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Treating patients in a care/nursing home

Discussion in 'General Issues and Discussion Forum' started by Jacky Nowle, Mar 20, 2014.

  1. Jacky Nowle

    Jacky Nowle Member

    Members do not see these Ads. Sign Up.
    "I normally set up an area in the main lounge of the home"

    what do people think to this statement?

    also, "when treating those in a care/nursing home you may need to drop your fees a little" a little yes...............but when you have people charging £8 per patient, that is dropping your fees a heck of a lot, not a little!
  2. anthony watson

    anthony watson Active Member

    have been in about 15 nursing homes over the last 3 weeks for NHS patients.

    A number of staff have said "oh will you do them in the lounge"
    My joking way around this is to smile and say no its not a spectator sport".

    However what I think is what the hell do you staff think this is.
    Each of these people have the right to treatment in private.
    most care I see is good I think its that not valued profession thing.

    My dad is in a care home and the staff are ok but I am on there case a lot so he can get some basic care.

    Regarding price I always ask what the private cost is when I visit a care home and it may shock you but £8.00 is about the norm in the North.

    My question is do you take 30 sets of instruments with you or use disposables.
    It all adds up to more than £8.00 a patient in my books!

    Glad I am not doing that type of private work.

  3. Claire72

    Claire72 Active Member

    Care home and nursing home = vast difference with mobility of residents.

    In the residential care home where I work, residents see the ‘foot man’ in a lounge where the environment is the same as it would be in their own home, I imagine.

    He sets out his stall and they go over to him as they finish their breakfast. 90% of the residents where I work have limited mobility so going back to their rooms after they have made it to the lounge (whatever time of day), for an appointment with the foot man would be a huge effort. Seeing him in the lounge makes it easier for the residents as they will sit there afterwards.

    In the hour or so that he stays he sees around 6 - 8 patients. No corns or callus, just nail care, done without a drill. The residents where I work pay upwards of £500 per week for their care,:wacko: and pay additionally for their hair and their feet (and anything else they want such as newspapers).

    Whilst £8 is very low, and probably around half what our foot man charges, the quick turnaround of ‘guaranteed’ patients, coupled with the fact that the (basic) care they have to pay for has cost them their home and every bit of money they ever saved, or is being paid for by their desperate families, or you the tax payer, makes it not so bad. :empathy:

  4. foot rott

    foot rott Banned

    I wonder if the "foot man" has heard of clinical standards,infection control and patient confidentiality.

    If this is acceptable then we don't need a clinic just go around each patient as they sit in the waiting area!!

  5. Fliss

    Fliss Active Member

    Most care/nursing homes have smaller private lounges in which you can see your patient in privacy from other residents, failing that, you can see them in their own rooms. Treatment in a general lounge is not ideal.

    Regarding fees, decide what you are prepared to charge and stick to it, they can take it or leave it.

    'Foot man' treating 6-8 people an hour? I agree with foot rott's comments, and don't see how it is physically possible without cutting a lot of unacceptable corners.
  6. David Widdowson

    David Widdowson Active Member

    I don;t know of any care homes that do not have a hair-dressing room, which may not be ideal, but provides a bit of privacy and has hand washing facilities in situ. I just make sure that I am not going to arrive the same day as the hair dresser. There is no way I could work for £8 pp, just doesn't make economic sense.
  7. davidh

    davidh Podiatry Arena Veteran

    The OP's quote is verbatim from an article for new FHP's in the SMAE Journal. He/she missed out the bit about taking a full med history/neuro and vascular check/treatment/ and all the other bits and pieces associated with thorough treatment.

    Of course the article didn't mention an £8.00 fee, not even once. Instead it talked about setting fees at an acceptable level. Specifically it talks about not charging a small amount just to attract patients, because this can make patients and other professionals question your competence. Then it mentions dropping fees a little in a Home environment.

    Nice article I thought.
  8. blinda

    blinda MVP

  9. Jacky Nowle

    Jacky Nowle Member


    You are quite correct about it not mentioning an £8 treatment fee.

    My point is this, in previous threads, people have talked about such treatment fees in care homes. The lady who wrote the article said about dropping your fees a little, but £8 from say (for arguments sake £20) is more than a little reduction!

    The lady also said about setting fees at a realistic fee. The problem is that there are too many housewives doing it for pin money, who are running their "trade" more like a social charity. There are also the NHS people "on the side" too doing this!

    I have heard of cases of practitioners who have never ever put their prices up in 12 years (even when petrol prices went up a lot). I'm sorry, but even registered charities arrange their finances better than that! That simply is not sustainable.

    A good quote by someone else was that "undercutting leads to a situation in which no one is making a profit/a living, and who gains from that!
  10. Catfoot

    Catfoot Well-Known Member

    I have also seen the article that davidh refers to. To say that it was simplistic is being kind.

    It is true that there was no mention of any actual fee amount, but I notice that the writer does not repeat what is promoted on the SMAE website ;-


    ie a £35.00 for a 30 min clinical session. I wonder why this was not emphasised?

    However, I was pleased to note that the article mentioned having business insurance for any car used for FHP work. The majority of FHPs in my area work evenings and w/ends - no doubt when the family care is available to them - and charge part-time prices for what is essentially part-time work. The standard price of a visit (one hour) is £15.00, so no wonder few of them survive.

    Not all are SMAE-trained, but a good many have gone that route.
  11. anthony watson

    anthony watson Active Member

    So guys
    can someone tell me what is the difference between a HPC reg SMAE pod and a HPC BSc pod.

    I ask because in many posts (some by David) it seems that the main factor in all of this is been HPC reg.

    Now when I was at uni the SMAE were seen as not been trained to a high enough standard and we had never heard of FHP.
    It is my belief having spoken to the Stonebridge College it will not be long before the FHP people become HPC reg.

    Supply and demand donates that most of us will tend to work in the NHS as private practice is now awash with people doing foot care.

    I agree with foot rot as in my experience £7.50 - £8.00 is the norm for nursing homes.
    I would not do this type of work due to this.
    I feel this is an NHS responsibility and the FCA teams they employ

  12. Rob Kidd

    Rob Kidd Well-Known Member

    One thing that has not been mentioned at all here is that care homes are generally heaving at the seams in MRSA; while clearly new instruments should be used on every patient, it is bound to happen that the bugs are transported around the place.
  13. davidh

    davidh Podiatry Arena Veteran

    Good point Rob.

    Podiatry could be highlighting this, instead of just going in and doing the feet.

    Of couse some of us believe that it is up to the individual Podiatrist to take responsibility - either for some outness in an area they work in, or just to highlight a particular issue within foot health.
    Mark R's is an extreme example of someone wanting to bring a situation into the public eye, but I can think of plenty of others which are more low-key.
    It wouldn't even be difficult to get H and S and/or Infection Control involved.

    Here's a thought - why don't some of you who work in Nursing Homes do some research on this topic and get it published? You'll feel good, the work will highlight any possible risks, and it may even elevate the profession a notch.
    Anthony - you have a degree so you know how to research - give it a go.

    Coming back to Anthony's question.
    Didn't you say you'd trained at SMAE?:confused:
    No matter - once a Pod is HCPC-registered that's it. Fully accepted and accredited by our regulatory body.
    Nowadays the only route into Pod is via a Pod degree.

    There is not a cat in Hell's chance of FHPs being HCPC-registered (imo).
  14. Jacky Nowle

    Jacky Nowle Member

    What about the FHPs that are registered with the voluntary register? The Alliance one!
  15. davidh

    davidh Podiatry Arena Veteran

    Well what about them?
    It's good they have a register, but that doesn't mean they'll get onto the HCPC Register.
  16. Jacky Nowle

    Jacky Nowle Member

    Couldn't other FHPs from other organisations join this register? I have heard that their regulator are the people who regulate the HCPC!
  17. foot rott

    foot rott Banned

    hi david
    have opened a thread on the difference.
    Hope you don't mind but used a bit of one of your posts.

    I think it would be useful to debate the issues around hpc -:drinks:morning:fhp, uncle tom cobbley and all !!!
    Ed :morning:
  18. davidh

    davidh Podiatry Arena Veteran

    Our regulator (for better or worse) is the HCPC. They are Govt-appointed.
    FHPs do not have the luxury :)confused:) of recognition by the HCPC, the Govt, or any other official body. They are voluntary.

    If in doubt, check directly with the HCPC. Give them a ring - they are very nice over the phone and will give you accurate information on this subject.
    I don't know if you are registered with them or not, but it doesn't matter - they will still talk to you.
  19. AlanCawthorne

    AlanCawthorne Member

    I also work in the North East, and trade under the name of 'The FootMan' - the above reference IS NOT myself. I also work part time for the NHS.

    I have previously found it difficult to get work in care homes for the pricing mentioned above. Most care homes expect to pay around the £7-£9 mark per patient. I went as low as £15 (bottom line) per patient to a local care home which was within walking distance, when their 'local pod' walked out (who was charging £8 pp btw). I explained I use single use / disposable instruments for each patient, full history take, meds check - etc, along with all dressings carried. I was still under cut by another 'Podiatrist' who was charging £9. Let them have the work!

    My attitude is I cannot / will not compete at those prices. My work has a standard which cannot be delivered at that price. As stated further up the thread, if everyone drops their prices, no-one makes a living, and we may as well stack shelves in the local supermarket.

    When I am working for the NHS in care-homes, I always enquire about the foot care, and most of the staff do not know if the person who visits is a Podiatrist or a foot-health practitioner. I've only found 1 being paid £20 per patient. All the rest have been less than £10. I do wonder exactly what these professionals actually do / record for the money.

    I always treat patients either in their room, or in a quiet side room, away from other people. Patient dignity costs nothing, and means everything. I wouldn't want my health situation discussed out in the open for all to hear.
  20. omg 123

    omg 123 Member

    30 pre sterilized sets, standard medical history form for staff to complete prior to seeing resident/patient set up in treatment/hair dressing room stool foot rest and drill.
    Easy reach of sink.
    Home provide clinical waste bag and coffee.

    Head down ass up and go for it!
    Not many people would turn down £300 a day for routine care! (or would they?)
  21. Podess

    Podess Active Member


    You said

    but I'm not sure how you arrive at those figures?

    If you deduct £5.00 for the cost of each (disposable) sterilised set, that takes £150.00 of the total before you start.

    If you have re-usable instruments then you need to factor in the time cost of scrubbing/cleaning/sterilising those instruments. Also, you need to include the time taken to write up notes and discuss any problems you come across with the care home staff. Most care home residents have lower limb pathologies, so "routine nail care" doesn't apply.

    This all assumes that the care home staff are available to bring patients to you. If you have to see some in their rooms it takes a lot longer.

    Don't forget those who cannot lift their legs as high as a footstool. That involves kneeling on the floor to treat them - so factor in the cost of a bad back as well.

    Then there are those with dementia who will scream, kick, try and pull your hair and punch you.

    So IMO anyone who wants to work in care homes for less than £20 per patient is crazy.

    And BTW, putting your clinical waste in the homes yellow bag is illegal - you need your own Waste Disposal Contract that will provide you with a Waste Transfer Note.
  22. omg 123

    omg 123 Member

    up to date steriliser rental for wrapped instruments is £50 a month on a 3 year contract with ultra sonic cleaner top range is also rentable at low cost.

    Following investment on 30 sets (trimesco lifetime guarantee) and disposable card nail files not D-debs and printable notes policies and guidelines from SOCP.
    Your set to go.

    It should take you no longer then 5 min to check foot condition including doppler of dp an pt and filling time/ foot health condition and current problem.

    It should take no more then 10 min per treatment in routine care and to complete a SOAP note format.

    Any patient/resident with risk factors such as ulcers infection and those who you feel appropriate should be seen by the NHS as it is more appropriate.

    If the day is worked out well it should be more then possible to see 30 patients (hard work but possible) save the EMI patients till the end and use the staff.

    Usually the home will give you a carer to work with you during the day.

    As you are working in an area were vulnerable adults are been looked after it is good the get a crb for the home (some will ask for this)

    As for the yellow bags and sharp bins? if you subcontracted in the NHS would you take your own clinical waste stuff?

    This is how I roll (don't think I am alone judging by the standard nursing home fee!!)

    I do understand its not for everyone but in this current climate it gets harder to scrape a living:D:D:D
  23. Pauline burrell-saward

    Pauline burrell-saward Active Member

    I no longer visit residential/ nursing homes simply because I am too busy in the clinic also it's real hard on the back( when you get to a certain age!)

    However when I used to visit ,it was easy money, as stated above it takes no more than 15 mins to do each pt, it was rare to do more than basic care, rarely a corn or hard skin, ulcers were on the NHS list or district nurse list.

    I could only do about 10 per visit , mainly as that's how many sets of instruments I had at the time also there was only a short time to do treatments, by the time they are mobile after washing/ bathing, had breakfast, coffee then lunch there is little time left.
    I could easily do 10 in two hours making at least £130 ,not much but good enough for 2 hours work and especially when you are setting up, it's also pretty much guaranteed every few weeks ,Get a few more on your books and you have paid your bills.

    I agree not the most exciting work and most give it up eventually but we all have to start somewhere. Also these people do need their nails cut and cared for!!!!
  24. goofyfoot360

    goofyfoot360 Member

    I visit 4 residential homes, in one home I am expected to treat patients on the lounge which I am not at all comfortable with, but there is no other option as their mobility is so poor, that by the time the 1st patient got to their bedroom, it would be time for me to leave!

    One home I visit I see 35 patients, it takes me from 9.30am to 5pm with a lunch break. I am set up in a dedicated room, I charge £15 ( clearly a reduced rate) per person. I bring 35 sets of sterilised instruments and do nails corns and callus, and, when needed I pad and strap, I do the best job I can . I took over from a chiropodist who saw the same number of residents in 2 1/2 hours! I doubt that a clean set of instruments were used per person, the record keeping was abysmal.

    Do the best job you can, when you can...privacy issues will always be there in a communal setting, some homes can offer this, others can't .

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