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COTA Thoughts

Rural Therapy

Published September 8, 2013 8:48 AM by Tim Banish
I just returned from a trip out to the Midwest visiting family. They live in a small town with a population of around 4,000 people. Towns out there are miles apart, and the closest city for major shopping is almost an hour away. That got me thinking about my first job as a COTA, driving around rural Missouri providing therapy in small hospitals, nursing facilities and patient homes.

My route most days was close to 200 miles, and it was normal to be on the road for ten or more hours a day. I would stop in several small towns; see a patient or two in a nursing home, hospital, or their home. This was before GPS and cell phones, so directional skills were an important part of the job too.

Back then reimbursement was not an issue the therapists had to worry about, that was all handled by the office. We kept a simple mileage log and dictated notes for each visit. The dictation was transcribed by a secretary and the paper copy forwarded to each therapist for editing and signatures, then to the facility for filing.

But traveling around through all the small towns on this trip made me wonder what rural therapy is like these days. With the price of gas and vehicle maintenance today I imagine it has to be difficult. Many of us had a company car back then and all we had to worry about were oil changes and gas, and we were reimbursed once a month for those expenses.

So it would be interesting to hear from any COTAs out there who work in rural areas. Is reimbursement an issue these days? Do any companies still provide a vehicle? How does modern technology assist you in your job?


Until next time, hope all your "Thoughts" are Good-






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Thanks Hannah for your detailed plans while working home health. Much sounds the same as when I did it years ago, schedule by territory, a car full of equipment and paperwork, and all the progress notes once you get home. Home health is a fun setting.

Tim Banish, COTA/L, Retired September 12, 2013 8:29 AM
Cincinnati OH

Great question! The few years I have been in the field I have worked for 2 home health agencies. The basics demands are the same, but I am sure payment is much tighter. I enjoy this setting, but paperwork will kill you.

Organization: You make your schedule and routes. I use an old fashion day planner to plan a week in advance.  I set regular patients time frames (AM/PM) and regions based on patient preference to cut back on drive time and reduce missed visits by noting visits for doctors, PTs, and aids, yet give the patient control of their POC. Patients love knowing when to expect you!

Front load the week: I load my first few days up that way my cancelled/missed/sick patients still fit in late in the week without ruining payment. You get paid per visit. You do not get paid if you show up and you don't see the patient or if the patient went to the hospital and hasn't been seen by PT/RN for post-hospital OASIS, I have a few floater patients who are open to any day/time which is great to fill gaps.

Technology: Laptops are a growing resource, however, not every company provides them for home health. I was on paper for both companies, but that was not too bad. I don't know if I would have survived without my smartphone for GPS to new patients, calls ahead to patients, and texts to the office. However, GPS doesn't always get signal it in the mountains. Printed old fashioned maps of the area came in handy for shortcuts and visualizing my route for the day. I printed a map of my counties and penciled their initials in for quick access and shortcuts, especially because I was unfamiliar with the territory.

My personal therapy stash must haves: Theraband, theraputty, balance disc for sitting trunk strengthening/balance, tape measure, arm bike, straws, balloons, medium size bouncing ball, basic adaptive equipment (reacher/sock aid), blank paper, and handouts for ther-ex, safety, falls, energy conservation, colored duct tape, scissors, zip ties

Downsides: Paperwork, once you get home from approx. 7-8 45 minute sessions plus drive time you have to sit down and write a note on each patient to turn in the next day. I use my own car which is my therapy closet, office, file cabinet, lunch room, plus regular personal use off the clock. I get reimbursed $0.50 or less per mile, time doesn't matter in driving so whether I spend 30 minutes crossing a busy city a few miles or 30 minutes going 30 miles way out to the "heels (hills) or hollers (hollows) of KY" I get paid per mile. I record my miles, drive time, and visit times on paper time sheet. I probably average about 80 miles a day.

I love the setting, great application of occupation! But whew, it can be very taxing at times.

Hannah, Home Health - Occupational Therapist September 10, 2013 11:56 PM
Central-Eastern KY

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