Would you consider HHC a stable position?

[TipitiwichitRN]

Would you consider HHC to be a stable position? As the main insurance provider for our family, I am nervous about making a switch.... Of course change itself can make you nervous, but somewhere I got it in my head that a hospital or LTC would be considered more stable.

And the toll it takes on your car.. What do you do??! Do you save all mileage for repairs? If so, the GAS is coming directly out of the nurse's pocket...

I am a full time day shift ortho nurse in a smaller community hospital. We do have our own hospital HH services, but since I already work full time, I am sure that adding a per diem role would not be something the hospital would want to do. I would need to seek per diem from an outside agency- to see if I like it- and to gain some experience... It is hard to locate HH places!

After reading many many threads here, I have come to the conclusion that I would love the autonomy, the travel, the possibility of greater nurse-patient connections...

..... but I am so nervous to make that leap.

Any advice? Thanks everyone! : )

[paradiseboundRN]

If you need to support a family with consistent pay, benefits etc than you will need to find an agency that will hire you salary or guarantee you 40 hrs per week. Working per diem is a risk because if they don't get enough referrals (patients) than you don't work. I have found the agencies with the salaried positions, best benefits and mileage reimbursement are the hospital affiliated ones. Some of smaller ones may pay better, but its usually not salary and they offer lousy benefits. As far as mileage, the IRS sets the reimbursement rate at about .50 cents per mile and they adjust it every 6 months according to gas prices. The good agencies will usually be close to that. That should be enough to cover gas and repairs. But honestly I haven't kept track. I have seen a lot of nurses support their families doing HHC. Good luck!

[TipitiwichitRN]

Thank you for your feedback. I am thinking then that working per diem for any old agency- in addition to my hospital position- may be a good start. This way I can decide if I like it enough to transfer within my hospital.

I hope I find this as my niche, I feel as though I am a little stuck in limbo. I am good on the floor- but I just do not want to do it forever! There are some nurses that have been at my hospital for 30+ years. I get a little nauseated thinking about that being me.

I was also wondering if the Health Care Changes in the government could possibly have detrimental effects on the HHC industry? Does anyone have any thoughts on this?

[AnnemRN]

Home health will be even more important with the health care changes. In an effort to contain costs hospitals will be relying on home health to keep patients from being readmitted too soon.

I would look for a home health agency that pays hourly (that's my preference), pays the govt. rate for mileage and has a reasonable driving radius.

I'm working per diem for a great company and always have more than enough work. You should find out how busy the agencies are that you're applying to so, you can get an idea if it will work for you.

[TipitiwichitRN]

Thanks AnnemRN, I am going to look into that. How do I go about finding out how busy they are?

Talked to a good friend of mine in case management and she said that our hospital is always going back and forth on closing their HH dept. So maybe going with an agency is the way to go. And then if it is something that I do like I can stay half time at the hospital so that I can keep my benefits. Ah, choices choices!

[AnnemRN]

TipitiwichitRN,

Find out what their census is and how many visits each nurse has daily. I would want to know how many case managers there are and what their caseload is.

If your hospital is going back and forth about closing their HH dept. I would look elsewhere. I worked for a hospital affiliated home health dept. that was closed after 25 yrs because the corporate office said it was losing too much money.

[paradiseboundRN]

Home health has been growing steady for the last 5 years and that will continue. Due to remimbursement cuts by Medicare, the hospitals can't afford to keep the patient admitted for any length of time and have to discharge the patient as soon as they show any signs of improvement. However, hospitals lose their Medicare reimbursement altogether if the patient is readmitted within 30 days for the same diagnosis. The most cost effective way to keep patients out of the hospital is home care. The bottom line is home care will continue to grow rapidly, and that's where the nursing jobs are going to be!

[TipitiwichitRN]

Thanks everyone! I am starting my search for per diem work! I am excited to check it all out!