Sometimes while I am interviewing potential new hires, I feel their apprehension and anxiety about moving into the field of home health physical, occupational, and speech therapy. Although the idea of home health sounds like a flexible and rewarding career path, they are still nervous about the “what-ifs”. Let’s break down the common myths and misconceptions about home health therapy, keeping in mind that the reward is worth the risk:
What if the house is dirty or in disrepair, or if there isn’t good caregiver support? I don’t know what I’m walking into.
Ok, so this one is not exactly a myth. Sometimes you really don’t know what you’re walking into. But by the time you are ready to make your first visit, you’ve already spoken to someone on the phone and/or another healthcare provider has already been to the house. You can pick up on a lot of what’s going on before you even arrive. If you hear dogs in the background, you can ask that they be put away when you arrive. If you can tell the person on the phone is a little confused or unreliable, you can call the emergency contact person and arrange for someone else to be there when you arrive. It is rare that the “worst-case scenario” in your head even remotely approximates the reality of bad situations. You have a team of people supporting you, and together you all support the patient.
Keep in mind that, usually, the patient has just spent some time away from home in the hospital, or they’ve been chronically ill and unable to maintain the home. This is a reality that is out of everyone’s control. Your job is to improve their home environment and physical status so that self-home management is possible, or to put support systems in place to improve the situation. The more you get to know and understand the human being you’ve been sent to help, the less you notice things that would normally make you uncomfortable. Compassion and empathy are sometimes the substance of miracles.
What if there is an emergency?
Then you get to be a hero. How fortunate for your patient that you arrived just in time to recognize the worsening symptoms of congestive heart failure, that you were there to notice the spike in blood pressure, that you were able to call the doctor about a possible infection brewing along the incision site! Whatever the emergency, it’s YOUR eyes that caught it. You will deal the emergency calmly and swiftly, with the guidance of the physician and home health agency supervisors. You are a trained professional… you can handle it!
I worry I’ll be out there all alone.
Valid concern- you will be alone. BUT, you will also be a part of an amazing group of professionals who are only a text, email, or phone call away. You have resources in the relationships you build with other therapists, nurses, and administrative staff who are always available to help. Autonomy is a great feeling of professional achievementabandonment is not. When you don’t know something, ask. It’s as simple as that.
Ugh, all that driving.
Love, or contempt, for driving from home to home is a personal preference. We have therapists who love driving along winding, rural roads, as much a 10-15 miles between clients. We also have therapists who navigate some of the most congested highways and city streets in the country. What they will tell you is that they use that time for some productive purpose: for reflection, for decompression, for making calls (hands-free devices of course), for listening too books on tape or music, for planning the next treatment session or arranging carpools for the kids. Traveling between patients also allows for a quick detour into Target or the grocery store that a clinic job can’t provide. There is also the opportunity to work in the assisted living environment, where the need to travel between patients is minimal to naught.
I don’t want to be a full-time employee, but I worry about not having a consistent paycheck.
In our company, where we pay our clinicians per visit, there is a risk of ebbing caseloads and smaller paychecks. Other companies do offer full time compensation, but it is tied to productivity minimums and time management oversight.
As a per visit employee, it can be hard to deal with fluctuations in income. There are ways to manage the risk, however, by learning how to effectively manage your time and capitalize on opportunities. Establish a “take home” minimum and work to save the profit from the fatter checks to supplement thinner times.
It is important to understand the ebbs and flows of home health. A boat load of clients are discharged from inpatient facilities just before holidays, so take these cases if possible for when things are slow during the holidays. I find things get slow from Dec 25th to about Jan 10th each year and the last three weeks in August for physician vacations with less elective surgeries like joint replacements. So, this is a good time to plan vacations or other projects.
Work on the “honey do” list, start that painting project, or get caught up with your exercise workouts to “redeem the time.” Usually, the problem
always seems to be too much work, so enjoy the short break.
I won’t become a better therapist unless I work in a more structured environment.
There are many advantages in working in hospital or clinic settings, and experience in those settings certainly enhances the skill sets of therapists with diverse backgrounds. But in busy clinics, where there may be ten to twelve therapists buzzing around with three patients to see each hour, how much collaboration is there? How much time do you have to figure something out, or try something new? How personalized is the care one joint replacement patient is having compared the joint replacement patient on the next mat table? In the home health setting, where the client is receiving 1:1 care in his or her own environment, each situation is different from the last. You learn how to apply neuro techniques during a real, functional activity, instruct stair training on his or her own stairs, provide strength and balance programs using whatever equipmentis available in the home, fatigue a muscle group with your bare hands. No, you don’t have a $40,000 balance trainer but you do have a sofa cushion or square foam, walker and your gait belt to do an awesome balance training treatment! Home health helps you develop creativity and resourcefulness. You find yourself digging deep when you’re challenged, reaching into a wealth of knowledge and experience and never coming up empty. You routinely go above and beyond the minimal requirements because this person in front of you needs you to. And that, my friends, is the essence of excellence.
Isn’t home health a side job?
Once upon a time, home health was viewed as the “extra job”. It was a way for therapists with full time jobs to earn a few bucks after work and on the weekends. Home care, however, is no longer a casual commitment.
Ever changing and expanding Medicare guidelines regarding the provision of physical, occupational, and speech therapy under the Part A home health benefit have turned home care into a highly regulated industry. With more and more baby boomers coming of age and utilizing their Medicare entitlements, the Centers for Medicare and Medicaid have really tightened up the purse strings. Keeping track of therapy dollars and having therapists routinely justify and qualify the need for intervention requires constant therapy input. Making the most of limited Medicare dollars drives therapists to accomplish goals that are necessary for the client to function at home. Developing a repertoire of tricks and a knack for prioritizing issues that need to be tackled are skills that are learned… leading to mastery earned.
Home health therapy is very much a specialized field- one that requires out-of-the-box thinkers with big hearts and broad perspectives. Previous experience in nearly any field, from pediatrics to orthopedics to burns to cardiac care, will all come in handy at some point. Home health introduces you to such diversity of conditions and expectations that it could easily be labeled as the rehabilitation world’s box of chocolates- ya never know what you’re gonna get.