Insights for Home Health Physical Therapists

How I Started My Home Health Career & Why I Stayed

Hi, I’m Kayla, a passionate physical therapist with over a decade of home health experience. I began as a new grad, despite discouragement from professors, as the market was oversaturated and opportunities lacked full-time status. It was a bumpy road but my challenges will not be in vain! I’m here to share what I wish I had known and strategies I’ve procured along the way. Read My Full Story Here

Let’s get started!

How did I find home health? Well, I suppose it found me! I didn’t have many prospects after I graduated. I went to school outside of my hometown and hadn’t made connections there. That was an oversight on my part, but there was nothing more I could do to change it. So I submitted my resume to anything that looked interesting. However, I came to a frustrating realization that most places would only hire me for their as-needed or part-time roles before I could even be considered for a full-time gig. In some cases, I would have to wait until a full-time position became available and who knows how long that could be?! The only full-time option open to new grads and equipped with the benefits I needed laid in a senior living community. So I applied. I heard nothing and after 2 weeks I reluctantly followed-up. To my surprise they weren’t aware that they had posting! Was that a red flag? Maybe, but I chose to look past it because I needed a job… any job! And thankfully, they hired me. The rest is history.

Throughout my career, I have sought opportunities to leave the home health setting but I’m never able to fully commit. I always come back. It’s the clientele, environment, autonomy, and compensation that suits me perfectly. I choose home health PT time and time again.

Home health is a unique combination of adventure and familiarity. It requires confidence with a multi body systems approach to holistic care. It’s like bringing a clinic to someone’s home and then some.  In my experience, the clientele are more motivated to get better because they crave their independence. They want to get well and stay well. With one on one care, I am able to connect more deeply with clients and spend time in their environment. This allows me to truly assess their needs and put recommendations into place immediately. Documentation follows suit, which I often complete at point of service. As for the commutes between visits, they are a welcomed respite to decompress from the former client and prepare for the next. Scheduling is flexible and travel to new parts of town is a nice change for every now and then.  Home health essentially shares the adventurous spirit and higher pay to that of a travel PT but allows the comfort of staying in your hometown and sleeping in your own bed.

Outpatient wasn’t the right fit for me. My experiences felt monotonous. I was tethered to a laptop and felt stuck inside a florescent lit box. Connecting with patients and getting them to buy-in to their care was a challenge. Most sought a quick fix and didn’t invest much time and effort into their personal recovery. Interventions were repetitive, sometimes boring, and patients didn’t appreciate any attempts to spice it up. Furthermore, as insurance reimbursement changed, clinic operations changed. Because of this, I began to feel a lack of autonomy and meaning to the work I was doing. And despite value in outpatient learning culture and camaraderie, I needed something different.

Acute care wasn’t the right for me. My experiences in rural coastal communities lacked connection and resources. Many patients were discharged home or transferred to a higher level of care shortly after they were evaluated. Thus, interventions lacked depth and team collaboration was brief. I am aware that larger facilities, in metropolitan areas for instance, may have specialized teams to treat clients more effectively and keep them for longer periods of time. Which would keep things much more interesting! But I just never felt called to further explore those options.

Inpatient rehab wasn’t the right fit for me. Acute rehab and skilled nursing required nearly 100% hands-on treatment time and was very physical. With a chronic shoulder issue, I was concerned I may experience an injury in this setting. I was also concerned the physical exertion and fatigue would negatively impact my work-life harmony. So I never pursued it further. But when it comes to friends and former colleagues that have stayed in the skilled care setting, it is a unanimous thumbs-up! From spending a lot of time with clients to developing meaningful connections, it makes the work feel fulfilling.

All in all each setting has its own unique highlights and challenges, and this is a good thing! Variety allows clinicians to find their own path that empowers their own individual interests and strengths. For me, that path is home health. I thrive in its flexibility, changing scenery, and complexities that require a multifaceted approach to wellness. Although some clientele are difficult to navigate, many are motivated by their immediate needs and typically have stable health to participate without acute concerns compared to the hospital or skilled settings.

Challenges I encountered in home health involved ensuring safety and discerning clinical boundaries. This is important across all settings, however home health’s hands-on approach and occasional need to heavy lift can be risky when there is no immediate access for help. Thus, the main focus is to determine what clients and caregivers need to stay safe while promoting independence – all the while, ensuring our own safety while determining solutions. For instance, a client who is unable to walk safely may be a good candidate for a wheelchair. A client who is unable to sit at the edge of a bed or bear weight to transfer may need a Hoyer lift. Some recommendations are temporary and equipment can be returned after progress is made with home therapy. However, some clients will need to make permanent arrangements if adequate progress is not achieved or anticipated. This can be a difficult conversation with clients and family members as realistic goals may not coincide with their personal goals. It is important as home health clinicians to always advocate for clients, but to also discern a realistic prognosis and plan that aligns with insurance coverage (for better or for worse). After all, the ultimate goal of home health is to promote self-sufficiency with or without long-term assistance. It is our job as PT’s to ensure clients are aware of our scope and limitations to maintain a realistic focus, utilize services appropriately, and keep everyone safe.

All things considered, it is important to understand your employer’s expectations, compensation package, and to brush-up on time management strategies when deciding which setting is the right fit for you. For example, certain home health visits require more involved documentation, but in my experience the point system or per visit rate factors that into payable time. Meaning, I do not work beyond my full-time contract of 40 hour per week. This makes for a desirable work-life harmony. However, some employers do not buffer adequate documentation time into a shift but expect notes to be done by the end of the day. This was my experience in outpatient. I spent most of lunch and an hour after work completing notes. Some colleagues even took their computers home and documented into the evening. To me, this matters! For example, if you are paid $2000 for a 40 hour week, but consistently work 2 additional hours every day without compensation, you have lost 10 hours of personal time and $500 of compensation per week. So make your time work for you and don’t just give it away for free.

Stay tuned for more!

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