r/hospicestaff

Hi! I have seen posts from years past but I am currently wondering what the current average or standard case load for a RN case manager looks like? I moved from hospital bedside nursing to hospice 2 years ago and have remained with the same for-profit company. I am very burned out and I notice that we have a rotation of case managers. One of the longer lasting nurses, who has worked here for close to 5 years, turned in her resignation this week. I thought perhaps I was the only one fatigued and burnt out until now. Our case loads as case managers range from 20-24. What are you guys seeing?

Hospice social workers would you push back on this change in responsibilities?

I’m looking for some perspective from other hospice social workers because I’m pretty new to hospice and don’t know if I’m overreacting.

I recently left hospital social work/case management because I really didn’t enjoy the constant discharge planning and wanted a position where I could actually build relationships with patients and families. I took a full-time hospice social worker position and have genuinely been loving the home hospice side of the job.

During my interview, I was told I would help cover our inpatient hospice center about 1–2 days per week. We have a small inpatient unit that can have anywhere from roughly 1–5 patients, but obviously their needs and turnover can be very high.

Our agency is currently going through a Medicare TPE, and leadership has now decided they want a social worker physically at the inpatient center for at least half of every weekday. Because I’m the only social worker who works full-time Monday–Friday, I was told that person will essentially be me.

My concern is that this feels very different from the job I accepted. In addition to being there every day, I would potentially be responsible for the inpatient patients, additional documentation, IDG updates, inpatient meetings, discharge-related needs, etc., while still maintaining a home hospice caseload. My manager mentioned possibly giving part of my home-care territory to another social worker to make room for this.

The problem is that I don’t want to give up my home-care territory. That’s the part of the job I really enjoy, and building relationships with those patients and families is a major reason I left hospital social work for hospice in the first place.

I’ve been wondering whether it would make more sense for the inpatient responsibility to be shared between the social workers rather than having one person become primarily responsible for the entire unit. For example, new inpatient admissions could be divided between us, and whoever picks up a patient could continue following that patient throughout their stay and handle their documentation and IDG. That would still provide continuity for patients and families without putting the entire inpatient caseload on one person.

I’m not opposed to working at the inpatient center at all. I knew it was part of the job and was completely fine with the 1–2 days/week I was originally told. It’s the change to every weekday and potentially becoming the primary SW responsible for the entire inpatient caseload that I’m struggling with.

For additional context, there is another social worker who works four days per week, and our home hospice responsibilities are pretty comparable. We each cover roughly the same number of ZIP codes/areas and generally have around 10–15 home hospice patients each. That’s part of why I’m wondering whether sharing the inpatient caseload would make more sense than shifting most of that responsibility to one person and reducing that person’s home-care territory.

Would you push back on this? How do other hospice agencies handle social-work coverage for their inpatient units? Does sharing the inpatient caseload while maintaining our existing home caseloads sound reasonable? And if leadership does expect one person to take primary responsibility for the inpatient center on top of home hospice responsibilities, would you consider that a significant enough change in the role to discuss compensation?

I’m in perimenopause and my hot flashes are no joke. Between my own internal furnace, the summer, and the hot houses of our beautiful patients I am overwhelmed by heat. I’ll be doing wound care or something and feel sweat dripping down my back. It’s horrible. I’m wondering if there would be any reason why I couldn’t wear an electronic neck fan that’s pretty quiet while I work to keep myself cool? Would that be weird? Do you think patients and families would be ok with that?

For those working in hospice volunteer services, is your hospice currently meeting the 5% volunteer requirement?

If so, I’d love to hear what has been working for your department. What types of volunteer activities are generating the most hours? How many active volunteers do you have, and what strategies have helped you consistently reach or maintain the 5%?

We have been working on increasing volunteer utilization and would love to learn what other hospice volunteer departments are doing successfully.

Any insight or ideas would be greatly appreciated!