In Texas, Caregiver’s RN On Call Achieves Goals for Nurses, IDD Individuals Via Exclusive Supplement


(June 5, 2019 | Fort Worth, TX) … When Caregiver, Inc.’s Director of Nursing, Randi Morgan, RN, BSN, launched a single-market RN On Call pilot in 2012, she had three priorities in mind: sustain excellence in continuity of care, assure immediately available support after hours for direct service professionals (DSPs) caring for individuals with intellectual and developmental disabilities (IDD), and provide weekend and evening relief for staff nurses with full caseloads.

Today, the Caregiver RN on Call program’s dedicated team of full-time, after-hours telephone triage nurses are hitting those targets as they help manage health issues that arise among the nearly 2300 individuals with IDD issues whom Caregiver serves throughout the State of Texas.

“The pilot was an epic success,” Morgan (pictured left) noted. “We saw the positive effects immediately and began expansion statewide.”

No other service provider for IDD care in the state has such a supplementary, full-time, professionally staffed on-call program in place, according to Morgan. Texas cities served include Dallas, Fort Worth, Houston, Baytown, Beaumont, San Antonio, Lancaster, Temple, New Braunfels, Amarillo, Abilene, Lufkin, Mexia, Benbrook, Brownwood, Wichita Falls, Granbury, College Station, Lubbock, San Angelo and Victoria.

According to Morgan, through the RN On Call program individuals Caregiver supports have reduced hospitalizations, decreased emergency room visits, and greater quality of life. Caregiver’s coterie of highly-skilled after hours triage nurses helps drive greater accountability, lessen fatigue and burnout for the daily nursing staff and assure a better flow and continuity of reporting. And importantly, front line DSPs report reduced stress and peace of mind knowing after-hours help is one phone call away.

“Daytime nurses are more satisfied with their jobs, with reduced downtime and enhanced retention,” said Morgan. “Caregiver’s Direct Support Professionals, families and guardians receive quick after-hours access and support 24 hours a day, seven days a week, 365 days a year.”

Such responsiveness and access is important, as telephone triage can be more complicated when serving the IDD community. Frequent issues include illnesses, medications, injuries, and maladaptive behavior, among others.

Each quarter, Caregiver on-call RNs receive thousands of calls, often averaging 30,000 calls annually. In the last quarter of 2017, of 5,056 calls answered by RN On Call nurses, only 137 resulted in transfer to emergency departments and less than a quarter of the calls required a follow-up conversation.

Among the goals of the program are facilitation of after-hours access, reduction of delays in response time, sustaining excellent continuity of care, and preserving ER and doctors’ visit appropriateness.

“The program has exacting protocols and guidelines,” said Diane Rickman, RN, (left) Caregiver Lead On Call RN nurse in West Texas. “This assures that good judgment underpinned by years of experience and strong educational backgrounds prevails.”

Randi Morgan explains that such judgment capability also reflects metacognition, thinking about thinking. Nurses have scientific skills, empathy (generally defined as an effort to appreciate the patient’s experience from his or her perspective) and situational consciousness that can guide the interviews with Direct Support Professionals so that each DSP supplies the best information about the individual they support to the RN On Call nurse.

“Our nurses draw upon finely-honed intuition informed by experience and decision-making over many, many years,” said Morgan.

Experience also contributes to clear communication. Information shared via electronic health records helps on-call nurses appropriately manage or escalate any situation. Healthcare data and full histories are available at their fingertips; Caregiver will have fully implemented its Taskmaster Pro electronic health records protocol by the fourth quarter of 2019. As communication capabilities continue to evolve, accessible records, voice and now video conferencing inspire even better assessments.

“With video conferencing, we can see the injury, look at the skin condition, essentially get a full picture of each patient,” Rickman states. “In many cases individuals are nonverbal, so visual interaction assures that nurses see facial expressions and observe behavior.”

IDD individuals’ complex situations are often exacerbated by multiple diagnoses. According to the National Council on Disability, “…adults with developmental disabilities are at risk for hearing and vision difficulties, cardiovascular disease, obesity, seizures, mental health and behavioral problems, poor oral health, and poor general fitness.”

Considering those complexities, Morgan reiterates that thorough information-gathering by the nurse is critical.

“Direct support professionals, while skilled at working with the individuals they serve, are not licensed medical professionals,” she noted. “Licensed nurses can help guide each DSP so that the nurse gets the best information.”

A residual benefit is the value of educating the Caregiver Direct Support Professional staff. Each registered nurse shares knowledge and understanding during every conversation.

Five years ago, Caregiver staff nurses had to take call in addition to their daily activities. Even when tired, professionals still had to be the eyes and ears to everything. When fatigued, nurses could miss less transparent behaviors in this complex population, Morgan explained.

“Now, there is less fatigue and more transparency,” she said. “Transparency and visibility of daily reports assures everyone understands what is going on, at all times.”

Morgan stresses again that Caregiver is the only company that works with IDD individuals in Texas to have an on-call nurse triage department. Before the RN On Call program began, Caregiver used contract nurses exclusively. While adequate, continuity was lacking. There was less familiarity among the teams, and peace of mind suffered. Having full-time, on call triage nurses was the solution.

“I believe the RN On Call formula is people + passion = improvement,” said Diane. “We integrate technology and relationships. Each personal touch builds trust and connection. Every team member at Caregiver understands his or her common reason for being here. In short, good staff means good care.”

For 2019, managing ratios of nurses on staff is at the forefront. Morgan has developed the proprietary Caregiver RN On Call training program that includes an 1100-page nursing guidebook, a five-hour education course and Caregiver’s electronic health records training for both waiver and non-waiver reimbursement programs. She is ready to add RN On Call team members who have patient experience, excellent communication skills, depth of pathophysiology knowledge, and a thorough understanding of pharmacology.

During the third and fourth quarters of 2019, Randi Morgan anticipates expanding the RN On Call program just as soon as practicable to additional Caregiver service areas in Tennessee, Indiana and Ohio


Caregiver, Inc., is a privately held company with over 3500 employees within the headquarters support group in Fort Worth and branded affiliate organizations in four states. The affiliates provide intermediate, home and community care services to nearly 2800 individuals who qualify as developmentally or intellectually disabled or are impacted by related conditions. Caregiver, Inc. was formed in 2015 and now includes these affiliates: Unified Care Group, Southern Concepts, River Gardens, Daybreak Community Services Inc., St. Giles Living Centers, DSA of Indiana, CG-HHC, All Care Services, T/R Residential and S&K in Ohio, and Omni Support Services of Tennessee. All have similar service offerings and strong reputations in their local communities. Caregiver services include supported home living, family protective services, case coordination, nursing services, respite services, day habilitation, psychology services, dental treatment, specialized therapies, adaptive aids, minor home modifications, and supported employment. Caregiver president and CEO is Mark Lashley. Company headquarters are at 4800 Overton Plaza, Suite 440, Fort Worth, Texas 76109. Phone is (800) 299-5161. They are on the web at

“With the RN On Call program, individuals Caregiver supports have reduced hospitalizations, decreased emergency room visits, and greater quality of life. Caregiver’s coterie of highly skilled after-hours triage nurses help drive greater accountability, lessen fatigue and burnout for the daily nursing staff and assure a better flow and continuity of reporting. And importantly, front line DSPs report reduced stress and peace of mind knowing after-hours help is one phone call away.” Randi Morgan, RN, BSN – Caregiver, Inc.’s Director of Nursing

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