In my 28 years of practice I have had the opportunity to work in adult inpatient , skilled nursing, outpatient, acute care and home health. I loved aspects of each of these settings, but I find myself feeling the most comfortable and excited to work in home health. I thought it would be interesting to do a search for information on OT and home health and I was surprised that most of the search results were home health companies advertising their occupational therapy services. There appears to be little research and publications regarding OT in the home health setting.
I thought I would share some of the most interesting information I found before I talk about why I love working in home health as an occupational therapy practitioner.
It is estimated that by 2034 the number of US older adults will outnumber children. As an aging population chooses to age in place if possible, Medicare has reported that home health spending has increased 60% from 2002 to 2016 (Zahoransky & Lape, 2020). With increased spending I would expect increased utilization of all homecare services, especially occupational therapy. Occupational therapy addresses meaningful occupations including self care, IADLs, health management (including self-management of chronic conditions) which are all imperative to be able to live in the community. In recent years there has also been increased efforts for healthcare organizations to reduce hospital readmissions for their clients. According to an independent study published in Medical Care Research and Review, "occupational therapy was the only spending category where additional spending has a statistically significant association with lower readmission rates" (Rogers et al, 2016). The study focused on three conditions: heart failure, pneumonia and acute myocardial infarction. Looking at the data, one may assume that occupational therapy services would be highly utilized in the homecare setting.
Unfortunately, this is not the case. The evidence actually suggests that occupational therapy may be underused in the home and community setting. The ratio of physical therapy to occupational therapy for full time equivalents is 4:1 in home health but less than 2:1 in skilled nursing. One study (Craig, 2012) contributes the under-utilization of OT services in home health to a lack of awareness of the services that occupational therapy can provide, workforce shortages, the unfortunate reliance on physical therapy to identify the need for occupational therapy, and Medicare polices that until recently did not allow occupational therapy to establish eligibility for home health services. Despite the recent changes that allow occupational therapy to complete start of cares, many agencies are not utilizing OT services any differently.
This may seem like very discouraging information for occupational therapy practitioners, but for me it is a motivator to better demonstrate how beneficial OT services can be for those who are receiving home health services.
My Top 10 Reasons I Love Working in Home Health:
1. I am able to assess the actual home environment and equipment available, including it's structural stability.
2. I am able to assess an individual's actual performance in the context of their environment and how they actually complete a task.
3. I get to go in different houses everyday! I have this weird interest in seeing people's homes. Since I was a kid, I would love to sit in the car and just look at all the houses that we passed. I am fascinated with the concept that simultaneously we all live in this world, but to some degree we all live in our own little world. As no person is the same, no home is exactly the same.
4. I love not being confined to the exact same facility or office everyday, I get to be in the fresh air and always in a different area and on the move.
5. I learn something new everyday. Long ago, I realized that there is more than one way to solve a problem. I am amazed at the things that my clients and their families build and the strategies they come up with to meet a challenge.
6. I love the adventure of home health, though the adventures can sometimes be a little uncomfortable and safety is always a bigger challenge than working in a facility. You never know when you may see a rogue group of runaway cows ravaging a neighborhood, goats blocking the road, wild bears walking by your car or breath taking scenery that my geographical region offers.
7. I am able to perform a more comprehensive occupational profile as being in someone's home can help me identify what occupations have the most meaning to them.
8. I feel that working in home health gives me the opportunity to more fully address self-management of chronic conditions such as pain, congestive heart failure, diabetes, anxiety, depression and chronic obstructive pulmonary disease to name a few.
9. Working in home health allows me to better work on changing behaviors and addressing habits, roles and routines that impact falls risk as well as performance of the occupations of health management, ADLs, IADLs and sleep and rest.
10. Last but not least, working in home health has given me the opportunity to better promote what occupational therapy is and our distinct value in this practice setting. I have the opportunity to communicate with less time constraints with my clients and their families. Home health also allows me the opportunity to communicate more directly with physicians, nurse practitioners and physicians assistants regarding the unique perspective OT has regarding an individual's occupational performance as related to the home environment as well how we therapeutically use occupation to promote health and wellness.
There are so many things I enjoy about working in home health I could probably have made a top 20 list, but I am sure you are grateful that I didn't. I hope you love your current practice setting as much as I do. If not, I hope you find a setting that helps you feel more fulfilled. If you are having trouble finding the right setting, I hope you reach out to fellow practitioners, a mentor or a coach for support.
Zahoransky, M.A. & Lape, J.E. (2020). Telehealth and home health occupational therapy: Client's perceived satisfaction with and perception of occupational performance. International Journal of Telerehabilitation 12(2), 105-124. doi: 10.5195/ijt.2020.6327
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757652/#R20
Rogers, A.T., Bai, G., Lavin, R.A., & Anderson, G.F. (2016, SEPT 2). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Reivew, 1-19. dx.doi.org/10.1177/1077558716666981
Craig, D.G. (2012). Current occupational therapy publications in home health: A scoping review. American Journal of Occupational Therapy 66(3), 338-347. https://research.aota.org/ajot/article/66/3/338/5638/Current-Occupational-Therapy-Publications-in-Home
Written by: Kimberly Breeden, MS, OTR, Coach, Instructor and Founding Partner
I thought I would share some of the most interesting information I found before I talk about why I love working in home health as an occupational therapy practitioner.
It is estimated that by 2034 the number of US older adults will outnumber children. As an aging population chooses to age in place if possible, Medicare has reported that home health spending has increased 60% from 2002 to 2016 (Zahoransky & Lape, 2020). With increased spending I would expect increased utilization of all homecare services, especially occupational therapy. Occupational therapy addresses meaningful occupations including self care, IADLs, health management (including self-management of chronic conditions) which are all imperative to be able to live in the community. In recent years there has also been increased efforts for healthcare organizations to reduce hospital readmissions for their clients. According to an independent study published in Medical Care Research and Review, "occupational therapy was the only spending category where additional spending has a statistically significant association with lower readmission rates" (Rogers et al, 2016). The study focused on three conditions: heart failure, pneumonia and acute myocardial infarction. Looking at the data, one may assume that occupational therapy services would be highly utilized in the homecare setting.
Unfortunately, this is not the case. The evidence actually suggests that occupational therapy may be underused in the home and community setting. The ratio of physical therapy to occupational therapy for full time equivalents is 4:1 in home health but less than 2:1 in skilled nursing. One study (Craig, 2012) contributes the under-utilization of OT services in home health to a lack of awareness of the services that occupational therapy can provide, workforce shortages, the unfortunate reliance on physical therapy to identify the need for occupational therapy, and Medicare polices that until recently did not allow occupational therapy to establish eligibility for home health services. Despite the recent changes that allow occupational therapy to complete start of cares, many agencies are not utilizing OT services any differently.
This may seem like very discouraging information for occupational therapy practitioners, but for me it is a motivator to better demonstrate how beneficial OT services can be for those who are receiving home health services.
My Top 10 Reasons I Love Working in Home Health:
1. I am able to assess the actual home environment and equipment available, including it's structural stability.
2. I am able to assess an individual's actual performance in the context of their environment and how they actually complete a task.
3. I get to go in different houses everyday! I have this weird interest in seeing people's homes. Since I was a kid, I would love to sit in the car and just look at all the houses that we passed. I am fascinated with the concept that simultaneously we all live in this world, but to some degree we all live in our own little world. As no person is the same, no home is exactly the same.
4. I love not being confined to the exact same facility or office everyday, I get to be in the fresh air and always in a different area and on the move.
5. I learn something new everyday. Long ago, I realized that there is more than one way to solve a problem. I am amazed at the things that my clients and their families build and the strategies they come up with to meet a challenge.
6. I love the adventure of home health, though the adventures can sometimes be a little uncomfortable and safety is always a bigger challenge than working in a facility. You never know when you may see a rogue group of runaway cows ravaging a neighborhood, goats blocking the road, wild bears walking by your car or breath taking scenery that my geographical region offers.
7. I am able to perform a more comprehensive occupational profile as being in someone's home can help me identify what occupations have the most meaning to them.
8. I feel that working in home health gives me the opportunity to more fully address self-management of chronic conditions such as pain, congestive heart failure, diabetes, anxiety, depression and chronic obstructive pulmonary disease to name a few.
9. Working in home health allows me to better work on changing behaviors and addressing habits, roles and routines that impact falls risk as well as performance of the occupations of health management, ADLs, IADLs and sleep and rest.
10. Last but not least, working in home health has given me the opportunity to better promote what occupational therapy is and our distinct value in this practice setting. I have the opportunity to communicate with less time constraints with my clients and their families. Home health also allows me the opportunity to communicate more directly with physicians, nurse practitioners and physicians assistants regarding the unique perspective OT has regarding an individual's occupational performance as related to the home environment as well how we therapeutically use occupation to promote health and wellness.
There are so many things I enjoy about working in home health I could probably have made a top 20 list, but I am sure you are grateful that I didn't. I hope you love your current practice setting as much as I do. If not, I hope you find a setting that helps you feel more fulfilled. If you are having trouble finding the right setting, I hope you reach out to fellow practitioners, a mentor or a coach for support.
Zahoransky, M.A. & Lape, J.E. (2020). Telehealth and home health occupational therapy: Client's perceived satisfaction with and perception of occupational performance. International Journal of Telerehabilitation 12(2), 105-124. doi: 10.5195/ijt.2020.6327
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757652/#R20
Rogers, A.T., Bai, G., Lavin, R.A., & Anderson, G.F. (2016, SEPT 2). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Reivew, 1-19. dx.doi.org/10.1177/1077558716666981
Craig, D.G. (2012). Current occupational therapy publications in home health: A scoping review. American Journal of Occupational Therapy 66(3), 338-347. https://research.aota.org/ajot/article/66/3/338/5638/Current-Occupational-Therapy-Publications-in-Home
Written by: Kimberly Breeden, MS, OTR, Coach, Instructor and Founding Partner
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