r/nursing • u/No_Wheel_6096 • Oct 09 '24
Nursing Hacks Home Health RN pay
I’ve been a nurse for 8 years and have always worked in the hospital setting (travel nursing for the last 4 years).
Looking to transition to a nursing job outside the hospital and have been looking a lot into home health, clinic jobs, etc.
I got a job offer with a home health company and I’m wondering how these pay-rates (pay per visit) compare to others in the same area (Orange County, California)?
267
u/softboii22 Oct 09 '24
I know a few RNs who RAKE IT UP with admissions. They do 2-3 admissions a day with a few different home health/hospice companies. One of my RN buddies made 180k strictly doing admissions
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u/Competitive_Green126 RN - ICU 🍕 Oct 09 '24
why does this sound like a good future icu exit plan.. especially when one of the things that’s burnt me out long drawn out deaths. hospice sounds so much more peaceful.
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u/redluchador RN 🍕 Oct 09 '24
I did hospice admissions for a couple of years. The problem is a lot of your discharges are coming from the hospital. Of those some of them are actively dying. The discharge that is supposed to happen at noon will keep getting pushed back. 2:00. Then 4:00. Then discharge is set for five. They will show up at 6. Did you make dinner plans because you figured you would be done with your admission by 3:30? Tough. Many hospice companies will not pay you a dime for sitting around and you can't really go do stuff because they can be discharged anytime and they usually really really need you to be there because.... well, I've had transport deliver a guy with an active Hemorrhage out of his rectum for example. And if that's the case you have to stay and do what you can to get the patient comfortable. In that scenario it took the poor guy about 3 hours to die. They didn't discharge him with any meds. So I was making calls cleaning him up trying to stop the family from freaking out etc etc etc
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u/Competitive_Green126 RN - ICU 🍕 Oct 09 '24
okay that’s not peaceful
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u/redluchador RN 🍕 Oct 09 '24
I was doing two admissions a day and I would probably get a train wreck like that once or twice a week
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u/TheNightHaunter LPN-Hospice Oct 09 '24
I can't emphasize enough how much a union changed that, a visit like that would be moved to second shift at my place is all. No on call there is a triage department that handles that
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u/ReadingLizard Oct 09 '24
Hospice hours are NOT the same - more call, overnights. I will always recommend home health over hospice if you’re looking to move to home based care unless your heart is REALLY into end of life care.
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u/Competitive_Green126 RN - ICU 🍕 Oct 09 '24
i work straight nights already and have for a couple years. it works very well for me.
0
u/PeanutbutterArbuckle Oct 10 '24
Imagine working all day then taking night call. You may end up working 20 hours a day. Not for the faint hearted. At some places you may work a full day, then end up being up most of night taking call and getting done at like 2am only to start the next day at 8am
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u/ipark88 Oct 09 '24
We have call team, I don't work call, nights, weekends or holidays. Mileage may vary.
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u/TheNightHaunter LPN-Hospice Oct 09 '24
No that depends on the agency, my hospice we have night nurses, no one is on call that works days
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Oct 09 '24
I left the icu and went to home health a couple months ago. I’m still in orientation right now but taking patients on my own in increments. Im definitely not as stressed out. I think switching back to a day shift life and going from 3 12s to 5 days was the hardest part but there’s some days nurses are done with visits in the early afternoon and then go home to finish charting. The flexibility is a plus
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Oct 09 '24
How long does an admission take? More than an hour?
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u/MusicSavesSouls BSN, RN 🍕 Oct 09 '24
When I did home health, it would take me about 45 minutes. I wasn't paid per admission, though. I was hourly.
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u/lindslinds27 Oct 09 '24
When i did admissions for hospice it could take 45 mins for a visit or 3+ hours depending on how much of a shit storm you want into. However, the main part of admissions that really takes long is the charting afterwards….LOTS to chart, lots of phone calls to coordinate DME and other services, and then making sure the care team is all set up too. It’s better than hospital nursing but still can be stressful
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u/moon_of_blindness BSN, RN 🍕 Oct 09 '24
How did it only take 45 minutes?? If there was a med rec with 20+ meds it could take me a half hour to just do the meds and sort out complications. But this was many years ago. I’m hesitant to go back.
5
Oct 09 '24
I was a Visiting Nurse as well for 3 years and yup with some of these patients… Starts easily good 2 hours because literally their lives were a mess, meds everywhere, zero medical or med literacy, high anxiety, complicated wounds or Vac changes. Your easily stuck for hours in a patients home THEN add in the Oasis charting AND possibly calling multiple MD offices to clarify orders or whatever THEN chart all of that! H3ll to the NO! The charting never ends. I’d never go back to Home Care.
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u/fishonthemoon Jan 26 '25
This happened to me recently. I was up until 3 am completing all of the documentation for that patient. 😭
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Oct 09 '24
Some agencies will upload the med list from the referral and you can just go through what’s there and add or edit if you need to
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u/TheNightHaunter LPN-Hospice Oct 09 '24
Depends on the vna, for profit or non profit? Also pay structure hourly is better hands down always. Lastly is there a vna based of a hospital group in your area? That makes life easier due to same emr, referrals from same place and med lists are more accurate
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u/MusicSavesSouls BSN, RN 🍕 Oct 09 '24
That's how long it took me. Don't know what to tell you. *shrugs shoulders*
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u/Neither-Magazine9096 BSN, RN 🍕 Oct 09 '24
Same. And looking at these rates, I was underpaid.
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u/kpsi355 RN - ER 🍕 Oct 09 '24
This is for Orange County CA, cost of living is high. If you’re not in a similar COL area you might not have been underpaid.
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u/ReadingLizard Oct 09 '24
I was fast and could complete an assessment, documentation and all, in about 40 minutes. Learn your system really well, use talk to text for narrative notes, and get a rhythm for that as well. Makes it move very quickly.
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u/Life_of_Mediocrity_ Oct 09 '24
How much do admissions pay though? I avoid doing admission because revisits can take 1/4 of the time to do for me.
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u/Desertnurse760 VN with an attitude Oct 09 '24
I made $60 per visit as a Wound Care/Hospice HH LVN in Palm Springs. The OC should be twice that for an RN.
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u/inarealdaz RN - Pediatrics 🍕 Oct 09 '24
Florida is known for having shitty nurse pay and that's what I made here 2 years ago with a HH job. Oasys charting is time consuming and soul sucking. No thanks.
39
u/Mandated-Tofu Oct 09 '24
Those rates seem a little low to me (central CA). Start of care should be 150-200. All oasis at least 130-150. Regular visits at least 100. $55-60 hourly
2
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u/echk0w9 Oct 09 '24
Most home health jobs use a point system. Looks like they are doing $50 for a routine visit and $250 for a start, that’s ok. The problem is the pay for the other visits. The high tech, recert, eval, and roc pay rates seem off. A roc is time consuming as is a recert and you’ll do by far more of those as a case manager than starts.
I’d shop around for a company who does a point system. It’s easier to compare hh pay that way.
Also, just saying bc a lot of people don’t understand what home health is. I know you’re coming from a hospital system but home health is not an easy job. At all. You can make bank and once you’re good you can get home early most days and just do paperwork. However, the paperwork is a lot, you are working more or less alone with some complex medical and social situations. There’s a ton of autonomy but also responsibility/liability bc it’s just you in the home. There no “clocking out” like working inpatient. So boundaries are important. Please talk to a friend who already works home health about what it’s like and where to and not to work.
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u/Simple-Practice4767 RN 🍕 Oct 09 '24
Can you please explain the point system?
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u/echk0w9 Oct 18 '24 edited Oct 18 '24
It’s a weighted payment system. So instead of hourly it’s by productivity point. So instead of 40hrs a week for full time most places want 30 points a week for full time. Routine visits are around 0.9-1 point. Recertifications, high tech visits, resumption of care, evals, admissions are all worth more points.
It’s weighted to account for more intensive visits and also incentive being productive vs just showing up. That’s bc of the high level of autonomy in home health. They aren’t gonna pay you to fuck around in one visit for 8hrs and then have the visit not even be billable.
Part of the weighted system is because of the nature of the job. Minimum 30 minute visit. You can complete a routine visit and documentation in that time and go home with no work sometimes as an RN. However, there is scheduling your appointments, finishing up documentation for oasis visits, calling md offices, care coordination/case management to account for too. So the weighted visits and billable nonvisit activity compensates you for that too.
At the same time, you can make an unlimited amount of money based on efficiency and efficacy.
So you can calculate your yearly/monthly income based off of your expected points. If you may $35-45 per point and you make at least 30 points a week for a year that’s your income.
Now if you just wanna work and go home at 2pm? You can be efficient, make your 30 units a week and be happy. If you like money, I’ve seen ppl pull over 100 units a week…. (the math doesn’t math but they have excellent clinical outcomes and rave reviews. So, idk the magic. lol.) this is rare. I’ve only seen 2 ppl in my life do that and they are clinically excellent and everyone loves them. I have no idea how. Either way, it’s on you.
Home health rewards outcomes and efficiency, it’s not for the lazy or the dull. It’s for the sharp, resourceful, and autonomous. Can you heal a wound? Can you keep someone out the hospital? Do you have a teaching spirit? Can you communicate well? Are you resourceful? Do you like money and being able to make an observable impact? Then it’s for you. If you are ready to retire or you think it’s where “nursing goes to die” please look elsewhere. It’s where nursing thrives.
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u/mizJ11 Oct 09 '24
When I did HH, you'd be expected to earn like 5 points a day. A regular visit was 0.5 pts SOC 3 points. ROC or Recert were 2 points. Discharge was like 1.5 point (if I'm remembering correctly). Then a different company bought mine out and they dropped all those points by a half point, so a SOC became 2.5, etc. that way, they could squeeze every last sad, exhausted drop of productivity out of you. You'd still need to see 5 points of pts a day, but each visit was worth less than before so you could see at least 1 more patient.
1
u/TheNightHaunter LPN-Hospice Oct 09 '24
The point system is so fucking dumb, my non profit hourly vna ya that doesn't exist. We have "productivity" but its more you have 5-6 pts max with admission being a 2.5 visit weight so you do two admins your done for the day (no you don't have to clock out) 8-430
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u/myanxietymademedoit BSN, RN 🍕 Oct 09 '24
That's what I made as a HH RN in MO, but i would think it should be more in California as the COL is higher. Also, resumptions should be at or near the same rate as admission visits, as they are basically the same amount of paperwork.
10
u/Beneficial-Winner-62 Oct 09 '24
Find a salary HH job!! When you have low census (which will happen!!!) you still get the same pay. I am salary up to 30 points (SOC 2.5 points, regular visits 1 point, full agency DC 2 points, recerts 2 points, resumption of care 2 points) Once I hit 30 points I get the PRN rate for anything over!
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u/Unlikely_Candy_7884 Oct 09 '24
Exactly! I’ve been doing it 20 years I did per diem for 12 and now full-time 8 and I literally had like three patients on Monday and home by 1 PM 🤫 this happens quite a few times, and I work for a large hospital system.
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u/Beneficial-Winner-62 Oct 09 '24
Yes!! Usually summer is our slow time!! So I still get my full pay with only having 4 points But then when we are busy and I am over o get extra pay!
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u/hazmat962 RN - Psych/Mental Health 🍕 Oct 09 '24
South Louisiana here.
I wouldn’t even get lot of bed for those rates.
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u/typeAwarped RN 🍕 Oct 09 '24
I’m a 7 year nurse brand new to hospice. I’m Midwest (not a big city, average sized area). I’m salary at $83k, mileage reimbursement, M-F 8-5, no point system, back up call nurse about every 10th weekend on Saturday and Sunday 8-5 with a comp day off the following week. Some days I’m done by 3, latest I’ve worked is 5:30. Best gig by far.
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u/IllustriousCupcake11 Case Manager 🍕 Oct 09 '24
That’s great! The point system and productivity is ruining it for home care and hospice nurses.
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u/TheNightHaunter LPN-Hospice Oct 09 '24
Ya it's for profit non sense, my union at my vna we have pt maxiums, ya sure they call it "productivity" but it's a census.
Yesterday I had 3 patients then went home, clocked out at 1630
4
u/dvinz01 Oct 09 '24
I work hospice and my weekend gig (every other Sunday) I pull about 1200-1400 in about 8 hours that includes the drive time there and back and charting. Super blessed though. This is paid per a visit with 1099. My full time job the pay is kinda low at 55/hr W2 but there are plenty of days where I get paid for 8 hours but only really work 5-6 due to lack of admissions.
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u/succubussuckyoudry BSN, RN 🍕 Oct 09 '24
Well but you have to count the driving time and charting time. I used to make good money since all of my patients live 5 to 10 mins away from each other. But after a 30-minute visit and can be more with more interventions, I had to spend 20 min on charting. So, in the end, I didn't make as much as it seemed. It is nice cause I can self schedule, but some oatient is such a pain in the ass cause they cancel at the last minute or cancel without telling me. The company won't pay if the patient cancel the visit even though I am already at their house, waiting for 30 mins. Later, my patient group changed. I had to drive 1 hour to each patient's house, and the company didn't help with gas or extra driving hour.
4
u/jenna-wranglindixie Oct 09 '24
That’s terrible pay to begin with but if you’ve never done it before, prepare yourself because $150 for start of care takes atleast a couple hours and then you absolutely WILL still be working on it well into your evening at home plus driving? You’re at about $35 or $40 an hour! It’s horrible and inconsistent and be leery of the company because so many are broke or will short you out of pay. Like they can be so shady. It used to be excellent money in the beginning of home health but was so abused, it’s just not like that anymore.
1
u/Esoteric716 RN - PCU 😎 Oct 09 '24
$35‐40/hr is bad...?
1
u/fishonthemoon Jan 26 '25
Yes, because when you go home and spend another 5 hours charting you aren’t paid for that time.
3
u/ConfidentSea8828 Oct 09 '24
Just please be cautious. Remember the nurse who was killed in a home by a "patient". Please be safe out there!
I know that was the exception and not the rule but we as nurses are generally not told the psycho/social hx and certainly aren't privy to that of their family/neighbors. A word to the wise from a near 30 year veteran who has been chased through my own facility by family members (with no recourse or protection or apology by my admin), among dozens of other dangerous experiences :(
3
u/supermomfake BSN, RN 🍕 Oct 09 '24
If you love charting do home care. I’ll never go back due to the charting (OASIS is the devil). Also disgusting homes, if I have to wear a hazmat suit into your house then no thanks.
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u/EternalSophism RN - Med/Surg 🍕 Oct 09 '24
Looks about right. I make 40-44$ per hour depending upon pt acuity and insurance plan.
2
u/drmikept Oct 09 '24
Coming from a PT, these rates are awful. If this is LHC/optum, make sure to stay away.
All visits but especially the SOC should be much higher
1
Oct 09 '24
I’m new to home health and don’t really know anyone else who’s worked in it. What’s up with LHC/optum as an agency?
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u/drmikept Oct 09 '24
They are awful. They will increase your productivity points or make you drive way out of your way. Make you see up to 7 people a day. Horrible management. They will also just assign you people mid day with no warning. Just an endless pit of annoyance. Working for LHC was the worst point of my life and I got out right before Optum took over
1
u/Judas_priest_is_life RN 🍕 Oct 09 '24
7? My boss puts me for 10. Though I have some med admins close to my house, so I generally do 3 to 5 med admins, a couple regular visits, and 2 or 3 recerts a day. LHC/Optum in CT.
If I were to do prn crap, the rates are about 15% lower than that picture.
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u/drmikept Oct 10 '24
Holy crap. Run far away. That is not sustainable. 10 people a day? Just say no haha.
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u/WirthmoreFeeds RN 🍕 Oct 09 '24
Seems low. I make around that, but I live in NH. I'm guessing OC COL is higher. The OASIS form for SOCs is lengthy... SOC should be 3× a revisit.
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u/Emergency-Ad2452 Oct 09 '24
I did home health in the 90s. Ended up with a visit to a crack house that got raided a few days later. Good times.
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u/IllustriousCupcake11 Case Manager 🍕 Oct 09 '24
When I did in-home hospice and home health, 6-7 years ago, we were hourly, plus mileage. I preferred it, that way, if I was stuck in traffic trying to get to another patient’s home, I was getting paid for it. Also, since the majority of the time, I ended up having to do documentation at home, after hours, I got paid for it, where with the point system, or per case, you did not.
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u/TheNightHaunter LPN-Hospice Oct 09 '24
Ya it's absolute nonsense, my second job is like that but they are the only for profit vna I know in my state that pays double for wound visits.
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u/Kiwibirdee Oct 09 '24
This chart is pretty much exactly what I was making in home care 5 years ago in the Southeast, the region well known for having the worst paid nurses in the country. I would not accept this in California.
Everyone else talking about the drudgery of home health charting and care coordination is correct. The amount of phone calls to all of the primary care and specialist physicians you have to make to get orders and report changes is ridiculous. Hospice was much better for care coordination because you really only report to your medical director and once you establish a rapport and establish trust with the physician as being a good nurse there is a lot of freedom without being micromanaged.
The uncertainty of timing for admissions and the on call requirements are what eventually burned me out on hospice but it was nice for a long while. It’s a great contrast for previous experience in critical care when you start to feel like you’re harming people be keeping them alive.
2
u/Judas_priest_is_life RN 🍕 Oct 09 '24
Interesting, I can't really do my charting at home, I have to clock in and out for each visit, and it takes a gps snapshot. I'm salary, and all they whine about is productivity, they don't particularly care where my visits are and how far from each other, as long as there are enough. Some days I'm working 8 to 6, some days I'm done by 330. Rarely, I'll have a couple hours in the middle of the day to go home, eat lunch, and play video games...but they don't need to know about that.
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u/fishonthemoon Jan 26 '25
I don’t even know how people can do all the charting in home. With some visits it’s possible, but if you have to do a lot of hands on work or teaching it cuts into the 30 minutes so quickly that there is no time to sit there and chart before you have to run off to the next person.
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u/Acrobatic_Green8710 Oct 10 '24
I work 7 days on 7 days off nights as a hospice nurse and I make 89,000K a year and sometimes I don’t even have to see anyone. Just a thought. And I get paid mileage starting from my home and I have half as much charting than the day time nurses.
1
u/LegalComplaint MSN-RN-God-Emperor of Boner Pill Refills Oct 09 '24
G-tubes and trachs are only worth an extra $10, huh?
1
u/CraftyObject RN - ER 🍕 Oct 09 '24
I just started in home health ages months ago. Despite the pay, I don't see myself staying much longer than a year.
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u/Then-Bookkeeper-8285 Oct 09 '24 edited Oct 09 '24
I am a home care nurse. Home nursing or private duty nursing tend to pay the lowest in the industry unless you're doing admissions. Its also extremely boring with plenty of downtime. There is usually extremely high turnover amongst most cases. On average, Nurses leave clients every few months. The biggest determining factor of whether you stay with a client is how well you mesh socially with the family.
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u/sirisaacneuton BSN, RN 🍕 Oct 09 '24
I did home health in Texas about 6 years ago and these rates are nearly exactly what I was paid.
1
u/Life_of_Mediocrity_ Oct 09 '24
Late to the discussion but I currently work per diem in NY. Revisits: $75 SOC & ROC: $150
If someone else works full time, please let me know how much fee for service is for you. I want to negotiate a higher full time salary and FFS if I go back on full time
1
u/TheNightHaunter LPN-Hospice Oct 09 '24
For the love of every god, find a place that is hourly. Trust me I work for both and one you are fucked when it comes to how much time you spend. Is your visit only 20mins and barely any charting? Same pay if you spent over an hour there and had to do multiple charting.
My vna is based outta a hospital group and we have a union it's night and day. I actually get mileage from my home to first house and have a max of 6.
Meanwhile my second job I do once a week I can get 14 max according to the state. Only difference in pays is if it's wound care. O RNs at the pay per visit place is now doing admission quotas for all RNs.
Find an hourly place for your sanity
1
Oct 09 '24
Those rates seem. Bit low to me. I was making 60$ per point. Soc was 2.5 points so basically the same ratios but higher pay in WA. You definitely can make a lot of money if you’re good at managing time and learn to chart fast.
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u/Total_Window_8570 RN - Hospice 🍕 Oct 09 '24
Seeing this and the comments as a someone who quit home health in Canada 😳😳😳 I was making 33$ per visit and initial visits were 1.5x my visit rate….
1
u/gdtags RN, BSN Oct 09 '24
Those were the rates when I was home health RN but that was like ten years ago. Should be more.
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u/Rare_Ad2283 Oct 09 '24
That’s almost what I made in PA almost ten years ago! I hope you can get way more!
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u/Lpn669 Oct 09 '24
I’m currently an LPN doing hh in ne FL. I’m ppv as well. I had to find another job because I literally cannot afford to keep this job. And same as a previous comment it feels like the work never ends. You have to call all of your patients for the following day the night before and then the day of you out seeing patients, rarely are you able to complete the charting in the home so it’s time consuming at home and it’s not hourly so you aren’t getting paid. Personally I think it affects the quality of care and documentation. And I know the rns have even more with starts, recerts and discharges. Oh yeah and the company cell phone that patients think are their personal hotline, even with a on call number provided to them…
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u/Aggressive_Clock_296 Oct 09 '24
These are crappy pay outs. In Atlanta the pay is similar but our cost of living is much less. They don't have the mileage compensation, case manager pay bump.
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u/Aggressive_Clock_296 Oct 09 '24
What kind of PTO, weekend duty frequency. Insurance options, and perks some places give you a company car. Not to mention having to clean up after people that just go in and treat the hole in the patient instead of the whole patient. You're required to document wound measurement at least weekly, document med changes. Trust me I have followed a lot of half assed nurses and PTs. What good is giving premium care if you ignore the legal peripherals. Longest time meds went unchecked and updated TWO YEARS. Finding out the pt went to the wound doctor and the nurse NEVER updated the wound care plan or ordered the new supplies. THIS HAPPENS ALL THE TIME.
1
u/Lower_Comfortable392 Oct 10 '24
The rates seem a little low. I am in the inland empire and have better rates
1
u/Revolutionary-Two989 Oct 18 '24
Anybody ever run into issues with not being paid the over quota rate? I’m salaried with a 30pt quota..after that I get paid per visit. Recently found out that if I submitted any late charting after payroll closed, I was not paid for those over quota visits.
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u/[deleted] Oct 09 '24
Here’s my experience as an hourly home health nurse:
Start by setting up your day, calling each patient and looking through their chart. Then it’s driving, mine were about 20 minutes from my home and you don’t get paid mileage from your home to the first patient but you can start in the office first if it’s closer to patient. I would see about 5 people a day, mixture of visits. An admission would take about 1.5 hours in the home. Then it’s charting. A regular visit may only need 15 minutes of charting but any OASIS is going to take much longer. The admission would usually take me another 1.5 hours to complete the set up. Oh and you have to call the doctors much more frequently than you would think and that takes more time. And then you get back a bunch of revisions from any OASIS you may have done recently because the agency wants to make sure they are reimbursed to the highest possible amount.
That’s not taking into account what happens when you are setting up and they cancel so now someone in the office needs to get you a replacement. Or time having to stop by the office for supplies you may need if they are new. Or the follow up from the doctors that call back days later.
I loved the freedom of it, I loved that I controlled who I saw and when, and I loved being able to see the same patients and visualize their progress. I hated that it felt that I was never done with my job at the end of the day despite putting in 10+ hours. I personally would never do it at a pay per visit rate but would do it for hourly pay. I’ve seen far too many nurses taken advantage of by slapping them with salary or per visit rates.