Written by Travis Kemper, PT, DPT
As travel therapists, there are a lot of opportunities to work in home health across the nation. And, the pay is usually pretty high which makes it an attractive option. It might be even more attractive for someone who is getting started as a new grad and looking at a large amount of debt to pay off. Recruiters often offer to submit new grad therapists to home health positions; but, as with everything, there are some positive and negatives to consider with home health therapy that should be taken into account before being submitted.
Here’s my take on working in home health after doing my first two travel physical therapy contracts in the setting. I will expand further on each bullet point below to give you a more comprehensive view of my thoughts, but here is an overview of the basics:
PROS:
- Even as a new grad, you have will the opportunity to dramatically improve the quality of care that patients are receiving in this setting.
- You can create closer relationships with patients than in most settings, and potentially make a larger impact on their personal lives than in other settings.
- You can make your own schedule, or at least have a significant amount of flexibility in your schedule.
- The pay is much higher than other areas of practice, although of course pay also depends on location.
CONS:
- On the flip side of #1 from the “pro” list, the con in this situation is that your colleagues may not be the best and your patients may not be receiving the best care across the board.
- There may be the potential for less growth as a clinician in this setting.
- Sometimes there are higher productivity requirements.
- There is more time spent in front of a computer than in other areas, and way more time being sedentary. The paperwork is much more intense than any other setting where I have worked.
Let’s take a closer look at the positive aspects of working in home health:
1. As a clinician, and even as a new grad, you can dramatically improve the quality of care that patients are receiving: This is in some ways a pro and a con. The pro is obvious: you can literally be a rock-star clinician in home health on day one. I was told on numerous occasions, by numerous people, that I was the best home health provider that has ever come to see the patient. That’s awesome, and very rewarding for you as a clinician, but also incredibly sad. Check out the cons list below to see the flip side of this.
2. Potential for increased quality of relationships: I have patients/caregivers that still contact me from across the country to tell me how much they appreciate the work I did for them. There is a great potential to make a larger impact in your patients’ lives than in other settings. There is nothing in healthcare that can prepare you to see how a patient moves in his/her home environment. Sometimes you must get creative to make their homes work for them. I routinely helped patients redesign their living rooms to make them safer, and I also removed two bathroom doors because the patients’ assistive device would not fit through the door and the patients could not safely access the commode without a device.
3. More flexibility in your schedule: Because you can design how your day looks with visiting each patient, it allows things like making stops to the post office or other businesses that have daytime only hours much easier to manage. It also makes it easier to design a schedule that works for you as an individual, within reason.
4. Higher pay than other settings: This depends on the location, but home health is almost always one of the highest paying settings. This is a huge pro for choosing to work in this setting. More money, more options in life.
Let’s take a closer look at the negative aspects of working in home health:
1. Other clinicians in this setting may be sub-par: As I mentioned above, sometimes you can really stand out in home health as an amazing clinician, because unfortunately sometimes the patients are receiving sub-optimal care from other clinicians. Sometimes, depending on the team you are working with, you may have to perform tasks or communication for the patient that is more appropriate for another discipline, such as nursing, social work, or another therapist, or else the patient will not get the care they deserve. For example, at one point I worked with an OT who would perform an evaluation, make goals, and on the next visit perform a discharge stating all goals were met, when the patient had not received or been trained on half of the recommended equipment. This happened with several patients. Unfortunately, when providers are paid for quantity, as is the case with most home health companies (presumably because that is how insurance pays the company), quality of care will decrease from most providers. This caused me a lot of stress because I care about my patients, and I get incredibly frustrated when I see sub-par care.
Here’s a quote that I feel is appropriate to my experience in this situation: “People that aren’t used to quality always chase quantity.”- unknown
2. Potential for less growth as a clinician: When it comes to growth as a clinician, I believe you grow by seeing and interacting with other therapists as well as performing personal research, going to conferences, and earning CEUs. In home health, although you often work with a team, you are by yourself almost all the time. I truly feel that as a physical therapist, I did not grow nearly as much in this setting as in other settings where I have worked.
3. High productivity standards are standard: This has obvious downsides. I have only taken hourly positions in home health, but the company will still try to enforce productivity standards on you. This is the toughest thing, especially with the cons listed about your potential coworkers and why you can be a “rock-star” as a new grad, which requires extra work from you if you want you to provide the best care. This combined with last con on the list (see below) are the reasons that, unfortunately, I probably won’t be doing home health anymore.
4. Lastly, the paperwork is brutal! People have tried to tell me that it is no worse than other settings, but I have worked in just about every setting between clinicals and paid positions, and it is by far the worst in my opinion. Every day I would spend half my day documenting, and that was with doing as much as possible in the home with the patient. Combine documentation time with drive time, and you have landed a sedentary profession. I chose a career with physical in the title. I don’t want to sit, and I hate computers!
Conclusion
Overall, I think home health can be a great place for the right person. If you’re very organized and don’t mind increased paperwork, you can make a huge impact in this setting right away and really feel you’ve provided a lot of value to your patients. But, there are definitely some cons to consider, and you want to make sure to ask all the right questions before going into a contract in home health.
I hope this helps you! Please feel free to reach out with any questions about home health here. I will happily look at your contract, set up a phone call to chat about home health, or provide any other assistance I can.
Stay tuned for a future post about specific questions I recommend asking during a home health interview!
