When Travis and I first seriously considered travel therapy, we agreed that Home Health was not a good idea for us, because we did not want to be on our own without a support system right out of school. However, when this position came up, there were too many pros to turn down: low overhead cost to get to the site, guaranteed 35-40 hours per week, a solid pay package, and 3+ weeks of mentorship with the existing PTs before taking over for them. In addition, the PTA on staff had several years of experience, there was an experienced OT on staff, and the company was enthusiastically new-grad friendly (read: desperate, but still very nice to feel welcome).
We have completed 9 weeks as new graduate Home Health Physical Therapists, and here are our findings:
Schedule: Making your own schedule is awesome, especially if you have a dog. Travis starts his days early and tries to get home by 2-3 pm, when he will come home to write notes. I leave a little later, around 7:30 or 8 and stay away from home until my notes are done (between 4:30 and 6 pm).
Autonomy: There is usually a lot of freedom in how you treat your patients, as the order is often “evaluate and treat:” we have had experienced nursing staff as well as patients tell us that we are great PTs/the best PTs they have had, because we make a concerted effort to customize our treatments and (as long as we schedule wisely), spend as much or as little time with them as is necessary.
Support: At least with our contracted company, there is a team present to draw on, which is great: Physical Therapy, Occupational Therapy, Speech Language Pathologist, Nurses, Home Health Aides, a Medical Social Worker, and a Supervisor (RN in this case) available to answer questions, mostly about documentation, but also clinical decision making (confirmation of correct decision to call 911 for patient, how the heck do I answer this OASIS question, etc.).
Productivity expectations: We see an average (generally) of 3-5 patients a day, including 1-2 evals. There have been weeks where we saw more, some where we saw less, but we have literally never gotten flack for our patient to weekly hours ratio. I am slower at notes, so I often work a few more hours than Travis, and they haven’t had a problem with it.
The paperwork can be awful, especially if completing Start of Care (OASIS) documentation. You should know going in if you are going to be doing these or not. We are sure that the documentation is more thorough and tedious with Home Health than other settings we have experienced.
You need orders for EVERYTHING. Order comes in for an Eval? You need another order to continue with visit #2-16. Want to monitor pulse oximetry because they get short of breath walking to the fridge? Need an order. Most offices respond within 48 hours, but it does get frustrating.
We have ended up enjoying and appreciating home health overall. I struggle more with the paperwork because I am very detail-oriented and am still learning to focus. Travis is fairly sure he is going to continue with HH because of the flexibility it provides, especially with having a dog and trying not to leave her alone for long hours during the day. I would be willing to do Home Health again, though it may not necessarily be my calling, and I will definitely keep trying other settings as we go. Home health can also offer a rewarding population to work with: people who are struggling just to live their daily lives, who are able to function much more safely and effectively by the time they are discharged. You often get to know your patients very well, and there are people now that I’ve worked with whom I will never forget.
How to be successful in home health as a new grad:
You need to be confident in your abilities. You will see a wide variety of patients, from patients released after joint replacement surgery to those with Parkinson’s disease, severe strokes, or simply general deconditioning and difficulty walking. You need to be willing to become a jack of all trades and look at the big picture: generally, the overall goal is to increase your patient’s independence so that they can care for themselves in their homes safely to the best of their abilities, get to a vehicle for community errands, doctors appointments, outpatient physical therapy, etc., and make them aware of the community resources and support available to them. You do not have to know everything going in, but you need to be willing to learn on the job and ask questions until you do know what you’re doing.