By: Melissa Cooprider, MS, CCC-SLP, Therapy 2000
Unbeknownst to most people, home health therapy can actually take place at a variety of settings. This could be in the patient’s home, at a family member’s home, or in a patient’s community setting such as a fast food restaurant or park. A full-time pediatric speech-language pathologist (SLP) in a home health position will typically see 28 patients per week (20 for part-time and six for PRN [as needed].) The schedule is determined by the clinician, who generally has a territory within 30 to 50 miles from their home, depending in part on whether the therapist treats in an urban or rural area. Most home health companies do pay mileage or offer company cars to those who drive further out. Very often, SLPs treat Monday through Thursday and use Friday to complete make-up visits, evaluations, and documentation. Some home health companies have regional offices, but most of the time, a home health therapist considers their own home and their car to be their “office.” Patients are treated individually, and it is best practice to have the caregiver in the session for training. Visits last 30 to 45 minutes, and evaluations may take up to an hour. A family-centered approach is key to success in pediatric home health. Goals must address the functional skills the patient needs for successful feeding or communication while at home or in community settings. Informal assessment and parent interview are just as important as standardized evaluations in a home health setting.
Many home health patients are too medically fragile to travel to a clinic for therapy. Sometimes these patients get therapy through both their school and a home health agency. When this is done, Medicaid (a primary payer for home health) would like to see different goals targeted for each setting. Some of the children seen through home health agencies are on homebound status and present with trachs and feeding tubes. Feeding therapy is a large part of a home health SLPs caseload. Babies released from the NICU will often transition to home health therapy. Children who age out of early childhood intervention (ECI) (at age 3) and need continued service also may transition to home health. A pediatric home health agency will serve patients between birth and 21 years of age.
Patients may present with a wide array of issues ranging from a language delay or articulation impairment to aspiration during swallowing. Augmentative communication needs revolving around the use of an augmentative and alternative (AAC) device also may need to be addressed. Many agencies also offer physical therapy (PT), occupational therapy (OT), and/or nursing care. It is always beneficial to carve out time to consult with these other providers regarding patient progress, scheduling, and OT or PT strategies that can be used during speech therapy sessions.
In the home health setting, patients are typically offered to therapists based upon the clinician’s skill level and territory. Once a patient is accepted by an SLP, a request for approval of an evaluation is sent to the doctor and the Medicaid/Insurance company. Once authorization is given, the SLP can meet the family at their home for the initial evaluation. Patients are usually treated for six months at a time. Re-evaluations are completed every five to six months. Patients may be seen two times a week, once a week, or even once a month, and services may continue for three to four years. It is all dependent on the nature and the severity of the issue. The home health setting offers immense flexibility, the opportunity to work directly with families, and the ability to see patients one-on-one. However, a home health therapist must have the ability to work independently, strong organizational skills, and excellent interpersonal abilities.
Procedures typically performed in a home health setting:
- Speech, language, and feeding/swallowing evaluations and treatment
- Communication and training with families, nurses, and other caregivers
- Communication with OT, PT, school therapists, physicians, and other medical professionals
- Request for and analysis of MBSS
- NMES and sensory feeding
- Transitions from trach to Passy-Muir valve
- Weaning patients off feeding tubes
Patients often seen in a home health setting:
- Infants transitioning home from NICU with feeding/swallowing issues
- Children with autism, Down syndrome, genetic disorders, or neuromuscular diseases
- Children in the foster care system, with a history of trauma, neglect, and/or abuse
- Children from indigent families
- Children with TBI
Additional resources for SLPs getting started in home health care can be found here: https://www.asha.org/slp/healthcare/start_long/.