Physical Therapy, Occupational Therapy and Speech Therapy in a Home Care Environment
The two main purposes of therapy in a home care environment:
- To transition the patient from an acute care or inpatient setting to a home environment
- To evaluate and restore the patient’s ability to remain in the home setting
Home care therapists accomplish this by the following:
- Evaluate patients level of functioning as it relates to ability to adapt safely at home
- Assess emotional, sensory, physical and environmental barriers and the impact the limitations will have on the patients plan of care
- Minimize risk of falls by performing risk assessments and educating patient and caregiver to potential hazards
- Review goals accomplished during inpatient therapy and assist patient in adapting those goals at home
- Evaluate basic independent living abilities and basic self care to develop interventions to assist a patient to maintain maximum capacity as long as possible
- Manage multi-dimensional needs of the patient and caregiver in conjunction with an interdisciplinary team
Why Home Health Therapy?
Therapy for patients returning home is important for many reasons. Below are some examples of issues that can affect a successful transition:
- Unpredictable environment
- Patient with limited resources
- Variable caregiving assistance
- Unanticipated needs
- Psycho-social issues
Home care for patients transitioning
Therapy at home does not necessarily “re-do” or repeat therapy provided in an acute care or inpatient setting. Rather it evaluates the progress and abilities achieved in a structured environment and assists the patients in adapting to that level of functioning at home. Therapists providing care at home often serve as case managers accessing psycho social issues, service needs and the need for additional disciplines to provide care.
Focus of care in a Skilled Nursing or Rehab Center:
- To help the patient function at the highest level possible in preparation for transition to home or other setting.
Focus of care at Home:
- Assess psycho-social issues that may impact progress toward goals
- Connect patient to community resources to maintain support following discharge
- Maintain maximum independence in self care, transfers and ambulation to remain at home as long as possible
- Function safely at home or to progress to outpatient therapy
SIMILARITIES AND DIFFERENCES
There are many similarities and differences between therapy provided in an acute care setting and therapy provided at home. Regardless of the setting, both are providing care to patients complex physical, emotional and psychosocial issues requiring an interdisciplinary team approach
The plan of care and treatment modalities are based on findings if a comprehensive assessment, previous history and physician orders.
Discharge planning is initiated upon admission and consistent documentation of skilled need and patient progress toward goals in maintained.
DIFFERENCES
| ACUTE CARE | HOME CARE |
| Services and treatment provided in a structured, controlled environment | Services and treatment provided in a non-structured sometimes chaotic environment |
| Environment for treatment with minimal obstacles, good lighting, wide hallways with grab bars, even surfaces | Environment with many obstacles: animals, bathrooms on second level, extension cords, rugs patients won’t remove, uneven surfaces, poor lighting, towel racks or furniture used as grab bars |
| Equipment/ modalities readily available for exercising and training | Equipment/ Adaptive equipment often cannot be ordered until therapist evaluates how it will fit into the home environment |
| Long term goals, broad focus (average time with therapy pt is 36 days or longer) | Short term goals, intensive focus ( average time with therapy 6-9 visits) |
| Patient supervised 24/7 with the ability to continue therapy exercises/ ambulation throughout 3 shifts | Patient only supervised by health care team during one hour visits, often lives alone, or under supervision of elderly spouse or intermittent caregiver |