Think back to when you decided to go to PT school. What drew you to the profession? Was it the opportunity to help people? Was it the work-life balance? Was it the environment in which you were working? Was it because you loved exercise? Was it because the job market was good? It was probably a combination. How many of you chose PT because you wanted to do home health?
My guess is that you didn’t go to PT school because you had an amazing experience doing home visits with another PT. You probably didn’t even know home health existed. To an aspiring PT, there is often the outpatient clinic, the hospital, maybe the SNF or inpatient rehab facility, and nothing else.
The pros of home health
Now that you are a PT, you might have negative opinions of home health, or maybe a negative perception. You might think that it entails going into dirty, dangerous homes to treat your patient.
I remember going to a state PT conference during my second year of school. The owner of a home health agency was trying to recruit other students for his business. He told the students and me bizarre stories about his experience as a home health therapist.
When I graduated from PT school, I had no desire to do home health. It was the last setting I would ever consider. I really enjoyed the outpatient setting and the hospital, and I was determined to work in one of two of those settings.
When I decided to travel, I wanted to start my career in Texas and make good income as a traveler. The only thing available was home health and SNFs. I had had my own experience with SNFs and I definitely wanted to avoid those too!
I decided to give home health a shot.
The first patient I ever had was a man named Luther who lived with his family in a double-wide trailer in a small town in Texas - a town so small you might not notice it if you blink. To this day, I can remember the horrible stench of that trailer. It smelled like a combination of sweat and old gummy bears. He was a veteran, but now he was easily 100 pounds overweight.
I remember thinking, “this is going to be a LONG assignment!”
Things improved. I developed a good routine and developed a system that worked for me. I was only seeing 5 or 6 patients a day, I had a laptop that the company provided, and I was on my own.
I came to like home health, though it does have its disadvantages. In fact, as I write this, I’m on my fourth home health assignment. I’m not a member of the home health section, and I don’t work directly for a home health agency.
It makes no difference to me if you do home health or not, but at least consider it. Here are some reasons why:
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You might like orthopedics, but it's not exactly flexible.
You have to be somewhere at a specific time to see your patients. You have to be there at 8 am, you can’t leave until 5 pm, and you can’t be anywhere during that time except the clinic.
If you need to make an appointment with someone else, you have to take time off to do it. You have to do your errands later in the day. If something in the house breaks, you either have to take time off or wait until the weekend.
This is not the case with home health.
You can do your errands during the day and no one cares. You can schedule a dentist appointment in the morning and then go see your patients, because you make your own schedule. You can stop at a restaurant to get lunch. You can go home and use the bathroom and use your own kitchen.
I remember working in a hospital after doing home health. I felt like a factory worker confined to a building all day. I was trapped inside a cage until the day was over. Wearing scrubs only made it worse.
Once you taste the flexibility of home health you might not go back.
You make your schedule in home health. The scheduler assigns you patients and then you schedule the patients as you please. If something changes, then you call the patient. If the patient cancels, they calls you.
You can start your day later if you want. You can insert a lunch break whenever you want. You can stop for gas or stop at the post office. The schedule is flexible in home health.
Now compare home health to the outpatient clinic. The outpatient clinic has a very fixed schedule. If the appointments are only 30 minutes, then you can feel overwhelmed at times. Seeing 15-16 patients is not uncommon (I’ve heard of 25 in one day- avoid this situation at all costs). Working outpatient every day can be hectic.
If you can’t do an evaluation on Friday, then you can move the patient to Saturday and complete it then. I always preferred that because it gave me something to do on Saturday and it made my Friday less hectic.
For those of you who got into the field to build relationships, then you’re going to love home health. There’s no better way to build relationships than to be in the patient’s home multiple times.
You’re in the patient’s physical space for several weeks, and you can build solid relationships.
Compare this to the hospital where the patients are there one day and the next day they’re gone. In home health, you see patients over 4-8 weeks, or sometimes longer. Your elderly patients will not hesitate to share stories.
Because you’re in the patient’s home, you can do exercises that pertain to the patient’s needs. You can assess the situation, make recommendations on equipment, see potential barriers in the home, and design a program that is specific for the patient.
Some patients have steps or stairs, others don’t. Every patient has different needs, different demands, different goals, and a different home.
Have you taken NGPT's quiz to determine which physical therapy setting is best for you? If not, you need to take it. One of the questions asks you how much physical effort you want to exert during your job. If you answered, “not a lot”, keep reading.
Visits are only 45-50 minutes (evaluations are 1 hour, and if you have to do OASIS, probably 2 hours), but you’re doing a lot of charting. You’re talking with the patient. You’re there not only to do exercises, but to also monitor the patient’s status.
Even the rehab component itself is not demanding. You’re not going to be doing a lot of manual work. You’re not going to be walking around a lot like you are in the clinic.
The exercises are more simple in home health because your patients are going to be elderly and they’re not going to have a lot of capacity. In a future article, I will show you some exercises that work well in home health.
One reason some PTs go into home health is that their previous job was too demanding. Remember we’re doing physical therapy. This is physical work. This isn’t like being a radiologist.
Sometimes our jobs can be stressful. Manual therapy can be hard on the hands, and lifting and transferring patients can be demanding. In fact, PTs and other rehab professionals suffer from musculoskeletal injuries more than other professionals.
Pay and opportunity
Home health jobs usually pay better than jobs in outpatient clinics and hospitals. I’ve received offers for home health jobs that pay almost as well as travel jobs. If you’re willing to work in a rural area, the compensation can be excellent, and you will only be seeing 5 or 6 patients a day.
There is no shortage of home health jobs. At CSM, I met at least two dozen home health agencies across the country. You can work anywhere and anytime with home health. There is a home health agency in almost every county.
Another opportunity is to work PRN, or as needed (PRN= pro re nata in Latin, or as necessary). If you don’t want to do home health full-time, you don’t have to. You can do 1-2 extra visits during the day or on the weekends and add a few hundred dollars to your other job.
That’s the beauty of home health. You have tons of flexibility and freedom.
Start embracing home health
I hope you consider home health as a first assignment. It can be challenging at times and you may feel uncomfortable at first, but you will adapt. Remember, I had zero experience as a PT, and no experience in home health when I started, but I learned how to do it.
Home health offers freedom, flexibility, and opportunities that few other physical therapy settings can provide. You make your own schedule, never sit at a desk, never have to go to a building, don’t have to commute anywhere, and you don’t feel trapped in one place all day.
If you’re a PT who values autonomy, relationships, and flexibility, you should consider home health.
Finding a job won’t be hard and you will probably pay off your loans faster. So forget everything you’ve been told about home health and ignore the horror stories. Your next job is in your car.