Is Home Health Care for You? Get to know the facts about the home health setting’s unique scheduling and on-site service delivery before taking the plunge. On the Pulse
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On the Pulse  |   December 01, 2018
Is Home Health Care for You?
Author Notes
  • Jennifer Loehr, MA, CCC-SLP, is a field integration specialist for Encompass Health, training nurses and therapists across all disciplines on home health compliance, processes and procedures. Her 35-year career includes 15 years in home health care. She is a certified specialist in OASIS (Outcome and Assessment Information Set, a required federal document that collects information on home health care patient outcomes), and recently represented ASHA on a technical expert panel on reimbursement issues for home health care services. jennifer.loehr@encompasshealth.com
    Jennifer Loehr, MA, CCC-SLP, is a field integration specialist for Encompass Health, training nurses and therapists across all disciplines on home health compliance, processes and procedures. Her 35-year career includes 15 years in home health care. She is a certified specialist in OASIS (Outcome and Assessment Information Set, a required federal document that collects information on home health care patient outcomes), and recently represented ASHA on a technical expert panel on reimbursement issues for home health care services. jennifer.loehr@encompasshealth.com×
Article Information
Healthcare Settings / Practice Management / Professional Issues & Training / Attention, Memory & Executive Functions / On the Pulse
On the Pulse   |   December 01, 2018
Is Home Health Care for You?
The ASHA Leader, December 2018, Vol. 23, 38-39. doi:10.1044/leader.OTP.23122018.38
The ASHA Leader, December 2018, Vol. 23, 38-39. doi:10.1044/leader.OTP.23122018.38
Fifteen years ago, I was working in a small skilled nursing facility and enjoying the patient caseload—but struggling as I tried to balance running after my children with meeting productivity requirements.
A friend convinced me to look into home health care—and it turned out to be the best move for me. This work setting offers some unique opportunities for flexibility, autonomy and patient-centered care, as well as challenges, such as lots of driving and scheduling changes. So be sure to know what you’re getting into before you decide to make a change.
Typically, speech-language pathologists work for a home health agency directly as a full-time, part-time or PRN (“pro re nata,” Latin for “as needed”) employee.
About home care
Started in the early 1800s as philanthropic nursing care, home health care has expanded to become a bridge for patients discharged from acute care but unable to regularly travel to outpatient clinics. Rehabilitation services were added after the Medicare system was established in the mid-1960s. Today, Medicare Part A covers 100 percent of eligible home health services (with no limits), and other insurance companies offer varying degrees of reimbursement.
Home health speech-language pathologists treat a variety of conditions in homes, assisted living communities and memory care facilities. Patient needs and insurance coverage—whether Medicare or private—dictate session frequency and duration.

Home care offers some unique opportunities for flexibility, autonomy and patient-centered care, as well as challenges, such as lots of driving and scheduling changes.

The pros
Working in home health has some definite benefits.
Flexibility. The biggest draw for most SLPs is the flexibility in scheduling. Even if you choose full time, you can easily schedule sessions to allow for other appointments (your kids’ and your own!). If you are full-time, you will likely have a productivity requirement. Depending on the size of your agency and caseload, it’s generally fairly easy to fit your other responsibilities into your patient schedule.
Pay. In ASHA’s 2017 SLP Health Care Survey, 51 percent of home care respondents reported more job openings than job-seekers in that setting, well above the 31 percent rate of all home care respondents. The home health care industry provides the second-highest pay rates for SLPs in the country, according to a 2017 Bureau of Labor and Statistics report. Most companies offer salaried positions that include benefits for the full-time SLPs and pay a per-visit rate without extra benefits to those who seek part-time or PRN positions.
Autonomy. For the most part, you can set your own schedule and be independent during your day, even with the amount of collaboration home health care involves. Medicare requires home health agencies to provide coordination of care. The SLP works with a team of health care professionals, who communicate with the patient and one another daily. Providers from different disciplines are not usually in the patient’s home at the same time—but with technology, we can collaborate effortlessly while also having the freedom to work independently.
Intimacy. Providing services to people in their home allows the clinician to see how the patient performs in their living environment and to develop a plan of care suited to the patient’s strengths and needs. I have worked with patients in the hospital and subsequently in home care, and I find that patients perform better and demonstrate more rapid progress once they are home.
The cons
Is home health care a dream job? Perhaps. But there are some downsides.
Windshield time. If you don’t like to spend time on the road, home care may not be for you. Home health clinicians may have a total caseload that is close to their home, or they may need to drive many miles each week to patients’ homes. Some agencies provide a vehicle, gas and car maintenance to employees who drive great distances. Most agencies offer mileage reimbursement to employees who drive their own cars. If your agency has contracts with assisted-living and independent-living communities to provide care to the communities’ residents, your windshield time may be substantially less.
Unpredictability. Patients’ schedules frequently change without warning. They may need to schedule medical appointments outside their home or may not feel up to treatment. Or perhaps your agency receives a number of new referrals who, per Medicare rules, need assessment within a certain time period. Understand that schedule changes are to be expected and be flexible.
Autonomy. Yes, autonomy is a benefit, but it can also be a drawback. Although you are constantly in contact with your patients and team members, there may be days with no face-to-face contact with colleagues. Home care clinicians work much more independently than those in other settings. Create a “lifeline” of colleagues to whom you can reach out for advice or guidance.

Providing services to people in their home allows the clinician to see how the patient performs in their living environment and to develop a plan of care suited to the patient’s strengths and needs.

Tips
Are you still interested in home health care? Here are some more suggestions.
  • Try it out before you make a full commitment by finding an agency that will let you sign on as a PRN clinician.

  • If you’re choosing among several agencies, look them up at Home Care Compare to see their patient outcome and satisfaction rates.

  • Use technology efficiently. Most agencies use hand-held or mobile devices for documentation, allowing clinicians to document onsite and avoid playing catch-up later.

  • Leave the workbooks, handouts and paper tasks in your car. Working with patients in their living environment gives you access to functional materials that are meaningful to the patient. Work on expressive language drills with the patient in the kitchen or bathroom so they can practice using practical, meaningful words. Use the patient’s photos, albums and calendars for memory exercises. Introduce strategies for refilling a prescription or following a medication regimen. These tasks don’t require special materials and, importantly, help the patient live as safely and independently as possible.

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December 2018
Volume 23, Issue 12