Thursday, January 14, 2010

Caseload Recommendations

I recently wrote about my unusually low caseload, prompting a question from "anonymous" about state regulations on caseload maximums for hospice social workers. I'm not sure that states would regulate our caseloads; if such regulations exist, it seems something more along the lines of NHPCO or Medicare. Correct me if I'm wrong. About a year ago a coworker tracked down the NHO operations manual (from 1997) and copied the page on Productivity and Caseload Issues.

NHO issued the following general guidelines for staffing ratios:
  • Nursing. Caseload of 8-12 patients per FTE (full-time employee); range of 15-25 visits per week
  • Social Work: Caseload of 20-30 patients per FTE; range of 15-25 visits per week
  • Chaplain: Caseload of 40-60 patients per FTE; range of 15-25 visits per week
  • Home Health Aides: Caseload of 7-10 patients per FTE; visit length ranging from 1.5 to 2.25 hours
Affecting caseloads are the following factors: geographic location/travel time, patient acuity, limitations/stress level of primary caregiver or other members of the immediate family, and the extent of staff roles and responsibilities that conflict with direct patient care time (i.e. IDT meetings.)

The 2009 NHPCO Facts and Figures: Hospice Care in America report: "In 2008, the average patient caseload for a home health aide was 9.5 patients, 13.3 patients a nurse case manager, and 24.2 patients for a social worker."

Are you aware of any other current caseload recommendations? Please let me know!

Since my brief reprieve before Christmas, my caseload has gone back up to around 37 and I know there are a couple more new patients coming down the pipeline. I also have the largest territory of all the social workers (and generally the highest caseload). There was a period a year or two ago that all the social workers were carrying caseloads over 40- the rest of the hospice team's caseloads were similarly impacted. It was too much but the administration said we'd have to keep the caseloads that high for at least a few more months before they would even think about hiring another social worker, much less other staff. Of course, we didn't sustain those high numbers for the required amount of time; we just had to make do. I hated doing that to the rest of my caseload but new and high acuity patients always come first and my sanity last. The ebb and flow of caseloads is an ongoing issue. How do we provide quality care without sacrificing ourselves in the process?


Anonymous said...

that is exactly what I am going through. I have about 42 now and it is impossible to give the attention you need and want to give to your patients and families. Plus do all the documentation. I heard the numbers were going up to 35-40 for SWs.

Anonymous said...

Does anyone know who is pushing for the 30-40 patients per SWer? I am relatively new to Hospice, but a 20 year veteran to Social Work and can't believe that I am working a 45+/- caseload, covering over a 100+ mile territory, in addition to assisting with admissions and funerals.

I know if we say OK to 40 patients, it will be "pushed" to 45-50, so just wondering where this is coming from?

Any ideas?

LeighSW said...

My theory is that it depends on the organization. If the administration values the well-being of their employees, they will carefully watch over caseload numbers and limit them to a workable number, also taking territory and other factors into consideration. This of course is ultimately in the patient's best interest too! It seems that hospice is becoming more numbers/money oriented, even the nonprofits, so that is likely why caseloads continue to climb upwards.

Anonymous said...

Lately, I was asked by my Supervisor to be responsible for over 80 cases

Do I have any rights?

Gillmania said...

Hi, I was wondering if you knew specifically where to get the guideline information from NHPCO? Are there any medi-care guidelines? If so, do you have exactly where? I am a chaplain and they let the other chaplain go for 100 pts. It is too much for me, but they say "show me the print".