COTA’s & Home Health
I think in my past posts, I've really touched on the LTC and salary/job topics the most. Since there are many COTAs involved with other areas, I thought today would be a good time for a change. One other area that COTAs work in is Home Health. I have seen many different "descriptions" of what home health is supposed to be, and have worked with many companies doing home health visits, so hopefully I can share some of my knowledge on this subject matter here.
First, home health consists of a visit/treatment in the person's home due to the fact that the person is homebound, or that attending therapy as an out-patient would be a hardship. These visits can be from a nurse, home aide, or therapist. There can be quite a difference of the actual time spent in the home depending on what type of visit you are completing, however for an Occupational Therapy visit I normally allow anywhere from 30-45 minutes.
The time spent for a visit has always been a disputed fact. I'm not really sure if there is an official regulation that states the recommended length of time a home visit should last. Some companies do develop their own guidelines; others leave it up to the therapist. I have heard of a few therapy visits lasting less than 15 minutes. With a visit this short, I wonder if anything therapeutic is accomplished.
Being homebound is another gray area. Normally home health is supposed to be limited to a homebound person, but an occasional doctor visit or other required trip outside the home is usually overlooked. For someone that shows it to be a hardship to attend therapy, consideration is also allowed. However, for a person who can easily and safely leave the home, whether that be by public transportation, a family member or friend, or drive themselves, they are not a true home health candidate. This determination is usually made by the nurse in charge of the case. Keeping the charge nurse informed of any discrepancies is one of your responsibilities though. I have shown up early at one home to find the patient just returning from a shopping trip where she drove to the store herself.
Working with a person in their own home is one of the best ways to assure that they are safe and capable of daily tasks. From basic ADL's to higher level home chores, I find it easier to teach someone a skill within their own environment. Making adaptations or recommending equipment is also much easier due to the fact that you can actually see the need or barrier of the space. This means that the therapist must know what types of adaptive equipment are available for many different areas. It is also helpful to know something about home design and construction, or have someone to consult should the need arise.
For documentation, I have always liked using a voice activated Dictaphone. This allows you to record any important notes about the visit to review later. After seeing several people in a day's time, this information will be invaluable and ensure you don't forget anything. With today's computer documentation, using a Dictaphone and software to convert voice to text is another helpful tool. This allows you to copy/paste parts of your documentation to forms specific to your company's requirements.
As far as job availability in home health for a COTA, this is something that I've found can really vary in different parts of the country. I have found that rural areas seem to have more need, but then you will be driving quite a few miles per day. Home health in a large metro area may mean fewer miles, but the possibilities of traffic jams or detours could mean more time spent in the car. Salaries are normally comparable or higher than LTC jobs, but one must factor in the costs of gas, higher insurance rates, and vehicle maintenance to your bottom line.
All in all, I find home health to be a great area to work in as a COTA. Use of modern devices such as GPS's and Dictaphones do make it easier. Mostly though, I find that working with a patient in their own home to be challenging, yet quite rewarding.
Until next time, hope all your thoughts are good,
Tim