New Grads in Home Care

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It might be the most commonly asked home care question that we hear from students:

Should I begin my career in home care as a new grad?

As with all questions in the PT world, the answer is a little less defined.

It depends.

When deciding if home care is the right setting to begin practice, one needs to evaluate their professional goals, desires, and expectations for their career. HERE you will find some tips that I think should help a PT thrive in home care. But, what if you aren’t at that point yet?

There are a few additional questions to ask yourself that should help determine if home care after graduation is right for you.

Am I intrinsically motivated?

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Yes, you really are alone – at least in the physical sense – for a large majority of your time working in home care. For some, like myself, I actually enjoy the “me” time. It gives me a chance to reflect on patient visits, reassess my examination and evaluation methods, and mentally prepare for upcoming patients on my caseload, all while driving from house to house.

To be effective in home care, you must be able to stay intrinsically motivated towards learning and staying current with best practice interventions and patient management. You don’t have a physical desk that you can stash issues of PT Journal during a sometimes-much-needed patient cancellation. You also don’t have the same access as in a clinic environment to call over an OCS colleague to help explain something you had been pondering while with a previous patient.

You need to feel comfortable quickly searching for, and integrating, additional clinical knowledge into your practice. You should feel confident in your current skills but always be eager to advance them for your own future professional growth. And, you should make it a point of emphasis to set aside time for yourself each month to both review clinical information specific to your current caseload, in addition to seeking out new information you may not yet have been exposed to.

How much physical mentorship do I need…or want?

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I emphasize physical mentorship, as opposed to general mentorship, because these are two quite different things. As mentioned above, the ability to have frequent, hands-on mentorship within home care is difficult. It’s just the nature of the business. It is much more challenging to seek out a colleague to assist with reminding you of a specific transfer technique, joint mobilization/manipulation, or correct implementation of a test&measure.

For some people, this is okay. A lot depends on your previous clinical experiences and educational opportunities within your specific PT program. Some students receive more lab training and psychomotor practice than others.

General mentorship is an entirely different issue, and one that I think every student should seek, regardless of setting. I have found it much easier to call or even e-mail a colleague to discuss patient management, presentation, or intervention ideas.  The ease of this for you will primarily depend on the home care agency you work for, and dictated by the questions you ask at the interview (future post).

For the the purpose of this discussion, you simply need to self-reflect and determine not only how much physical mentorship you need, but also how much you are expecting to receive with your first position. You may be very unhappy 6 months into your home care position if what you expected to receive and what you are actually receiving do not equate.

Am I chasing the money?

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Admit it.

One of the reasons you are even thinking about a career in home care is because of the financial advantage you will receive in comparison to many other settings within Physical Therapy.

It’s ok.

I don’t think anyone should ever feel ashamed of exploring their options in a niche such as home care simply because it pays more. This is human nature and a part of the game we call Life, as everyone’s personal circumstances are different. Some are the sole provider for their family. Others have lifestyles which require increased take-home pay. And, even more have an unheard of amount of student loan debt. The fact that you are contemplating a career in home care for financial reasons is a good thing. It means that you care about not only your current state but also your future aspirations. With that said, there is one important point to consider that should guide your weighing of this additional income:

  • Do not sacrifice professional growth solely for increased income

Your first few years as a Physical Therapist are some of the most important of your career. During this time you will refine and enhance your psychomotor and clinical reasoning skills. You will develop your preferred methods of evaluation and treatment philosophies.

Whatever you do, don’t let a mere 10-20% increase in income cause a 50% decline in the professional growth you worked – and paid so much – for.

 

“Boy, this party really died”

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After reading the above you are probably thinking, “Wow. Why was I ever debating on a home care position as a new grad?”

This couldn’t be further from the truth. However, I just feel it necessary to point out a few of these very important issues that students need to evaluate before deciding that home care is right for them. You cannot make a bad decision, as long as you make an informed one.

Feel free to leave any questions or comments.

Stay tuned for the next post: Why you SHOULD consider a PT career in home care.

– Preston Collins, PT, DPT

 

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Five Tips for Home Care Therapists

I am frequently approached by PT students and clinicians alike, who are interested in the Home Care realm of physical therapy. Most are looking to try something new, but often do not have any experience within this area as internship experiences can be limited depending on the region and program connections.

I have been a practicing therapist within Home Care for the last 2 years after transitioning out of a privately owned outpatient clinic. I have learned a lot during this time, both clinically as well as professionally, that has helped improve my overall patient management. There are many things I wish I would have known prior to my move to Home Care that I would like to share.

Below are Five tips to make one more successful within this physical therapy niche. My hope is to assist other clinicians with similar transitions as mine, while also demonstrating to students that Home Care isn’t as scary as some make it out to be (a future post in itself).

Tip #1 – Time Management

The number one determinant of whether a therapist will thrive in Home Care resolves around a simple question: Can you manage your time?

A large portion of the skill within Home Care comes in the form of time management. This is a big separator of novice and seasoned clinician. Acting both as therapists and case managers, PTs are often juggling varying appointment times, phone calls to MDs/other teams members, answering e-mails from the office, and submitting timely documentation.

To be successful, I recommend using free phone Apps (ex: Calendars 5) as well as creating a regularly-updated, weekly schedule that includes patient name/address/DOB/phone number/Frequency&Duration/Visit authorization, as well as MD contact information. See below for an example.

This will help to decrease time spent looking for this info when you need it during phone calls or for documentation and quick reference.

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Tip #2 – Effective Scheduling

As any Home Care PT will tell you, there isn’t much worse than having more “windshield time” than absolutely necessary. Excessive time spent driving between patients can be the deciding factor between a good day and a bad day, and take from you the exact flexibility you were seeking from a career in Home Care.

One way to improve your efficiency and decrease time spent in the car is to effectively schedule your patients. One strategy I use is to schedule patients who live closest to me for the beginning and end of the work day. This allows me to let rush-hour traffic pass during my first appointment before heading further from home, as well as beat the evening rush-hour back home prior to my last appointment.

Because some therapists don’t see many patients near their home, here is a different strategy: Try to schedule the furthest patient from your house first thing in the morning. Most patients don’t want to be seen until 9:00am, or sometimes 9:30am, which can put you in a pinch to start your day. If you choose to see the furthest person first, you will effectively start your day earlier and get the long drive out of the way before the middle of your day hits. This means that you could end your day at 3:30pm, instead of 5:00pm if you waited to see the patient until a different time in the day.

Tip #3 – Communicate with other team members

Physical Therapists are known for their communication skills – after all, that’s why they have school interviews, right? You definitely will need to make use of those skills in Home Care to be effective.

One big difference between working in Home Care vs the clinic setting is the ability to work with many other professionals on the same case -RNs, LPNs, OTs, COTAs, SLPs, MSWs, HHAs. While this should be viewed as a benefit, if you aren’t proactive it can quickly turn to a negative. Imagine this: you are scheduled with patient Bill for 11:00AM on Wednesday for a PT visit. You call him on Tuesday night to confirm, and everything is good to go. You are planning on heading across town after this visit to see your next 3 patients before ending your day. Upon pulling up to the patient’s house you see an unfamiliar car parked out front. You get to the door and to your surprise, Mary the OT answers and says she just arrived and began working with the patient.

Boom. Your day and entire schedule just got derailed.

It happens very often that other clinicians don’t reach out to you and let you know when they are scheduling a patient. It’s even more common that the patient will forget to tell you that another discipline has already scheduled for the time you asked for, and you won’t find out unless you take an extra step.

My advice is two-fold:

Call and confirm your appointments the night before the visit.

-AND –

Make sure to contact the other disciplines with your planned visit times for the week. This will ensure that they don’t already have something scheduled with the patient at the same time, and also gives them the warning of when you will be there so they avoid just “showing up”.

Tip #4 – Timely Documentation

We all know that it isn’t wise to get behind on documentation. Before you know it, this can turn in to a massive snowball that makes it near impossible to get on top of. – As an aside, I recently heard of a PT being fired from an established hospital system because she was behind on over 600 notes. Six Hundred! –

Besides professional standards and payment reasons, another reason to ensure you are caught up on Home Care documentation is because of the overall poor health of the patient population. You are often seeing very sick people with many different diagnoses. As unfortunate as it is, you will have patients die while under your care. When that day comes, while we hope it is not due to any adverse medical treatment/care, one of the last things you want is for multiple visit notes, communication notes, MD orders, etc. being outstanding in the patient’s chart.

Remember that above all else, it is vital to protect your professional License. Protect yourself and keep your documentation up-to-date!

Tip #5 – Stay Current

It’s no secret that in Home Care you often don’t have the same collegial interaction and brainstorming that is found in the clinic setting. You don’t have another therapist riding in the passenger seat to discuss new treatment ideas or interventions to attempt with your next patient.

In order to be successful in this setting, and to promote further professional growth, it is critical that clinicians find ways to stay current on therapy literature. A few excellent resources for this are:

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If you can follow these five simple tips, you will set yourself up for great success as a Home Care therapist.

What else would you like to know? Feel free to comment with any other questions.

– Preston Collins, PT, DPT