I think the best place to practice occupational therapy is in a person’s home. There is no theory or simulation, just the actual challenges and supports your patient has to navigate each day. While home health is a good place for occupational therapy, an OT might wonder if they are a good fit for home health. I worked in home health for more than 25 years alongside some awesome practitioners, so here are the top three traits that I think contribute to a successful OT career in home health.
Cheryl Hall, OT
Author and Illustrator, Occupational Therapy Toolkit
To be effective in the home health environment, you need to be assertive (and I mean that in the most positive light possible). The unpredictable nature of home health, coupled with the fact that you are essentially on your own, means you need to be able to take charge of situations and not hesitate to advocate for change or help.
You will need to be assertive about communicating with peers, other members of the health care team and your supervisors. If you are struggling with too many evaluations, high productivity standards or appointments that are too far apart, you need to initiate a talk with your supervisor. The goal is not necessarily to ask for a break, but to ask for tools to better manage your responsibilities. When you don’t see your co-workers every day, effective communication may depend on you initiating both conversations and follow up. Finally, if either the profession or setting is new to you, take the initiative to find a mentor. Hearing another OT’s perspective and learning from their experience will be invaluable.
You will face more distractions in a patient’s home than you might find in a facility and it can be harder to leave at the end of the appointment. To stay in control, talk to your patient and/or caregivers at the beginning of the visit about the length of the appointment and the plan of action. Be firm when it is time to leave. You also may be presented with problems such as hoarding, potential abuse or neglect, bedbugs, lack of heat or water, aggressive animals, or other unsafe conditions. You will have to take on the role of advocate and find your patient the resources they need to be healthy and safe in their homes. While potentially uncomfortable, these conditions must be addressed before you can be effective.
It goes without saying that all OTs are creative, but home health is the perfect setting for those unique, creative solutions that maximize patient outcomes. Whether you are addressing home modifications, ways to manage chronic conditions or walking a patient through a safe transfer, being in the home allows you to address the unexpected. You don’t have to pretend what the barriers are to showering because you and the patient are in the bathroom together facing those challenges.
But when it is just you and the patient (and whatever you have in your bag or trunk) you may find you have to step up your game. I think being creative comes more naturally when you are doing something that you love and are passionate about, but there are other ways that you can increase those creative moments. Collect questions and scenarios to bounce off your mentor, supervisor or the rest of the health care team. Participate fully in opportunities for training and professional development. Keep a notebook close so you can jot down inspiration when it strikes. Ask someone outside your industry for their perspective on difficult problems. And of course, Google is your friend (even in the middle of an appointment) if you are completely stumped.
When you have to schedule your own appointments, leave wiggle room for traffic and parking issues and rearrange on the fly when a patient cancels, you need strong organizational skills. Without a strategy to stay on schedule, your 8 hour day will extend to 10 or 12 hours. Always plan your schedule ahead of time and schedule everything! You should take into account the visit type, drive time, documentation and potential time drains like traffic and parking. Schedule time for lunch (even if it is quick), time to prep for the next day, and even time for the unexpected. Use whatever works best for you, from a time keeping app to simple printed daily schedule. The key is to use it faithfully.
As a home health provider, your car and home have now become your office! Use bags, binders and clear totes to keep your gear accessible and organized. Color coding or labels work great to keep you organized when you are in a hurry. Check out the portable work stations made for the front passenger seat to keep all your paperwork in one place. Also resist the temptation to dump items in the back seat after each appointment; it is easier to take a minute to put everything back in place. You could even schedule a little organizing time into your daily schedule. Also make sure to keep work gear separated from your personal gear. If you have a garage, put a shelf up near your trunk so you can unload work gear over the weekend.
Are there other traits I didn’t mention that you think are just as important to success in home health care? Let me know!