Home Health Chronicles

Today I completed 7 home health Start of Cares and 4 recertifications.

The Reality of Doing a Start of Care

I’ll admit it—A Start of Care isn’t alway my favorite visit. It can be lengthy, documentation-heavy, and mentally exhausting. But it can the most important visit we perform as home health nurses.

Depending on the agency, a Start of Care can pay anywhere from $150 to $300 per visit, with additional compensation often added for complex services such as IV hydration or IV medication administration that extends beyond the standard visit time. While the reimbursement can be rewarding, it comes with significant responsibility. You’re not just completing an assessment; you’re opening the patient’s case, establishing the plan of care, performing medication reconciliation, coordinating services, providing extensive education, and documenting every detail.

The Part Most People Never See

My day started at 7:00 a.m.

The first patient was a new Start of Care with a recently placed PEG tube. While I had my usual SOC assessment to complete, it quickly became apparent that the patient’s family needed substantial education and reassurance.

Teaching Is Just as Important as Nursing

I reviewed PEG tube management from start to finish with the patient and her daughter and son-in-law. I demonstrated how to crush medications, dissolve them appropriately in water, administer them through the feeding tube, and properly flush before and after medication administration. The patient’s daughter was extremely anxious and worried about making a mistake.

I encouraged her to perform each step herself while I supervised.

Then I had her do it again.

And again.

One thing I’ve learned in home health is that anxiety often comes from unfamiliarity. Family members are understandably nervous when they’re suddenly responsible for tasks that seem highly medical. But with repetition, guidance, and reassurance, confidence begins to replace fear.

By the end of the visit, she was performing the process correctly and asking fewer questions. If history is any indicator, by the next nursing visit she’ll likely be far more comfortable and independent.

Those moments are some of the most rewarding parts of home health nursing. We aren’t just caring for patients—we’re teaching families how to care for them as well.

The Rest of the Day

The remainder of the day included three wound care patients, two patients receiving IV antibiotic therapy, and a post-operative knee replacement patient who primarily needed assessment, education, and coordination of physical therapy services.

By the time I pulled into my driveway, it was 6:15 p.m.

I had taken two short breaks throughout the day to grab coffee and use the restroom, totaling about 30 minutes.

Let’s Do the Math

From 7:00 a.m. to 6:15 p.m. equals 11 hours and 15 minutes.

Subtract 30 minutes for breaks, and that’s 10 hours and 45 minutes spent driving, assessing patients, performing skilled nursing care, teaching caregivers, coordinating services, and completing visits.

But the workday wasn’t over.

I still had approximately four hours of charting waiting for me.

That brings my total workday to roughly 14 hours and 45 minutes.

The Work Doesn’t End When You Get Home

When people think about home health nursing, they often picture a nurse visiting a few patients and then heading home.

What they don’t see are the hours spent documenting, reviewing medications, coordinating care, calling physicians, completing OASIS assessments, educating families, and ensuring every patient has the resources they need to remain safe at home.

The reality is that many home health nurses continue working long after the last patient visit is complete.

Sometimes the most demanding part of the day begins after you pull into your own driveway.

What Does That Work Out To?

Let’s break it down.

• 10.75 hours on the road (and yes, I always include driving time because home health is essentially an all-day driving job)
• 4 hours of documentation (and that’s probably being generous)

Each Start of Care isn’t just one note. Every patient requires a comprehensive assessment, physician orders, care coordination, medication reconciliation, and a lengthy OASIS assessment. The documentation alone can take hours after the last patient visit is complete.

So if we use a conservative rate of $150 per Start of Care:

7 SOCs × $150 = $1,050

Total hours worked:

• 10.75 hours seeing patients and driving
• 4 hours charting

Total: 14.75 hours

That works out to approximately $71 per hour before accounting for gas, vehicle maintenance, insurance, taxes, and the inevitable wear and tear that comes from spending most of your day on the road.

Not too shabby.

But it’s also exhausting.

There are easier ways to earn a paycheck than spending nearly 15 hours driving between homes, performing assessments, educating families, coordinating care, completing OASIS documentation, and charting late into the evening.

Home health nursing can be rewarding financially, but every dollar comes with a significant investment of time, energy, and mileage on both you and your car.