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Nursing Home Fees...?

Discussion in 'Australia' started by ja99, Nov 21, 2007.

  1. ja99

    ja99 Active Member


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    Hi all...

    Just curious as to what sort of fees Pod's are charging with Nursing Home contracts (High care / Low Care). After a few years of charging the same fees I'm considering raising them...
    (Wife's getting tired of Home Brand Baked beans every night..........sharing a bed-sit with the Mother-in-law.........driving a Lada.........washing her smalls at the public toilets........drying out the teabags to reuse.........drinking Methylated spirits...........:confused:)

    Any suggestions or comments?
     
  2. DAVOhorn

    DAVOhorn Well-Known Member

    Dear Julian,

    How much does it cost you to run your practice?

    Do you rent premises own premises and all associated costs.

    Do you own and run a car and all associated running costs.

    What do you charge your practice for the services you provide on behalf of the practice.

    What Revenue does your practice need in a year in order to provide you and yours with a standard of living commensurate with your eduaction training skills and social standing.

    Also how much does it cost you to go to a Nursing Home and provide the high standard of care that the patients in the home expect of a health care professional. Remember you still have your practice costs and no revenues being generated by the practice while you are at the nusing home.

    Or does the home just want a $10.00 nail trim?

    We as a profession are embarrased to charge fees commensurate with our training and skills, ceratinly compared with our other AHP colleagues.

    Use the Medicare fee reimbursement of $47.85 for a clinic fee as a guide . This corresponds to a 85% reimbursement of a $57.00 fee.

    So you have to include your time and costs of taking all your equipment etc to the home time to set up and pack up etc etc.

    You are neither a charity nor a charlatan so charge a professional fee for a professional service.

    So what do i consider a fair fee.

    Does the home provide assistance from their own staff in helping to provide the care to the resident. Or do you trip from bed to bed buggering up your poor old spine in the pursuit of a painful retirement.

    So i would say that if you are provided with a suitable well equipped room with assistance from the staff then a fee of a at least $57.00 per patient based on a minimum of a 4 hour session plus call out time at $110.00 per hour travel and set up. So a awhole day of 7 hours duration tt time would give $800.00 plus travel and set up time of 1.5 hours at 110 ph is $165.00.

    So for a days work tt 14 patients you would create revenues of $965.00.

    Hopefully this would lead to a profitable days work after all costs are deducted.

    The above is just a rough outline on one brief way to cost out a days endeavour.

    regards David
     
  3. twirly

    twirly Well-Known Member

    Hi Julian & David,

    I am in total agreement with David.

    I charge the same for a nursing home contact as I do for a clinic appt. (local area only)

    The patient receives the same level of professional care as my clinic patients would expect.

    The only difference I find is the restriction in surroundings. Bed fast patients etc. + carting everything with me.

    I feel it fair to expect a professional fee for a professional service.

    Patients, regardless of location are paying not just for routine nail clipping but for your skills as a professional podiatrist.

    Regards,
     
  4. Asher

    Asher Well-Known Member

    Thanks for that David and Twirly. I am in a similar position to Julian in that I feel I should increase my pitifully low fees for the local aged care facility. Yes I do feel a bit mean in this regard when I know I shouldn't. :rolleyes: So thanks for the boost and for your advice.

    Rebecca
     
  5. Daniel Bagnall

    Daniel Bagnall Active Member

    Hello guys,

    Yes I feel the same way too. As far as I'm concerned, we are a valid profession just like any other, offering people professional service.

    I don’t understand what the stigma is with our profession? In my opinion, we help a lot of people, just as much as any other health profession. Why should we charge any less?

    Do we, or our pts, grumble when the accountant or lawyer dishes out the invoice? No. :mad:

    Why don’t we just send our pts back to their GP's to get their get there nails trimmed, I'm sure they wont complain when they get the bill.:bang:

    Dan
     
  6. twirly

    twirly Well-Known Member

    Asher,

    Another way to soften the blow is to give plenty of notice to patients.

    I always advise in advance of fee increases (usually with a minimun of 3 months notice)

    At least that way they can go elsewhere if your fee doesn't suit.

    There will always be someone willing to do the same for less but you may find your patients know, trust and on the whole will remain loyal to you.


    Regards,
     
  7. ja99

    ja99 Active Member

    Thanks for the replies guys.

    Certainly food for thought!
    I can assure everyone I do not charge $10 for a "nail cut" as one put it (I'm sure that was not serious though). Nor do I quite charge $57 pp.

    Now I will bump up the fees......

    Thanks for your encouragement dear colleagues.
     
    Last edited: Nov 25, 2007
  8. alvin

    alvin Member

    I recently went for an interview at a nursing home where they wanted another chiropodist to cope with the large amount of residents. All seemed to go well until we discussed fees. I said that my charge was £22.00. I was astonished to find the other guy was only charging£11.00 a patient. I was considered to be very expensive. Not the case I said, the other bloke is undercharging and in my opinion lowering the status of the profession. Needless to say I didn't get any work in that home. Probably a good thing!
     
  9. twirly

    twirly Well-Known Member

    Hi Alvin,

    This has also been similar to the scenario in the area I work in.

    Fees are (in my case as in yours) non-negotiable. :boxing:

    I would rather not work than sell myself/or profession short to appease anyone.

    I find it amazing that many individuals believe what you charge is ALL for profit.

    No tax, no overheads etc etc........ :rolleyes:
     
  10. jmcl

    jmcl Welcome New Poster

    This sounds all too familiar. I was just looking through the various threads to get some advice on this very subject. I have recently had a meeting with a nursing home manager about providing a podiatry service for the residents. The manager was new so didn't have all the details, but seemed to think the previous chiropodist treated either 60 or all 120 residents over 2 days every 6 weeks. She is going to confirm this for me when I phone her back. This was for £6.50 per patient, which is pretty standard in the Glasgow area according to other homes she has spoken to?

    I explained to her that 30 patients is a lot to treat in one day in order to provide the required standard of podiatric care. She also seemed to think that £15 per patient I quoted was excessive and doubted whether residents and their families would be willing to pay more than double the previous cost.

    I am keen to take the work on, but closer to my terms.

    John
     
  11. Jbwheele

    Jbwheele Active Member

    Hi Guys

    I vary my charge according to the number of people I have on the list at the homes. Under 6 and I charge $30-$33 ( Charity I know.) and over that $25 / Person. If they need Padding etc the cost usually goes up. The trouble is these people will pay $15 a week for a "Hair Set" and grizzle about $25 for a Nails and corns Ulcers and full Foot health assessment every 2 months. Its hard to charge full fees, because we Pods are competing against Beauticians and Laypersons who do "Nails". for peanuts.

    I have often pondered the Amount of $ budgeted for " Foot Care" in the Rest Home Rents tenants pay and how much is actually utilised for feet. But I have never had the gumption to ask the managers?

    Charging full fees and travel etc is just not feasible in the town.

    Cheers

    Joe
     
  12. ja99

    ja99 Active Member

    Hi John,

    I now charge $35 AUD per resident/patient and have a minimum of 10 patients rule (extra for padding, insoles etc and use the facilities dressings etc), my Australian Fee equates to 16 GBP or 18 Euro, so your charge of 15 GBP appears very reasonable.

    Of course charges vary from one location to another, but 12000 miles away and another continent and our fees seem relative !

    Unless you are desperate for work, I'd wish Madam Nursing Home Manager a pleasant day and advise her to make alternate arrangements. Her job is to negotiate a 'cheap' rate, yours is to cover your costs, cover your insurance (Car, Life, Professional) , and receive a fair remuneration for your expertise, if the residents are not fully utilizing your expertise, so be it!

    Just remember, if heaven forbid, you got ran over while traveling to the facility, Managers like this first thought is "...Oh dear, now we'll have to get a new Podiatrist !"
     
  13. Lizzy1so

    Lizzy1so Active Member

    its true that there seems to be a big discrepency between what people charge for podiatry within a care environment. I have been charging £15.00 for about 2 years in the residential homes near me. this is considered a lot and i tend to get the "How much!!!!!!!" quite often. it sometimes gets me down until i remember that it costs more to get the dogs nails cut at the vets by the assistant. Charge what you are happy to work for and you wont feel resentful about working hard and professionally.
     
  14. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi just a couple of sense worth:eek:
    I no longer do N/H as many of them have contracrts with big companies that supply the work.
    Unfortunately the common theme we hear is that you only get your nails cut!:eek:
    The fee charged does not cover any thing else.
    We see clients who are not happy as they have corns or other oproblems and these are not addressed.
    It is an interesting area, ;the companies or pods charge a low fee BUT they do not all do a podiatry service:bang:
    :eek::confused: for those who do I am only stating what I have continually had to deal with.
    As I refuse to put a colleague "down" it is hard to appease the clients with why private treatment is different to what they have experienced.
    I strongly believe those who do not do a full service and are paid by the number they do, so the more they do in the shortest time the greater the pay...Do a great diservice to their 3-4 years of study and to the profession in general!
    MUST BE LATE, I don't often get on the :deadhorse:
    Again I know there are many pods who do not fit this category and I congratulate YOU:

    Cheers
     
  15. Brummy Pod

    Brummy Pod Active Member

    Lack of adequate treatment is a category of misconduct according to the HPC's rules. Any podiatrist that has not treated the hard skin without giving a REASONABLE explanation to the patient, carers, is guilty of misconduct and that is therefore a matter for the HPC.

    A colleague of mine had a patient come to him about 6 weeks ago. This patient had had chiropody in a care home, but still had VERY thick callous. My colleague said that in his opinion, he was looking at months of callous build up and they had not been done properly whilst in the home. The patient was going to make a complaint.

    I heard of a case that was reported to the HPC, it was inadequate treatment. The chiropodist said, "well I only charge £13". The HPC's response to that was, "you do a complete job whatever fee."

    When some of these chiropodists start having to fork out for the cost of treating a patient (out of their own pocket) because they have quoted a care home a ridiculously low fee AND have to do a complete job, they may want to think twice before quoting a ridiculously low fee.
     
  16. ja99

    ja99 Active Member

    Good post Brummy...

    I would have paid good money to see the look on that 'professionals' face !
     
  17. Paul Bowles

    Paul Bowles Well-Known Member

    Weren't there some stats from the Australasian Podiatry Council some years ago stating that the cost to Sterilize (inclusive of time, energy, machine costs and disposable costs) a set of general Podiatric instruments was around $12AUD? So if my memory serves me correctly with those figures, those of you charging $25AUD for a consult are making $13 profit for your time?

    How do you run a business like that?

    Each of our patients is aware of where their money is spent. Via handouts, clinical information they are given costs as to why a consult is $X or why their orthoses cost $X or why their wound dressings cost $X (and why that is apparently expensive!)

    Education is all that is needed. Patients are happy to pay fee's when they know they get quality care.
     
  18. Brummy Pod

    Brummy Pod Active Member

    I agree with you on your point of patient education.

    I was talking to a friend of my sister-in -law a few months ago, saying that most elderly should be able to afford chiropody, it's a matter of priorities. I said that at a SOCAP AGM, someone said that elderly ladies can soon afford to have their hair nicely done, but they think that chiropody is too expensive.

    Jean's reply was, "well having your hair permed is more important, no one looks at your feet, they see your hair though." She did not realise what can go wrong if your feet are not done. Also Jean was amased that we have to sterilise our instruments in between patients and keep records. "You're joking" she said. "No I'm not, it is a legal requirment, and you can get struck off if you're caught not doing it!" She never knew.

    How many other customers do not know what is involved in carrying out our duties properly/legally, and what can happen if things go wrong! It is patient education!
     
  19. gush_horn

    gush_horn Member

    I would think that at least basing fees on what is recommended by the government ($48 medicare $ $57 DVA) would make sense. Have confidence in the fact that your providing a professional and valuable service.
     
  20. Paul Bowles

    Paul Bowles Well-Known Member

    But surely this is the wrong way to view this? Do you think other specialists base their fee on what Medicare rebate or suggest - absolutely not, that why my GP charges $77 for a consultation when the medicare rebate is sub $50.

    Gush_Horn - why do you use the Medicare schedule? Why don't you use the MBF private health schedule who think you are worth $22 for a subsequent consultation?

    I am sure a good deal of my well educated and experienced colleagues will attest that their valuable time is worth much more than a $48 medicare schedule per consult! The beautician across the road charges $82 for a pedicure - and they paint your nails as well!!!!!!

    The DVA argument is completely different - DVA actually pay quite well for services rendered. Rarely does a thorough consultation require only 1 item billed.

    In this day and age you get what you pay for - if you don't want to pay my fee, don't come back and complain that the "cheaper" person did a poor job!
     
  21. gush_horn

    gush_horn Member

    Completely agree Paul. I was saying that as a minimum (read posts above of people charging around $30). Podiatry is a really needed and valuable service and this should really be reflected in the pricing structures. Having people charge peanuts really goes a long way to undermining the profession
     
  22. Shilpa

    Shilpa Welcome New Poster

    Hi
    With regard to the fee, I was contacted by the owner of 4 homes, to carry out treatment to the patients, we agreed £15 per person( a verble agreement), each paitent is invoiced to pay the fee within two weeks of the treatment carried out in June 09.

    I am still waiting for some of the fee to be paid to me, I have sent several emails to the owners and the managers that run these homes with regard to non payments I have left several telephone massages for the managers to call me- to date I have not had any response from the owners and one of the homes has asked for me to come back and treat the patients.

    I have told this manager that as there are problems with fees , I will need to be paid on the day the treatments are carried out and I need this agreed in writting. So far he has not responded if anything he has asked for me to come and treat the patients. It seem he is ignoring my request to be paid on the day

    I don't think that I should be going back until I have received all my fees, and if I were to go I should want my fees to be paid on the day. Any advise is greatly apperciated.
     
  23. Brummy Pod

    Brummy Pod Active Member

    Shilpa.

    When asked about doing nursing homes as, "it must be a good source of income." My reply to the patient is, "you must be joking, very few chiropodists doing chiropody to make a living, and worth their salt, will touch a nursing home with a barge poll." Why, you are a dogsbody, the working conditions are atrocious, staff are not helpful, and the pay is atrocious. Two patients of mine got an almighty shock when I showed them posting from TFS re: nursing homes and fees!
     
  24. zaffie

    zaffie Active Member

    Hi

    My mum is in a nursing home for which £1000 per week is charged. The visiting chiropodist charges £13.00.

    I have seen this lass at work and have not been very impressed. She sits on the floor to do her treatments. How can we expect respect as a profession? I do not visit nursing homes in a professional capacity and make a living none the less
     
  25. charlie70

    charlie70 Active Member

    I think it depends very much on what treatment you are giving.
    It is a distinct possibility that over half the people in the home only need non-pathological nails cut/filed.
    Can we really justify charging people £25 for that? Even with all our lovely education I'm not sure it is a "fair" price. But then again, they're getting in a medical professional in - they should pay the fees for the medical professional. They always have the option of getting in a Foot Health Practitioner to do the social nail care and calling in the Podiatrist for any additional, medical care their patients need.
    NB: Medical care is supposed to be provided within the home fees (not so Social Care) so any charges you make will not be passed on to the patient/their families. Or should not at any rate.
    It's something you could discuss with the home at any rate? :D
     
  26. footsteps2

    footsteps2 Active Member

    I am a Podiatrist in Australia and have been working for myself for 3 months. I base my rates on what others charge in the area that have their own clinics and also go by Medicare or clinic rates.

    I don't do many low care nursing home patients and am lucky enough to have landed 4 day contracts with nursing homes where the homes pay me direct...and I earn a good day rate, in the region of $700 for 15-20 patients.

    After 3 years of study, I think $40-50 dollars per patient is reasonable, including transport fees, carting stuff around and putting your back at risk....
     
  27. ja99

    ja99 Active Member

    +1 :good:

    Totally agree...unless you are desperate...tell them payment on the day, I've been doing it for years and once they are in the habit it gets easier. As for when you will be returning to provide treatment - tell them you'll be in a few days after you get paid for the last visit, or, write a firm but polite letter asking for payment again and have it 'registered' with the Mail provider so they have to sign for it. This is evidence of receipt by them that you could use if you took the matter further.

    BTW AUD$40-50 is equal to about 20-27GBP, so you are NOT overcharging at all, and its a cheaper cost of living (generally speaking) in Aus than the UK!

    Hope this helps...
     
  28. markleigh

    markleigh Active Member

    Paul wrote back on 19th Feb that he gives handouts on his costs - can you expand on how you do this I.e. Do you give this info. to everyone & how much do you break down your costs? I'm getting of thread with this query.
     
  29. Airlie

    Airlie Active Member

    Julian

    I visit about 6 RCF's in SA, and my powers that be charge $32 per visit, with a min of 10pt half day and 20pt full day. This includes assessments and everything. Personally I am trying to gradually push this mould of care from the inside. I think the daily rate is about right, but the patient numbers and time frame are tight. Personally I do everything in a nursing home that I do in my private practice, and the reason i stay with it at the lower rate of pay is that someone has to do it. One facility when I first started going there didnt have recordds earlier than 2 years for regular podiatry for the poor souls relying on the facility to do the right thing.

    I would love to see all podiatrists charging minimum $50 for RCF's and everyone providing up to date assessments from skin to shoes and educating staff. Nurses would stop seeing us as toe nail cutters and you wouldnt have to worry about someone coming in with a cheaper service and undercutting the market. Perfect world?? try professional obligation.
     
  30. ja99

    ja99 Active Member

    Hi Airlie,

    Thanks for your post, my original post was just over two years ago and the landscape has changed considerably in that time frame.

    Now I charge much more $40-$60 AUD per patient depending on the treatment etc. Working at fewer facilities...

    My current issue is Podiatry aides being allocated by Management as pseudo-Podiatrists: Making independent Dx, Tx, referral etc. and that only refer to me for treatment at the discretion of either the RN or Podiatry aide. I refused to work under these circumstances and declared that I would simply continue to attend to low care residents - now the 'Manager' (It would be an insult to dodgy used Car salesmen to compare to this one!) has refused to release the residents own funds to pay for my services...so the poor old dears are between a rock and a hard case - I cannot treat them 'gratis', Manager won't pay out from their own funds...

    I am sure there are some 'ethical' RCF's out there that both care for the residents and turn a profit....of the many that I have worked at - I know of two!
     
    Last edited: Nov 23, 2009
  31. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Mark,

    We basically show patients what things cost in a realistic and non-biased manner. In consults we discuss it with them, on handouts for orthoses, minor surgery etc... we outline it. We try to inform the patients about all costs regardless of what they are.

    Patients understand and appreciate much better what they are paying for if you discuss it with them.

    Currently we are revising all of these and next year will have a much more detailed breakdown - i.e. we outline that sterilization of instruments for a standard consultation costs approx. $12-$15AUD, home visits take X amount of time out of clinic and hence cost $X due to this. Heck, we are even including costs of things such as L.A. and tournicot use for minor procedures - but hey, people want details, and at the end of the day they should know exactly what they are paying for!!!!

    It works much better than saying to a patient "a home visit costs $X" and them arguing that it is a ridiculous cost. At least they may understand why the charges.....

    Does that sort of answer your question?
     
  32. Freddy

    Freddy Member

    Hi all,
    I agree with some obgservations that attitudes and facilities in nursing homes do not meet professional standards or the needs of the residents. I see this as a challenge. I make it my business to get the managers, senior care staff and relatives on side. Education is key. I provide (with permission) a notice board with leaflets regarding foot problems, safe and correctly-fitting shoes, appropriate hosiery etc. I incorporate in the admission data sheet, footwear, gait, tissue viability and falls assessment. This serves as a good resource for multidisciplinary audit.

    When you have the respect of all parties, the cost of fees are evidently justified. compliance is usually also not an issue when you recommend 'expensive' safe footwear.

    Freddy
     
  33. Freddy

    Freddy Member

    Hi all,
    My experience of justifying nursing home fees is to get managers, care staff and relatives on side. Education is key. Leaflets, posters and samples displayed on a notice board highlighting foot problems andsafe footwear usually increases justification and compliance purchasing 'expensive' appropriate footwear. Prevention creates a win win situation all round.

    Incorporating data on admission sheets such as skin integrity, gait, footwear and falls assessment tools is a usefull multidisciplinary audit resource.
    Awareness of your scope and value in the HCP team to improve residents' quality of life will justify fees to the self-funding. When new managers try to negotiate lower fees, this argument usually wins. Low incidence of ulceration, infection and falls makes the visiting Podiatrist an indispensable asset!
     
  34. Nat Smith

    Nat Smith Active Member

    I recently asked the manager at one of my ACF's how much money they receive for High Care residents' care...she told me that with all the ACFI assessments they have to do, they receive UP TO a maximum of $150 per day per resident...that essentially has to cover all the costs of the resident's ENTIRE day's care.
    Let's not forget, ACF's are a business. If you want to charge say $50, there's no way facilities want to pay out a 1/3 of the patient's total daily budget for you to come in and cut some toenails...It's no wonder they try to negotiate the cheapest pod deal and usually go with the pod company that comes in the lowest.
    Treatment in ACF's cannot be compared to clinic treatment. Let's face it, the main scope of practice required is basic nail care. Facilities won't pay for orthoses or nail surgery etc. Families are required to take residents out of the facility for any specialised procedures and wound care management is dealt with by the nursing staff. When the majority of patients are sitting around all day in slippers and tub chairs, we are predominately only required to care for toenails and monitoring for any potential risks.
    How much do you really think you should charge for that, based on time you spend per patient, instruments, travel etc? And how much are you likely to get out of the facility? The costs don't really add up for anyone involved.
    The fact is though, that someone has to do it...
    When I was initially building my practice I was happy to take on ACF's in the knowledge that it was secure regular income that helped pay my rent. Now that I'm established, I don't really need to do them and can earn much more in my clinic...but where does that leave my patients if I decide to quit them? Do you just abandon your responsibility of care? I find it quite a moral dilemma.
    The ACF's will always seek the cheapest deal and you will have a hard time convincing them that a full pod service, with a full fee is required. That leaves the circling sharks to sweep in and offer the cheap rate, and the cheap service...and offer new grads ****ty work with ****ty pay...and the residents are the ones that suffer.
     
  35. ackers

    ackers Member

    Good discussion,
    I treat the elderly in Melbourne, and after treating at a high care facility for the last 10 years, upped my fee to $22.00 a patient. I lost the tender for the council to a cheaper firm. So now have to find other avenues to recoup the $15 grand a year I've lost. Sometimes the marketplace dictates the price
     
  36. ja99

    ja99 Active Member

    Hi Nat,

    I agree, also facing that moral dilemma as well.

    What helps me sleep easier is to realise that the majority of residents are far more advanced in years and 'should' possess the wisdom to know when the ACF is doing a sales job about hot and cold running doctors/nurses/pod's/physio's etc. I know their are dementia cases/STML etc etc but still the aged population appear so willing to hand over hundreds of thousands on a promise of a standard care commensurate with their investment. I also am aware of only a very small percentage who leave some of these ACF's even knowing the sub-standard care compared to the monies paid. None of this mitigates the ACF's often reprehensible behaviors of course.

    Just recently I had a falling out with an ACF manager over the poor handling of HC residents, this mananger has informed me not to return to the ACF, and in spite of the 25+ LC residents who want to continue being treated by me, this individual will not release their funds from their own accounts to pay for Tx. The residents are fully able to retain their own funds for Tx, but the vast majority cannot be bothered.

    So the residents 'are' the ones to suffer but a majority of them have the power to complain, leave, choose their own practitioners etc etc but for the most part meekly accept the ACF's practices.

    :bash:
     
  37. williac

    williac Active Member

    This is why the whole concept of Podiatrists attempting to 'sell' the rights to service a nursing home is absolutely ridiculous. There are no legally binding contracts. You are at the mercy of the ACF manager (and owners). They are in business after all - cutting costs is responsible business practice. So yes, the market will always dictate the price you can charge. Competition will ensure this.

    Chris Williams
    (Vic - Australia)
     
  38. Paul Bowles

    Paul Bowles Well-Known Member

    Ackers as a matter of interest what is your business model (breakdown of costs) for that $22.

    i.e. For each patient or $22:
    Sterilization cost - $x
    Disposables cost - $x
    Professional time - $x
    Travel costs/time - $x
    Insurance - $x
    etc....

    I would be happy to lose a contract paying me that poorly! I can't imagine you making any money off that at all. You will make 10 times that much in a clinical situation.

    I think I have said it before in this thread - if people want to pay peanuts, all they will get is monkeys!
     
  39. Pompy

    Pompy Member

    Im with Paul on this one. I can't believe you would work for $22/patient let alone less than that. How many residents would you generally see in an hour? What about in a day? I think it's probably a blessing in disguise for you Ackers that you have lost this contract. Good luck in your future endeavours.
     
  40. Freddy

    Freddy Member

    I agree up to a point that you get what you pay for. As a manager, I maintain that it is cost effective to justify paying for the best skills out of a budget.
    Paying peanuts for the services of monkeys is asking for monkey business further down the line. Potential consequences of poorly skilled and underqualified staff will only come and bite you in the bum later. The care of patients and your professional reputation is compromised.

    Audits of falls, tissue viability etc etc count when nursing homes are inspected. Homes can be closed down on the strength of standards of services provided.
    A highly skilled visiting HCP like a GP, podiatrist etc is peace of mind for any manager.

    This may be us one day folks, dependant on others for our basic needs. I know what I would choose. It's up to us to educate. I'm sure, deep down, most managers and relatives would want the best for the resident. In my experience, once you have taken the time to explain the rationale of high standards of care costing a reasonable amount (usually less than a hairdressers bill over an 8 week period!) the majority of managers and relatives are compiant.

    Income is 'swings and roundabouts,' job satisfaction overrides income in my opinion, when visiting nursing homes. Cost can easily be recouped in the clinic charging those in employment who can easily afford the charges. Our older folks deserve nothing less than the best our profession can deliver.
     
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