Camille Torvald starts her round at seven, a list of eleven patients spread across a forty-minute radius of eastern Brackwell taped to her dashboard. Her employer, a home-care agency called Meridian Home Health, pays her for the time she spends with each patient. The driving between them is unpaid.
“On paper, my shift is six hours,” she said. “In practice, it’s closer to nine, because nobody’s figured out what to do with the two or three hours a day I spend in the car.”
Home-care work has grown quickly in Brackwell as hospital discharge policies push more recovery and chronic-condition management into patients’ homes rather than extended hospital stays. Meridian’s own patient roster has grown by nearly 40 percent over three years, agency director Petra Solano said, without a matching increase in how travel time is compensated.
The maths of the round
Torvald’s visits themselves are billed and paid at a standard per-visit rate regardless of how far apart her patients live. A nurse whose eleven patients are clustered in one neighbourhood finishes her day hours before a nurse, like Torvald, whose patients are spread across a wider stretch of the city.
“I don’t get to choose my route for efficiency,” she said. “I get assigned the patients who need me, wherever they live, and the clock only starts once I’m through the door.”
Meridian covers mileage reimbursement, a per-mile rate that Torvald says covers fuel but nothing for the time itself. Industry surveys cited by the Brackwell Home Care Association suggest the gap is common across the sector, with travel time treated as an overhead cost rather than compensated labour at most agencies surveyed regionally.
“Travel time is real work,” said association policy officer Bram Vosloo. “It requires attention, it requires planning, and it takes a chunk out of every nurse’s day that this industry has mostly declined to pay for.”
What patients see, and don’t
Patients rarely see the unpaid hours behind a visit. Retired teacher Josefina Alden, one of Torvald’s regular stops, said she assumed home-care nurses were paid for their full working day until a conversation with Torvald corrected her.
“I had no idea,” Alden said. “She’s here fifteen, twenty minutes some days. I never thought about what happens to the rest of her morning.”
Solano, Meridian’s director, said the agency has looked at restructuring pay to include a travel component but has not implemented it, citing budget constraints tied to reimbursement rates set by regional health insurers rather than by the agency itself.
“We would like to pay for travel time. The rates we’re reimbursed at don’t currently leave room for it without cutting something else,” she said. “That’s not an excuse. It’s the constraint we’re working inside.”
Torvald has stayed in the job seven years despite the unpaid hours, a decision she attributes to the patients rather than the pay structure. She finished her eleventh visit a little after four, the dashboard list crossed off in blue pen, and started the drive home, the last unpaid stretch of a day that on paper had ended two hours earlier.
