In today’s blog, we have Spencer, a 3rd year OTD student, sharing her experience in home health! Spencer gives well thought out answers to all of my questions on the ins and outs of home health. If you have any questions, feel free to reach out to her through Instagram, linked at the bottom of the interview!
Hi everyone! My name is Spencer, and I am a third year OTD student in Fort Wayne, IN. I am originally from Portland, OR . I just finished up both of my Level II Fieldwork rotations and will be starting my Doctoral Capstone in January. I will be graduating from my program in May 2022!
I absolutely love working with children and young adults, and the schools have always held a special place in my heart. I am hoping to work with young adults with disabilities in either the school setting (middle/high school) or in a post-secondary transition program after graduation. My Doctoral Capstone will directly relate to these areas as I am working with Project SEARCH, a post-secondary transition to work program, to incorporate OT within a program site.
What setting are you sharing about today and can you give a brief description of it? What qualifies a person to receive therapy in this setting?
I will be sharing about my experience in a home health setting. Home health services are provided in the patient’s home (single family, Assisted Living Facility, etc.) and may include nursing care, physical therapy, occupational therapy, and speech language pathology. Clients are often from the older adult population (65+), but I did have a handful of younger patients in their 40-50s, and one even in his 20s due to the severity of his injury.
Clients are referred from the physician based on their functional abilities upon discharge from the hospital. Often, clients referred to home health do not qualify for skilled nursing/inpatient rehab or have decided they would rather receive in-home support. The main qualification to receive home health services is that the client has to be homebound, which basically means they are unable to leave their home due to their disability/illness/surgical recovery. The exception to this would be for doctor’s appointments and purchasing groceries/other necessities. At any time during the client’s episode of care, the client’s homebound status may change and would no longer qualify them for services if they are not homebound.
What is OT’s role in this setting?
There are two major roles we play in home health. The first is making sure the client is able to be independent with all of their meaningful occupations by providing them with a client-centered and occupation-based treatment plan. This may look different for each client as the heart of home health is client-centered practice. For one client it may look like returning to prior levels of function and for another it may involve adaptive equipment and modified techniques to accomplish ADLs.
The second role is making sure the home environment is safe for the client to maneuver. One of the most common conditions I would see clients for would be an increased fall risk, and while that may be due to decreased balance and muscle weakness, their environment can also play a big role in preventing falls. As part the evaluation process I would perform a safety check of the common areas of the home such as bathroom, bedroom, and living room to identify anything that may be a tripping/fall hazard as well as any adaptive equipment that may make an area safer for the client.
Additionally, due to the COVID-19 pandemic, OTs were given emergency clearance to perform admissions to home health services, called an OASIS. This involves an intensive look at the client’s medical history, medications, insurance, prior level of function and anticipated level of function after treatment. I participated in 3 OASIS admits during my rotation, each taking about 3-4 hours including documentation time. As of January 1, 2022, OTs have permanent clearance to perform OASIS admissions.
Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?
Going into this setting, I was a little bit nervous. I had just completed my Older Adults course the previous semester, so I felt like that was fresh in my mind. However, that course focused on an acute care/inpatient perspective, and home health was very briefly covered. Additionally, this setting was one I felt unprepared to work with as I did not have much experience working with older adults. To prepare myself before starting, I researched some common older adult conditions to better familiarize myself with the population. Furthermore, I contacted my CI and asked if there were any materials he recommended I look over before beginning and he provided me with some common assessment he used.
What resources were the most helpful during your time there?
I utilized some various fact sheets on AOTA about older adults and fall prevention. I also listened to the Seniors Flourish podcast with my CI often in the car as we had a lot of drive time. Additionally, materials and notes that I had from my Older Adults course from the previous semester, especially the assessments.
How did you stay organized and manage your time?
Since this setting involved going in and out of patient’s homes, I actually did not bring a lot of personal items, especially in the time of COVID-19. However, my CI provided me with a planner in his car to keep track of our appointments for the day as well as any other things we needed to remember or pick up at the office. Luckily, I would often have the chance to document the session right after in the car, which is unheard of in other settings. This allowed me to keep my documentation organized and as accurate as possible.
What was your schedule like?
For the most part my schedule was 8 am to 5pm Monday through Friday. However, in this type of setting there is a lot of driving involved not only from client to client, but from my housing to the geographical area we covered as well.
8am– meet my CI at his house and debrief on the schedule for the day; drive to the first client’s appointment often starting at 9am.
9am-3:30pm– treatment sessions and evaluations; a typical day would consist of seeing 5-6 clients. Additional down time would be used to stop at the office to grab supplies, and document. Often we would eat lunch at some point in this time frame as appointments allowed.
4pm-drive back to my CIs house; begin completing unfinished documentation from the day.
5pm– debrief; call clients to set up schedule for next day.
Being able to have drive time during this rotation was actually very beneficial to me. As my CI drove, I was able to become familiar with the documentation system which was accessed through a company tablet. This also gave me time to look over client’s charts and discuss treatment ideas and evaluation plans with my CI.
What assessments did you use most?
Modified Barthel Index for Activities of Daily Living
4 Square Step Test
Modified Clinical Test of Sensory Interaction in Balance (CTSIB-M)
6 Minute Walk Test
9 Hole Peg Test
What conditions/diagnoses did you see most often?
In home health you see a little bit of everything! The most common conditions I saw were generalized weakness from a hospital stay/post COVID-19 recovery; post-surgical recovery for shoulder, hip, and knee replacements; urinary incontinence; hand/finger contractures; and post-fall recovery. While this is a majority of the conditions I saw, it is in no means inclusive of everything I saw in this setting, which is the beauty of working in home health. I loved being able to work with such a wide range of conditions, and truly get hands on experience with so many different conditions.
What did a typical session look like?
- A typical treatment session would last around 30-45 minutes.
- I would begin each session with a COVID-19 symptom questionnaire, pain rating, and taking my client’s vitals (BP, HR, temperature, respirations).
- I would often have a series of questions for them to answer that were a standard for the home health agency such as: any falls within the past week?; any changes in medications?; any recent trips to the doctor/ ER?
- Then the rest of the session would be geared towards the client’s goals but may consist of going over a Home Exercise Program for upper extremity strength, practicing using a utensil with a built-up grip to eat, balance training, training on how to safely use adaptive equipment, safe transfer training, etc.
- Often I would have an idea going into the session of what I would like the client to work on, however their priorities were different than what I had originally planned. And that’s okay! Being flexible and being able to go with the flow is key to this setting.
How did you stay client-centered and occupation-based?
The awesome thing about home health is that being client-centered and occupation-based is at the heart of this setting. During evaluations, I would really try to figure out what my clients were struggling with, and what things they enjoyed doing and were not able to return to yet. My clients were active participants in the creation of their goals, and oftentimes would even help me decide what the treatment plan would look like.
Being in the home environment to provide treatment sessions is such a great way to make sure treatments were occupation-based. Several of my treatment sessions involved performing the actual occupation in the client’s home environment, or even adapting/modifying the environment to allow the patient to perform occupation-based treatments. This aspect of home health is something I really enjoyed, and it was so rewarding to be able to help a client who was struggling with a specific task be able to return to that task with independence or with new adaptive equipment to perform it independently.
Did you have to do a project or in-service? Could you share what topic you chose to do?
I was not required to do a project/in-service. However, my CI was asked to do an in-service on fall prevention in an ALF, and he asked me if I would be interested in leading it. I definitely took him up on this opportunity and it was so fun to be able to share what I had learned with the ALF staff and also hear their input on how we could all work together to help the residents prevent falls.
What was your favorite part of this fieldwork experience?
My favorite part of this rotation was the ability to develop relationships with my clients. It is such a wonderful thing to be able to see a client from the beginning of their journey through all the progress they make, any setbacks they went through, and all the things they accomplished throughout their treatment plan. Additionally, several of the clients I worked with were so grateful to see me each week and grateful that I would spend the time to try and figure out a way to get them back to their meaningful activities. Those clients make you feel like you are really giving back, even in the smallest ways.
What was your least favorite part of this fieldwork experience?
My least favorite part of this rotation was seeing some of my clients decrease in function after arriving home, or even graduating from services but returning again after having another fall. In this setting with this population, there is always the chance that your client may get sent back to the hospital or even pass away due to their age and their rehab potential, which can be heartbreaking.
What is something you learned that you will take with you for the rest of your career?
Something I learned on this rotation that I will take with me forever is to just be kind and to take the time to listen to your clients. It can be hard to slow down and converse with clients when you have a busy day or are running late. But taking the time to show them that you care can go a long way and help improve their quality of life.
What advice do you have for a student about to start in this setting?
Don’t feel like you have to know everything! This setting is a little bit of everything and can get very overwhelming. Just take a deep breath and focus on providing the best care for your clients. Even if you don’t know the answer, that’s okay! Home health is all about collaborating between the clients and the practitioners. Also, keep an open mind! I never thought I would love the home health setting as much as I did, and I am so glad I had a rotation in this setting.
AOTA Fact Sheets on Older Adults/Fall Prevention
AOTA has a lot of great general information about OT’s role with this population as well as resources on Fall Prevention and other common conditions. I used a lot of this information to supplement my in-service on fall prevention.
My CI and I had a lot of drive time throughout my rotation, and I remembered that Mandy, OTR/L from Seniors Flourish had spoken in one of my didactic courses about her podcast. She provides a lot of great information about working with older adults in various different settings and has even as more resources on her website.