for the case as a whole or for the half of the day that I regularly have two children? Opinions?

I would ask for an increase in pay for the period of time that you are taking care of two children.

That equates the increased income to the increased workload/complexity. Also, since the agency can only bill insurance for the extra hours when both kids are present, the agency (theoretically) only has the money to cover the additional wages during the hours they are able to bill additional services.

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I turned down a case where they asked me to care for two, but only get paid for one.

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Specializes in Peds Homecare.

A few years back I cared for a set of twins. I was not payed double, but I think it was like $8 or $9 over my regular rate. They were premies, both on apnea monitors, but bottle fed. You should be payed extra per hour when caring for two. It was an insurance case, mom and dad both worked.

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Thank you everyone for your replies.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Let us know how things work out for you!

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I'm not sure why it is necessary to pay more money for more than 1 patient. When I worked in the hospital, there were times my load was light and times it was insanely complex and heavy. The pay never changed based on my assignment.

Most nurses would be thrilled to have just 2 patients!!

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