Section 1: Your Contact Information First Name: Last Name: Title: Organization/Company Name: Business Model: HCAF District: Telephone: Email Address for Questionnaire: Email Address for Report: Please count all employees regardless of their employment status i.e. fulltime, part-time, etc.: # Administrative Personnel: # of Field Nurses: # of Field Therapists: # of Companions & HH Aides: # of Other Field Clinicians Average # visits per month: Average Patient Census: Average % of employed (not contracted) clinicians: Page 1 of 13
Instructions for Sections 2,3 and 4: * Please provide the info requested in these sections on an FTE basis. Definition of FTE: Salaried staff considered to be full-time staff under the agency's policies; or each 2,080 hours paid per year to part-time salaried staff; or each 2,080 hours paid per year to hourly paid staff or staff paid by the visit, or contractors paid pursuant to a contract. * Refer to "Definitions of Job Descriptions" to ensure the questionnaire position matches the position in your organization. * Convert salary info to an hourly rate. Formula: Salary / 52 weeks / number of hours per week Example: $30,000 / 52 weeks / 40 hours = $14.42 * Please report average wage info for positions with more than one incumbent. Section 2: Office Staff - HOURLY RATES (as of June 30, 2013) Position Starting HOURLY Rate Current HOURLY Rate Administrator / Exec. Director / CEO Chief Financial Officer (CFO) Corporate Branch Director Clinical Director Director of Nursing Medical Director (MD) # of hours MD paid over past year Admissions Nurse Scheduling Coordinator Branch / Clinical Manager Business / Office Manager Director, Business Development Director, Community Education Director, Managed Care Director, Rehabilitation Administrative Assistant Page 2 of 13
Section 3: Support Staff - HOURLY RATES (as of June 30, 2013) Position Starting HOURLY Rate Current HOURLY Rate Accountant/Bookkeeper Billing Clerk Clerical/Secretarial/Filing Data Processing OASIS Data Processing Information Management Intake / Home Care Coordinator Medical Coding Specialist Medical Records Specialist Nursing Supervisor Personnel Manager Marketing/Facility Liaison QA / Risk Management Supervisor Staff Development / Clin Educator Util. Review / Quality Assurance Page 3 of 13
Section 4A: Field Staff - DIFFERENTIALS BY AMOUNTS (as of June 30, 2013) DIFFERENTIALS are ONLY the amount ABOVE and BEYOND what your usual payment is. Ex: Hourly Differential = $3 if normal hourly rate is $20 and you pay $23 for evening hours. Ex: Per Visit Differential = $5 if normal visit rate is $13 and you pay $18 for evening visits. 1. Travel Reimbursement Amount Per Paid to Field Staff 2. Nursing Field Staff DIFFERENTIAL Only Amount Per 3. On-Call RNs DIFFERENTIAL Only Amount Per Week 4. On-Call LPNs DIFFERENTIAL Only Amount Per Week 5. Physcial Therapsits DIFFERENTIAL Only Amount Per 6. Physical Therapist Assistants DIFFERENTIAL Only Amount Per 7. Occupational Therapists DIFFERENTIAL Only Amount Per 8. Occupational Therapist Assistants DIFFERENTIAL Only Amount Per 9. Home Health Aides DIFFERENTIAL Only Amount Per Page 4 of 13
10. Speech Therapists DIFFERENTIAL Only Amount Per 11. Respiratory Therapists DIFFERENTIAL Only Amount Per 12. Homemaker DIFFERENTIAL Only Amount Per 13. Companion DIFFERENTIAL Only Amount Per 14. Escort DIFFERENTIAL Only Amount Per Page 5 of 13
Section 4P: Field Staff - DIFFERENTIALS BY Percentage (as of June 30, 2013) DIFFERENTIALS are ONLY the amount ABOVE and BEYOND what your usual payment is. Ex: Hourly Differential = 50% if normal rate is $20 and you pay $30 for evenings. (time & 1/2) Ex: Per Visit Differential = 15% if normal visit rate is $20 and you pay $23 for evening visits. 2. Nursing Field Staff DIFFERENTIAL Only Percentage Per 3. On-Call RNs DIFFERENTIAL Only Percentage Per Week 4. On-Call LPNs DIFFERENTIAL Only Percentage Per Week 5. Physcial Therapsits DIFFERENTIAL Only Percentage Per 6. Physical Therapist Assistants DIFFERENTIAL Only Percentage Per 7. Occupational Therapists DIFFERENTIAL Only Percentage Per 8. Occupational Therapist Assistants DIFFERENTIAL Only Percentage Per 9. Home Health Aides DIFFERENTIAL Only Percentage Per 10. Speech Therapists DIFFERENTIAL Only Percentage Per Page 6 of 13
11. Respiratory Therapists DIFFERENTIAL Only Percentage Per 12. Homemaker DIFFERENTIAL Only Percentage Per 13. Companion DIFFERENTIAL Only Percentage Per 14. Escort DIFFERENTIAL Only Percentage Per Page 7 of 13
Section 5: Field Staff - PER HOUR Rates (as of June 30, 2013) * Full time and Part time - anyone paid by salary or by the hour can be reported here as long as all values are converted to an HOURLY RATE. (Those positions paid PER VISIT or PER DIEM need to be reported only on the next section - NOT HERE!) * REMEMBER to convert all annual salaries to hourly rates! (Example: $30,000 salary / 52 weeks / 40 hours = $14.42) * Please only report regular weekday hours here. Special hours should be reported in Section 4. Field Staff Position a. Starting HOURLY Wage b. Current HOURLY Wage 1. Registered Nurse 2. Licensed Practical Nurse 3. Diabetic Nurse 4. Wound Ostomy Continence Nurse 5. Psychiatric Nurse 6:Other Specialty Nurse Type: 7. Case Manager 8. Home Health Aide 9. Medical Social Worker 10. Occupational Therapist (OT) 11. Certified OT Assistant 12. Physical Therapist (PT) 13. PT Assistant 14. Speech Therapist 15. Respiratory Therapist 16. Homemaker 17. Companion 18. Escort Page 8 of 13
Section 6: Field Staff - PER VISIT (as of June 30, 2013) Provide ONLY PAID PER VISIT amounts below. (Salary and paid per hour are in Section 6.) * Please only report regular weekday visits here. Special visits should be reported in Section 4. 1. Registered Nurse - PAID PER VISIT b. Current PER VISIT RATE c. Sign-up Admission d. Evaluation PER VISIT e. High-Risk/Tech Visit 2. Licensed Practical Nurse - PAID PER VISIT b. Current PER VISIT RATE c. High-Risk/Tech Visit 3. Specialty Nurse: Diabetic Nurse - PAID PER VISIT b. Current PER VISIT RATE c. High-Risk/Tech Visit 4. Specialty Nurse: Wound Ostomy Continence Nurse - PAID PER VISIT b. Current PER VISIT RATE c. High-Risk/Tech Visit 5. Specialty Nurse: Psychiatric Nurse - PAID PER VISIT b. Current PER VISIT RATE c. High-Risk/Tech Visit 6. Specialty Nurse: Other Nurse - PAID PER VISIT b. Current PER VISIT RATE c. High-Risk/Tech Visit 7. Home Health Aide - PAID PER VISIT 0 0 8. Medical Social Worker - PAID PER VISIT 9. Occupational Therapist - PAID PER VISIT c. Re-certification Visit Page 9 of 13
d. Evaluation PER VISIT 10. Certified Occupational Therapist Assistant - PAID PER VISIT 11. Physical Therapist - PAID PER VISIT c. Sign-up/Admission d. Evaluation PER VISIT 12. Physical Therapist Assistant - PAID PER VISIT 13. Speech Therapist - PAID PER VISIT c. Sign-up/Admission d. Evaluation PER VISIT 14. Repiratory Therapist - PAID PER VISIT c. High-Risk/Tech Visit 15.Homemaker - PAID PER VISIT 16. Companion 17. Escort Page 10 of 13
Section 7: Employee Benefits (as of June 30, 2013) Those eligible for benefits include: Insurance (select all of those that you provide): Health/Medical Life Dental Vision Automobile Personal Liability Short Term Disability Long Term Disability Supplemental Other Insurance: Technology (select all that you provide): Cell/Mobile Phone Laptop/PDA/Tablet Salary/Pay increase based on MERIT Do you offer merit increases? What was your recent average MERIT PAY increase %? Phys Portal for esignatures (select) Pager/Beeper If so, on what are they based? (select all that apply): Performance Productivity Budget/Available Funds Other Merit: Cost of Living Adjustment (COLA) Increase Do you give an annual COLA? (select) If yes, what was your COLA % increase last year? Staff Bonues Do you offer bonuses? (select) If so, what are they based? (select all that apply): Retirement Plans Performance Productivity Budget/Available Funds Other: Do you offer retirement plans? (select) If so, what type? 401K (select all that apply): 403-B Other: SEP Pension Page 11 of 13
Recruitment Incentive Bonuses Do you offer $ incentives to current staff to find new employees? Payment Conditions (ex: 50% Incentive Payment Amount: at hire; 50% after 6 months) (select) For finding which staff (ex: RNs, PTs, HHAides) Sign-On Bonuses Do you offer $$ sign-on bonuses to newly hired employees? Sign-on Amount (select) For which type of staff (ex: RNs, PTs, HHAides) Page 12 of 13
Section 8: Time Off (as of June 30, 2013) What kind of system do you have? Who is eligible for time off? (select) (select) If PTO system, do you also offer paid holidays in addition to PTO? (select) s (select all of those that you offer): New Year's MLK, Jr. Day Memorial Day Independence Day Labor Day Veteran's Day Thanksgiving Christmas Other s: Seniority System: Number of Personal Days: Time to Quality Immediately/Upon hire After 30 days After 90 days After 6 months Afer 1 year After 2 years After 3 years After 4 years After 5 years After 6 years After 10 years After 15 years After 20 years Number of Days Off (vacation or PTO) If accrued PTO/PDO is capped, how many days is the cap? If accrued vacation is capped, how many days is the cap? If accrued sick time is capped, how many days is the cap? If there's a limit for carrying PTO to next year, how many days may be carried? If there's a limit for carrying vacation time to next year, how many days may be carried? If there's a limit for carrying sick time to next year, how many days may be carried? # of Sick Days Thank you for participating in our survey! Please send completed surveys to Monica Smith by email msmith@homecarefla.org or fax 888-259-6274. Results will be released in October. Page 13 of 13