When I think about the philosophy of occupational therapy and the important role we play in providing holistic, client-centered care, home health comes to mind. Home health offers a unique and intimate opportunity to work in the client’s natural environment without having to re-create the client’s context. As such, occupational therapy practitioners in home health are able to gather rich and comprehensive information about the client’s spontaneous and habitual performance within the context of daily living, as well as identify supports and barriers that affect the client’s engagement in occupations. In that sense, home health is really the perfect context for occupational therapy.
According to Medicare, home health care is “a wide range of health care services that can be given in the home for an illness or injury” to help the client get better, regain independence, and become as self-sufficient as possible. To receive home health services under Medicare, the client must meet all the Medicare Eligibility Requirements, one of which includes being confined to the home.
“Occupational therapy practitioners find the right fit between clients’ abilities, needed and desired activities, and their home environment so clients can manage safely and productively—at home” – The American Occupational Therapy Association (AOTA)
OT practitioners provide skilled services to evaluate and address the needs of their clients in relation to their desired occupations so that clients can live safely and productively in their home environment. These areas of need include, but are not limited to, home safety, medication management,wheelchair seating and positioning, pain management, falls prevention, management of chronic diseases, dementia family caregiver training as well as palliative and end of life care. When working in the home health setting, an occupational therapy practitioner is more than just a clinician – the therapist also serves as an educator, client advocate and a member of a clinical team.
Unlike the hospital setting, a home health therapist is often working alone in the client’s home without a medical team. For that reason, it is critical to carefully monitor the client throughout the session. In addition to taking the vital signs (blood pressure, temperature, respiration, oxygen levels and heart rate), the therapist must also watch for signs that a condition is deteriorating or improving, documenting and reporting anything that may affect the client’s safety and health. Of the many areas assessed during a home visit, here are just a few observations that the therapist may make during a skilled observation:
CONDUCTING SKILLED OBSERVATIONS
- Cognition – How does the client describe his or her condition and the reason for the home care referral? Is the client able to describe what has happened in the past few days? Here are a few quick and free assessments for cognition: SLUMS, Mini Mental State Examination (MMSE), the Kettle Test, The Clock Drawing Test.
- Falls Management – Is poor lighting, loose rugs or clutter contributing to falls? Does narrow pathways impede passage? Does the client avoid valued activities due to fear of falls? You can assess fall risk using the Falls Efficacy Scale.
- Medication Management – Where is medication stored and is medication management and routine established?
- Vision – Is the client able to read the medication bottle accurately?
- Mobility – Does the client use a cane, walker or wheelchair and if so, is it being used properly and safely? Is there evidence of pain, dyspnea, fatigue or balance issues? What modifications and/or adaptive equipment are necessary to optimize safety?
- Sleep – Does the client sleep well at night? If not, what is causing disturbance? Incontinence? Pain?
- Meal Planning – How does the client get meals? Are there any dietary restrictions and if so, is the client following the restrictive diet? Would it help to partner with a dietician or recommend Meals on Wheels to improve daily meal time routines?
- In the Case of Emergency – How would the client call for assistance if necessary or exit the home in an emergency?
Be sure to choose an assessment that is appropriate for your client and gives you the most information for your client’s goals. For a list of common assessments, be sure to review the Common Assessments section below.
The focus of occupational therapy intervention is to support the client’s participation in self care and meaningful engagement in life roles at home. As such, the role of the occupational therapy practitioner can include a wide range of services including work simplification, joint protection, stress management, low vision adaptations, caring for children or pets, providing suggestions for leisure activities or even determining a grocery list for the week. When evaluated and treated in the context of the home, these tasks clearly identify both the barriers and supports that the client meets daily, which allows the therapist to provide individualized, client-centered care.
Taking meal prep as an example, the home setting is the ideal place to address this goal since every kitchen is set up differently. To maximize independence and kitchen mobility, therapists can make environmental modifications such as moving furniture or rearranging kitchen items to make things safer and more accessible. If necessary, assistive devices may also be recommended to improve independence and safety.
Additionally, occupational therapy practitioners may assess for needs such as adding handrails and grab bars in the bathroom or identifying hazards that might contribute to a fall. Other environmental safety issues may be related to fire and health hazards that can result from hoarding, clutter, or pest infestation. With skilled observation, environmental modification and client education, occupational therapy can help to promote greater confidence and minimize self-limiting behaviors that could lead to decreased occupational engagement. Here are other areas that are commonly addressed by occupational therapy practitioners in home health:
- Daily Management of Chronic Conditions – Taking diabetes as an example, occupational therapy practitioners can help with incorporating healthy daily routines such exercising, meal planning, monitoring blood sugar, practicing good hygiene and foot care. Additionally, occupational therapy practitioners can educate and train clients to use compensatory strategies for vision or sensory loss that may result from diabetes (Sokol-McKay, 2011).
- Medication Management – Providing strategies for improved medication adherence and integrating medication management into the client’s daily routines. For example, the therapist can help identify and remove barriers by addressing challenges that arise from low vision or decreased fine motor skills or coordination needed to manipulate pills and containers. In addition, therapists can educate and train clients on compensatory strategies and adaptive devices to provide reminders.
- Energy conservation techniques – Reducing demands of activities and helping clients incorporate pacing, planning and stress management to avoid exacerbations. This is especially critical for clients with Heart Failure and Chronic Obstructive Pulmonary Disease (Branick, 2003).
- Social Participation – Helping clients engage in social pursuits in the community.
- Leisure – Guiding the exploration of and engagement in activities that are intrinsically motivating and meaningful to the client.
When working in the home health setting, a restorative or remediation-oriented approaches may not be as beneficial as interventions that modify the environment or the activity demands. When selecting goals or interventions to restore body functions, ask yourself, “how much time and effort will the client have to invest in a home program to achieve the desired outcome? And will this improvement in body function make a meaningful difference in the client’s performance and engagement in valued activities?”
CLIENT AND CAREGIVER EDUCATION
Home health therapists play a critical role in educating the client as well as family members who lend support at home. By providing caregiver approaches and strategies, occupational therapy can help to reduce caregiver burden as well as improve the safety and well-being for both caregivers and the clients. With education and practice, caregivers can feel confident and competent in their skills to navigate and handle future care challenges.
According to the Medicare and Medicaid Statistical Supplement, the top 6 most common diagnoses of medicare home health beneficiaries include:
- Heart Failure
- Essential Hypertension
- Chronic Ulcer of the Skin
- Cardiac Dysrhythmias
Beyond the diagnoses listed above, there are many types of conditions common in the population receiving home health care services and these clients often have multiple conditions and co-morbidities that don’t fit neatly into specific diagnostic categories. As a result, diagnosis alone does not provide adequate information about the health conditions of home health clients. For that reason, it is up to the therapist to carefully assess the client’s unique home situation that influences the health of the client, including the cultural, social and physical contexts.
Here are some commonly used assessments in the home health setting.
- The Berg Balance Scale
- Canadian Occupational Performance Measure (COPM)
- Disabilities of the Arm, Shoulder and Hand (DASH)
- Functional Home Assessment Profile (FHAP)
- Functional Reach Test
- Modified Barthel Index: Self Care Assessment
- Modified Falls Efficacy Scale
- Occupational Profile – AOTA’s Occupational Profile Template
- SLUMS Examination – Quickly assess for mild cognitive impairment
- The Borg Scales of Perceived Exertion
For more assessments, visit the Rehab Measures Database, which provides a list of assessments you can use based on the client’s condition.
One of the greatest benefits of working in home health is flexibility. In home health, you can set your own schedule, determining when you start and end the day. If you prefer to start working at 10am, go ahead! If you prefer to have lunch at 2pm after running a few personal errands, no problem. If you have kids and prefer to keep a low caseload, by all means. You really are the boss of your own schedule when you’re working in home health. On some days, however, you will come across unforeseen circumstances or last minute cancellations that throw off your entire day, affecting your productivity and hours spent in the field. Take a deep breath and remember that providing care in the client’s home requires flexibility on your end as well.
Note: The level of flexibility and productivity expectations vary greatly depending on the agency and your employment status. For example, if you are a salaried, full time employee, you will most likely have a full caseload with set productivity standards, so you won’t enjoy the kind of flexibility that comes with a per diem or PRN position. Always do your research and seek an agency/position that best meets your needs.
According to the Bureau of Labor and Statistics (BLS) Data, the 2018 annual mean wage for a home health occupational therapist is around $89,840 for a home health occupational therapist and $67,800 for a home health occupational therapy assistants. This is one of the highest paying practice settings in occupational therapy so if you’re looking to quickly pay back your loans or to save up for that special occasion, home health may be a great way for you to reach your financial goals. Because of the flexibility in scheduling, many home health therapists also choose to pick up additional hours during the weekends for greater income. While many home health practitioners enjoy high pay, there are other costs associated with practicing in home health care. For one, there is a high wear and tear on your car. Get ready to go through tires, brakes, oil changes, gas and mileage like you have never done before. In addition, if you are a 1099 independent contractor, you may have to pay upfront for your own therapy supplies, equipment, health insurance and professional liability insurance as well as other costs associated with car repair, gas and maintenance.
Because tax laws are subject to change and new bills can be proposed, it is always best to consult a tax accountant or professional early on to determine what records you need to keep, as well as what items you can write off at the end of the year. Be sure to keep all your receipts and consider designating just one credit card for all your expenses for easy tracking.
Instead of using mock environments and simulated activities to mimic the client’s home, you will have the opportunity to work within the real barriers and strengths of the client’s environment to address the many roles and occupations that are most important and meaningful to the client. Working in your client’s environment also means you’re working in an unknown environment, which may not always be clean, safe or conducive to implementing treatment. Some issues you may come across include hoarding, mold, bed bugs or other infestation. For this reason, you must understand and take all safety precautions and infection control measures. Equally important, you must know your company or agency’s protocol for when you encounter situations that put you or your clients at risk. Taking bed bugs as an example, some agencies will have a policy to have the exterminator come out before any services can be rendered, while other agencies may expect you to provide services using specific protocols and safety measures, such as providing equipment for you to take and leave at the client’s home so you don’t risk bringing any bed bugs back with you. Whatever the protocol may be, be sure to understand your rights and know what you can do to protect yourself.
If you enjoy autonomy and are comfortable working on your own, home health may be the perfect setting for you. But that doesn’t meant that you won’t have to collaborate with other members of your client’s healthcare team. Despite limited opportunities for a face-to-face multidisciplinary team meeting, you will still have the full responsibility of ensuring timely and effective communication. Remember, the perk of working autonomously comes with the responsibility to be organized, communicative and proactive. Be prepared for a lot of phone calls, faxes, emails, and paperwork. Also, if you desire supervision or camaraderie with co-workers, you may find home health challenging, isolating and lonely. Many home health providers only stay in touch via phone or pagers and you may go days or weeks without seeing your supervisor or other members of the team. That also means that you will have limited opportunities for networking or collaborating with other team members.
When it comes to documentation, I’m going to skip the “pro” and go right to the challenge because documentation is a beast in home health. Combine that with the amount of scheduling and paperwork, you may end up spending hours doing paperwork at home. But fear not. Obtaining work/life balance is possible with the right preparation and mindset. Read on in the following sections to find out how you can stay productive, efficient and effective without compromising your integrity or quality of life.
- OT in Home Health Part 1
- Addressing Incontinence in Home Health: An Occupational Therapist’s Perspective
- Home Modifications-Bathroom Solutions Part 1
OT Miri uses MedBridge and offers a discounted rate for our readers at $225/year using the Promo Code “OTmiri.” This is the best discount available to individual subscribers. If you are a student, you can take advantage of this wonderful resource for $100/year by using the Promo Code “OTmiriStudent” and your .EDU school email. Find out more at MedBridge for Students.
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1. OCCUPATIONAL THERAPY TOOLKIT
With 283 pages of fully illustrated patient education handouts organized by 85 treatment guides, the Occupational Therapy Toolkit is one of the most popular and frequently utilized resource for OT practitioners working with physical disabilities and older adults. I recommend this book wholeheartedly and unreservedly!
2. QUICK REFERENCE TO OCCUPATIONAL THERAPY
The Quick Reference to Occupational Therapy will quickly become one of your favorite go-to resource for everything occupational therapy. Take this book with you and keep it handy for anytime you need that quick, At-A-Glance fact sheet on a disease, injury or disorder. Worth. Every. Penny.
ONLINE SUPPORT GROUPS:
- Home Health Occupational Therapy Facebook Group
- Home Health SLP OT and PT Facebook Group
- New OT Practitioner Support Group on Facebook
I’m a member in all three of these Facebook groups and have enjoyed reading people’s posts ranging from clinical and practical questions to creative treatment ideas and Do-it-Yourself adaptive tools. When utilizing online forums to post a question, be clear, specific and thorough. This will increase your chances of getting meaningful responses from fellow colleagues. For example, describe the clinical scenario, the context, age of the patient, acuity of the condition, patient goals, your current thoughts/ideas for treatment, etc. Doing so will help facilitate a conversation and collaboration.
1. Stay Informed
Home health occupational therapy services take place in the context of heavy regulations and a daunting set of rules. It is your responsibility to learn and know the rules, policies and regulations that govern home health services. Be sure to bookmark the Medicare, Centers for Medicaid and Medicare Services (CMS) and AOTA websites on your computer so you can stay abreast of all the changes that affect you, your role and the clients you serve.
2. Be HIPPA-Compliant
Adhere to the HIPPA privacy rules and safeguard your client’s privacy. For example, don’t leave your notes out and in the open while you’re getting gas or grabbing food. Don’t post information or photos of your client on social media or any internet site. Make time to call your client instead of communicating via text, as you can’t be certain who is receiving your texts. In everything you do, always consider what you must do (or not do) in order to protect your client’s privacy and confidentiality.
3. Infection Control
Learn to incorporate proper bag technique. It’s worth spending some time to understand proper bag technique to protect yourself and your clients from the spread of infection.
If you’re worried about offending your clients, you can always explain your rationale during setup:
“I want you to know that you and your family’s health and safety is top priority for me. As you can see from what I’m doing here, I take the highest precautions and safety measures during every home visit to make sure that we are keeping you, as well as all my other clients safe and protected. I appreciate your patience while I get set up here.”
ADDITIONAL SAFETY TIPS
- Don’t just sit on any surface, especially on any fabric furniture. If your client offers you to sit, either use your step stool or decline politely: “I’ve been sitting in the car all day and prefer to stand, but thank you.“
- Never place your bag on the floor without a barrier. You can use a step stool, paper towels, newspapers, plastic or other disposable barrier between your bag and a hard surface.
- Keep an extra change of clothes, shoes and hand sanitizer in your car.
4. Know How Your Productivity is Measured
With increasing demand and expectations to improve productivity, more and more home health therapists are experiencing burnout, ethical dilemmas and decreased job satisfaction. It is not uncommon for home care therapists to work off-the-clock for hours on end to meet unrealistic productivity standards and this is a common cause of therapy burnout.
In this environment, it is important that you know your rights as well as your responsibilities. First, understand how your productivity is measured. Are you given the necessary time by your employer or agency to complete paperwork and documentation between all the driving and patient visits? How about the time spent calling other team members and scheduling with your clients? If you sat down and really thought about everything you do between visits, you’ll realize how much work you’re doing that cannot be counted as “skilled” or “billable.” Now considering all this, ask yourself, “are these productivity standards fair or reasonable?”
ADVOCATE FOR A BALANCED CASELOAD
If you feel that you are not given a reasonable or accurate productivity standard, set up a meeting with your supervisor to find out how your productivity is being measured and seek his/her advice on what can be done or changed so that you can continue to perform ethically and efficiently without sacrificing quality care. Analyze your caseload and see how much time you’re spending on driving, documentation, evals, etc. If you’re having to do an overwhelming number of evals week after week, which can be time intensive, advocate for a more balanced and diverse caseload. Also, if you find that the majority of your cases require 100% supervision, request a more diverse caseload that is not so heavy with low-level clients so that you can incorporate Point-of-Service Documentation during some of your sessions. Otherwise, you may end up spending hours at home catching up on documentation. Bottom line: Don’t be afraid to speak up and advocate for yourself through an open and respectful dialogue.
5. Stay Organized
HAVE A SYSTEM IN PLACE
Keep your schedule and weekly planner easily accessible and editable. This may be your Google Calendar synced through your phone or a weekly planner you take with you in hard copy.
KEEP A LIST OF IMPORTANT CONTACTS
Be sure to keep a list of important contacts, including your client’s immediate healthcare team as well as numbers you can call in case of emergency. Consider keeping these contacts saved in your phone as well as having a hard copy in your folder as a backup.
TRACK YOUR MILEAGE
This is especially important if you are a 1099 employee. There are a few mileage tracking apps that make this process easy. MileIQ is one of the most popular and frequently used apps among home health therapists. In addition to your mileage, I would encourage you to find out which of the expenses are tax deductible.
Note: Since tax laws and rules are subject to change, it may be a worthwhile investment to hire a tax accountant to find out early what records you need to keep to get maximum deductions.
TRACK YOUR TIME
Learn to set boundaries with your client and their family. While family and caregiver education is an important component of home health, you must be able to draw clear boundaries on these family conversations to ensure you manage your time and productivity. You might even consider using a stopwatch to make sure you don’t go over the allotted time. Most clients will understand that you have a schedule you need to keep, so be sure to communicate your schedule clearly and politely inform them that you have “X” amount of time to do the session.
EXPECT THE UNEXPECTED
Keep an emergency kit in your car: Phone charger, jumper cables, tire-changing tools, portable air compressor, GPS, snacks, water and anything else you think you may need.
6. Get Familiar with OASIS
While some agencies may provide formal OASIS training, many clinicians get little support in developing good data collecting skills. Don’t be afraid to seek guidance and speak with your supervisor or team members if you need support. You can also utilize online resources from CMS and the OASIS Guidance Manual.
7. Master Documentation (Or at least try to)
Create a realistic plan and strategy for how you will complete documentation. Not just in your head, but an actual, structured system that you can follow. Without it, you will quickly become overwhelmed and end up spending hours at home completing paperwork off-the-clock. When creating your plan for documentation, you should consider your own work style and consider what location and time would be most conducive for you to efficiently complete your documentation on time. Your plan should also include a goal for how long you will be spending on documentation, depending on whether it’s an evaluation or treatment notes. Below are some examples from therapists who work in Home Health:
“I have a rule to never leave the driveway without completing at least 50% of my notes.” -Cindy K.
“My goal is to at least start my notes during the session and finish it in my car before I see my next patient. If I save my notes for later after seeing 5-6 patients, I’ll just forget everything.” -Sarah B.
“I typically spend the first and last 5 minutes of each session to do my notes. This definitely takes practice, but in time, it gets much easier and you’ll save yourself from going crazy at night trying to finish your paperwork.” -Kimberly R.
As you can see, some therapists choose to incorporate Point-of-Service (POS) Documentation, which means that you’re documenting at the same time you’re treating the client. It may not be appropriate for every client, but if done properly, POS documentation can help to improve the quality of your documentation, while also alleviating your burden to work off-the-clock to meet productivity standards. Be sure to check out my Point-of-Service (POS) Documentation article to learn how you can safely and ethically incorporate POS into your session.
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1. Patient Education Handouts
Keep an Accordion-style file folder that contains at least 10-15 copies of patient handouts and Home Exercise Program (HEP) for common diagnoses. The OT Toolkit is a must-have resource for home health therapists and it will quickly become your best friend. With over 350 patient handouts and 77 treatment guides, the OT Toolkit is one of the most commonly used and highly recommended books for home health therapists. I use it daily and recommend it unreservedly!
2. A Bag
If you’re just starting out in Home Health, you may be tempted to get a bag that holds everything you need for every client you’ll treat. However, it’s important to have a functional bag that is easy to maneuver and access. Although I have not personally used the Hopkins Medical Bags, I have heard great reviews from friends and colleagues. You can also find great bags on Amazon, Walmart or Target. When choosing a bag, here are 3 important factors you should consider:
- Infection Control: Can the bag be wiped down and sanitized? Does the bag contain at least 3 separate compartments? You should have at least two “clean” compartments, one for clean disposables and the other compartment to secure patient records.
- Durability and Functionality: Look for a bag with a strong durable surface that can be sanitized with an interior that contains different sections and pockets for organization.
- Portability and Ease: Your bag should not be too cumbersome or difficult to handle. Consider keeping most items neatly organized in the trunk of your car, taking only the essential supplies and equipment you need in the bag for each session.
You may consider using a bag with wheels to lighten the load and make it easier to maneuver. If you do choose to purchase a bag with wheels, be sure to check the policies and adhere to the “bag technique” when entering the client’s home. As you just learned in the previous “7 Essential Must-Knows,” you must not set your bag on the floor without first putting a barrier on the surface.
3. Therapy Supplies
Some of these supplies may be provided by your company. Always check to see what is provided before you make a purchase.
For Vitals: Blood Pressure Cuff, Pulse Oximeter, Thermometer. With the blood pressure monitor, some companies require manual blood pressure cuff, so if you prefer to go digital, be sure to first check with your agency.
For Activities: Hip Kit, Vinyl Gait Belt, Tape Measure, Built-Up Utensils, Dicem, Colorful Duct Tape (useful for low vision clients)
For Infection Control: PDI Sani Wipes, Gloves, Waterless Hand Cleaner and/or Hand Sanitizer, Disposable Trash Bag, Disposable Bag Barrier (some choose to use a wax paper, newspaper or step stool as bag barrier)
For Notes: Post-its, Pens, Highlighters & Notepad
When choosing your equipment, be sure to select those items that can be easily sanitized. For example, instead of using a cotton gait belt, consider a vinyl gait belt that can easily be wiped down. Anything that you take into a client’s home that you do not intend to leave there, should be disinfected before you put it into your car.
4. Step Stool
Your Step Stool will come in handy in a number of ways, and this one with polka dots is a commonly used step stool among home health therapist. My colleague actually carried two stools with her- one for her to place her bag and one for sitting.
5. DME Catalogues
Since you won’t be able to keep a sample of every piece of adaptive equipment or Durable Medical Equipment (DME), it will be helpful to have catalogues handy to show clients photos of what you are recommending. You can also create and carry around your own list of local vendors, community and religious organizations such as Goodwill, St. Vincent de Paul, or even local senior centers where families might donate equipment that they no longer need. But more often than not, online stores like Amazon and Walmart will provide the most affordable options with greatest convenience since it may be impractical for the client to go shopping at local vendors.
6. Professional Liability Insurance
Everything from a patient having a stroke and passing out to falling, every incident under your watch can quickly turn into a liability. To keep yourself protected and minimize your risks involving professional liability exposures, it’s important to maintain your own professional liability insurance. Regardless of what your company covers, add extra and get your own. Below are two commonly recommended companies:
- HPSO – It’s easy to apply with reasonable pricing
- Mercer – Be sure to check out AOTA Member Discount for members
You Are the Best Person to Decide
If you’re a new grad just entering the profession, you may be wondering if you can survive, let alone thrive, as a home health therapist. After all, new grads are often advised and warned against working in home health until they’ve had some prior clinical experience. However, every practice setting will come with its own set of unique challenges and home health is no different. Based on my own personal experience as well as others who have come to really enjoy the home health setting, your satisfaction and “fit” for the setting will largely depend on your own personal needs, expectations, priorities and personality.
For example, if you’re seeking mentorship, camaraderie and a predictable routine to your daily work schedule, you may have a hard time adjusting to the many hours you’ll be spending driving alone, documenting from home or making countless calls to schedule (and reschedule) with your clients on your caseload. However, if you are an independent self starter who enjoys researching and problem-solving on your own, you will find home health to be not only liberating, but conducive to further honing your sense of autonomy, creativity and initiative. So before you follow the general prescription and rule out home health, be sure to take some time reflecting on your own needs, priorities and strengths to determine if home health is right for you.
“As a new grad my first job was in home health. It is discouraging to hear fellow professionals say we don’t belong there. However, the strength of new grads is that we are open to and actively learning and seeking information and resources. This open minded model of practice that is collaborative and team based is good for patients and you will find a balance of building confidence in your clinical judgment and being open to continual learning opportunities. You can do it.” – Molly Nicolaus, OTD, OTR/L
TO HELP YOU SUCCEED AS A NEW GRAD:
FIND A MENTOR
A mentor is one of the most valuable resources you can tap into regardless of the stage of your growth or career. Mentors can provide you the support, guidance and perspectives you need to navigate your environment while helping you find new contacts and resources to grow and expand your network and support system. Don’t be shy when it comes to seeking mentorship. When you demonstrate a sincere desire to grow and give back to our profession, you will be met with the people and opportunities that support you to thrive.
SET STANDING MEETINGS
Speak with your supervisor to see if you can set up a regular, standing meeting, whether it’s by phone, Skype or in person. Having a regular meeting consistently to go over various cases and questions is a great way to alleviate any concerns you may have, while feeling supported in the work you’re doing.
Do Your Research
Be sure to do your research and find out as much as you can about the agency and its compensation and productivity expectations before accepting employment. Pay structure and productivity expectations can vary significantly depending on the Home Health Agency and these are major factors that influence a home health therapists’ job satisfaction and quality of life. Find out everything you can about your employer’s expectations for the number of visits per day (or week), distance between visits and mileage reimbursement (if any), documentation, and after hours paperwork and other administrative tasks related to coordinating and scheduling with clients. Finally, be sure to research and know your market value based on your location and level of experience. Without this knowledge, you will not be able to advocate or negotiate for a fair or reasonable pay/salary. To compare salary data by experience, location and titles, be sure to check out OTsalary.com, created by an amazing occupational therapist, Kate Boyd.
Questions to Ask During the Interview
- What does your onboarding process consist of? Do you offer training or mentorship?
- What is the size of the territory covered and how many miles do therapists average between visits?
- What is the average caseload? What happens if there isn’t enough work/clients?
- What is a typical frequency and duration of treatment for OT?
- How is productivity measured? Is it per visit or is it weighted by points? Is it measured on a daily or weekly basis?
- What kind of documentation system do you use?
- Do you encourage your staff to start/complete documentation during the session or after?
- How are evals distributed? Are they distributed by territory? (This is an important question because some agencies may give preference to other therapists for picking evals, leaving you with leftovers and an unbalanced caseload)
- How soon after intake does the eval have to be completed?
- What is the agency protocol on bed bugs or other safety issues or hazards?
- How do the different disciplines communicate about patients?
- For OTRs: Will I be supervising COTA?
- For COTAs: How will supervision with the OTR work?
- Does the company offer CEU reimbursement?
- Does the company provide therapy supplies such as BP cuff, pulse oximeter, DME, gait belt, etc? How about a phone and/or tablet?
- What are some of the reimbursable costs? Gas, mileage, phone, etc.
Read the Contract
Carefully read the contract and review your state’s employment laws. In particular, beware of signing any agreement that prohibits you from working for a competitor, such as a Non-Compete Clause. The non-compete clause outlines employee’s conditions and restrictions, both during and for a period after the employee has left the company. Although a non-compete clause is not enforceable in every state, don’t risk the chance of making yourself unemployable in the future by signing an agreement with unreasonable or unfair restrictions.
Understand How Your Employment Status Affects Your Pay & Benefits
If you are a 1099 independent contractor, your taxes will not be automatically deducted from your paycheck. That means, you have to set aside your taxes and figure out approximately how much you will owe at the end of each quarter. Be sure to speak with a tax accountant ahead of time to figure out how much of your paycheck you will need to save for taxes.
In addition, 1099 contractors will have to pay upfront for your therapy supplies, equipment, gas, professional liability insurance and other costs associated with providing home health care. So be sure to check whether you’d be an employee or an independent contractor. Here are the different ways of getting hired to work in home health:
- Regular Full-Time or Part-Time Employee of a Home Health Agency (HHA): Practitioners are paid either a salary or an hourly rate.
- Per Diem Employee of HHA (PRN): Practitioners are paid on the basis of services provided only when those services are needed.
- Contracting through a Staffing Company: Practitioner is an employee of the staffing company, who provides IRS Form W-2. In other words, the practitioner provides services on behalf of HHA, but has no direct relationship with the HHA.
- Independent Contractor: Practitioners subcontract with HHAs and is neither employed by the staffing company nor the agency. IRS Form 1099.
YOUR COMPLETE GUIDE TO THE PERFECT OT JOB
Begin your job search and application with OT Job Resources, which includes OT Job Search, Sample Cover Letter, Sample Resume, Interview Techniques, Frequently Asked Questions and Salary Information. These pages were designed specifically with new OT grads in mind to ensure you are well equipped and best positioned to stand out and get hired.
- Aota.org. (2013). Occupational Therapy’s Role in Home Health. [online] Available at: https://www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Home-Health.aspx [Accessed 19 Dec. 2018].
- Bondoc, S., & Siebert, C. (2010). The role of occupational therapy in chronic disease management.
- Sanders, M. J., & Van Oss, T. (2013). Using daily routines to promote medication adherence in older adults. American Journal of Occupational Therapy, 67, 91–99.
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