What's the difference between Home Health Case Manager-RN and Visiting Nurse-RN?

berube · Mar 31, 2011

from my experience the term "visiting nurse" is a term use in different regions,,,both are the same,,,,RN casemanager is HH , is the one who manages the care, visits, schedule for his/her case load, some agencies have a RN/LPN team and the LPN does most of the regular visits and the RN does the oasis visits....case loads can vary, i have had anywhere from 24-35 patients at one time to manage, taking into factor the frequency of the patients....i have never been paid more to be a "case manager"

RN276 · Mar 31, 2011

Thanks for your input. How is it that RN's can work part time in home health and handle a caseload?

KateRN1 · Apr 1, 2011

"Visiting Nurse" is a general term for any nurse who sees patients in the home. A Visiting Nurse may also be a "Case Manager" if that visiting nurse takes primary responsibility for a team of patients.

There are several ways that patients in home health care can be case managed, these are the two with which I am most familiar.

1. In-office case management. Care is dictated by a "case manager" in the office. The nurse who does the start of care calls report in to the office CM. The CM decides the frequency based on the RN's report and takes responsibility for doling out the visits to all nursing and therapy staff. The same nurse may or may not continue to see the same patient(s) because primary nursing is generally not a priority under this model. Almost all communication from all disciplines goes through the CM in the office and no one field person takes responsibility for the patient. Generally speaking, there is very little autonomy or flexibility with this model of care.

2. Primary Nurse Case Management in the Field. In this model, generally an RN admits the patient, has greater say over the frequency and who will be assigned to care for the patient and the admitting RN continues to follow the patient. If the team includes LPNs, the RN may elect to delegate routine care of the patient to the LPN with the expectation that the LPN will keep the RN informed of the patient's status. Other disciplines involved will (should) also report to the case managing nurse regarding the patient's therapy progress, etc. The primary RN, or Case Managing RN, is responsible for all care of the patient throughout the episode and has a greater level of autonomy for things like wound care changes, need for additional disciplines, etc. The downside of this is that the RN often becomes overwhelmed if there are many high-acuity patients or other staff do not take the case management role seriously.

What I find most often is that there is a combination of the two models used. Very rarely do I see pure primary case management model used to full effectiveness, often due to lack of buy-in from nurses, but also due to micro-management by nurses in the office.

It is quite easy to work part time in home health and handle a case load. Some of my best case managers are older RNs who believe whole heartedly in primary case management and carry a load of maybe half a dozen patients at a time. They also work for other agencies who don't use primary case management, but definitely like primary much better.

OkieeRN · May 21, 2012

I have been a field nurse case manager, a case manager that did all OASIS visits and had an assigned LPN conduct all regular SNV's, and an in-office case manager (with no hands on pt care), with the latter being my current role. The pay I received while working as a field nurse cm was per visit. I made the typical lower rate for regular nursing visits and a higher rate for OASIS visits. Both of the other case manager roles were salary.

lamona1955 · Mar 20, 2013

May I ask the rate of pay per visit? I was offered $25.00 per visit. That won't pay my gas there and back. Am I understanding the pay correctly?

paradiseboundRN · Mar 21, 2013

Thanks for your input. How is it that RN's can work part time in home health and handle a caseload?

It can be done. You would be scheduled a caseload depending on how often you want to work. For example, I worked M/TH/F. I had about 5/6 patients at a time. I saw them on M/TH and I used Fridays to open new cases or see patients that had a doctors appointment on Thursday. It doesn't always work perfect. If my patient was in the hospital and they're discharged on a Monday or Tuesday, I would need to do a ROC visit on my day off, unless I could get another nurse to cover. I worked this schedule for about 2 years with no issues until my agency decided that contingent nurses should only do SOC's.

paradiseboundRN · Mar 21, 2013

In Michigan, the case manager and visiting nurse are the same unless the agency uses LPN's. In that case, the RN is the case manager.

paradiseboundRN · Mar 21, 2013

May I ask the rate of pay per visit? I was offered $25.00 per visit. That won't pay my gas there and back. Am I understanding the pay correctly?

If you are an RN, that rate is too low. In Michigan the rate is $50 per visit for RN

salvadordolly · Mar 24, 2013

It depends on what payor source you agency is. If they do a lot of medicare, you'll be the primary nurse and case manager. If they do a lot of medicaid, they often have LPN's do the skilled visits and the RN's do the supervisory visits and oversee the case. It often pays lower to do the medicaid supervisory visits. I'm in WI and we pay $25 per supervisory visit. the skilled nursing visits are $30. To make more money, most of our RN's also take some skilled visits to round out their caseload.