As a home health OT, one will not have the flexibility to run to the equipment room, storage closet, or office to print copies of home exercise plans, grab Kinesiotape, or snag that sock aid that is supposed to be trialed in that session.
In home health, the vehicle one drove up in is the entire office/clinic/break room and gym, so planning ahead is imperative. A home health therapist may eat and chart in their car, or have a favorite stop on their route for lunch and a bathroom break. This most often does not include time to run back to the office to pick up any forgotten items. Coming up with a plan A, B and C will also allow the therapist to think quickly on their feet if the environment they were predicting for treatment changes in any way.
Remember, treating in the home, means interacting with everyone and everything that comes up in the home, which can throw a wrench in a treatment plan really quickly. Having an organized idea of what to do ahead of time will definitely come in handy.
Comfort with Autonomy
As a new grad, one may think that following graduation and fieldwork that they understand a setting or a population, and are experienced enough to treat on their own. Don’t let ego get in the way. School is a fantastic place for academia and learning, as well as collaborating with students, mentors, and patients in a supervised setting. In home health, one is on their own. In this setting, a therapist is not surrounded by coworkers with whom to ask a quick question or discuss best practices. They operate alone throughout much of the day. Of course, there is access to their employer via phone for any safety or case-related information, but they don’t necessarily have face-to-face interaction with other OT’s on a daily basis. Scheduled meetings and a ‘touch down’ at the office at the beginning and end of the day, may be the only time an OT interacts with others within the discipline. In a brick and mortar environment, it is much easier to speak with colleagues. Comfort in one’s decisions and rationale for a treatment method or approach is key to operating as a home health OT.
In-home care eliminates a lot of guesswork in terms of living conditions, environmental barriers to functional mobility, and access to tools in which to practice a home exercise plan (HEP) or perform daily activities. Treating in the client’s environment, and feeling, hearing and observing what they encounter on a daily basis is invaluable. The therapist can understand the barriers to which the client encounters, and tailor a very specific treatment plan that fits the client better than ever, incorporating meaningful and purposeful occupations.
“A pitbull is durable. An SUV with four-wheel drive in a Michigan winter is durable. A home health OT must also be durable.”
This also means, however, durability is key! Pet allergies, aversions to smells, and high expectations of cleanliness don’t bode well for those in this setting. Clients live in a variety of dwellings, and all have different ideas about what it means to keep a home clean, train pets, discipline children and styles for décor. All of these factors can be a barrage to the senses as well as to one’s personal beliefs about lifestyle.
Ability to Exercise Flexibility in Schedule and Finances
Rates will fluctuate depending on state, city, and region, of course, but home health positions can pay more, than say, an hourly rate at a hospital. This all depends on the level of experience, certifications, and population of clientele, etc., but typically rates will be higher than other settings. The flip side is that some companies pay per visit and do not have salaried positions with benefits, available.
They prefer that a therapist build up a caseload, which means that there is not necessarily a steady set of hours or income each week. This structure is not ideal for those with strict financial responsibilities. And for those that enjoy a clock-work set schedule, home health is anything but. Because clients are homebound, scheduling is relatively flexible, but also up to the therapist.
There are no office staffers to do this, so the therapist wears a multitude of hats that can be a blessing for some, and very uncomfortable for others who might have difficulty managing schedules as well as patient care.
For those who are not provided with a car from their company, they will be driving a personal vehicle. If this is the case, there will be an agreement for compensation over mileage, which is meant to include some wear and tear. Depending on locations, and weather and road conditions, this will most definitely impact the vehicle. A car, van, SUV or truck with an unpredictable starter, bald tires or missing mirrors is not appropriate for this setting.
Remember, patients receiving home health cannot leave their homes and rely on the therapist to come to them. Also if the therapist shares their vehicle with others, this could be difficult trying to manage the flexible schedules of patients with those with whom they are sharing a vehicle.
A home health therapist works primarily out of their vehicle, which also means that there tends to be a lot of equipment and tools that take up trunk or back seat space.
Snapshot of a Day in the Life
Review caseload for the day either at home or at the employer’s office. Pre-plan all treatment and pick up subsequent assessments, equipment, either at employer office or from the store of equipment in your vehicle. Plug the first client’s address into the GPS and hit the road.
Roll up to the client’s home, and park either in the street, field, or in a space on the driveway that does not block other vehicles. Depending on the treatment plan, choose the location in the house best to work within- whether that’s the kitchen for a cooking task or the bathroom to perform task analysis on the use of a tub transfer bench. If there are pets or other people in the home, make sure to stay focused on your plan and your client, while also remaining pleasant and approachable to the family.
After all, this is the support system or responsibilities of your client, and taking a holistic approach to care is important. If possible, document on your laptop within the session. If you’re not able, make notes as much as possible. Once the session is over, either stay in your car and document, or if this is awkward (especially if you are parked in the driveway), park down the road. If there is not enough time between clients to document, you’ll hit the road again, relying on your notes to fill in documentation later.
Need to use the bathroom? Spot a coffee or fast food joint while driving and pull over. If it’s lunchtime, maybe grab a bite, or eat your lunch behind the wheel en route. If there’s a time at lunch, document, but if not, keep on rolling! By the end of the day, either you’ll have a large chunk of notes done, or you’ll have at least a lot of notes that you can use.
Some companies will give you a hotspot to use for the Internet, which means you can submit documentation wherever you are - at lunch, in your car, etc. If, you’ll either go home or back to the office to finish paperwork and submit. Voila! You are done with your day!
Overall, a home health therapist must be quick on their feet to adapt to changing environments, have an open mind, endure all forms of sensory stimuli, have the courage to brave any weather condition, and possess the know-how to operate primarily independent of additional resources.