Home Health presents many variables and challenges that don’t exist in other rehabilitation settings.  For example, in outpatient, the initial evaluation is scheduled for you.  You make your own schedule in Home Health.

Here is a list of tips and suggestions I find extremely helpful when I do Home Health evaluations.

Scheduling

• Call in the afternoon the day before the visit. Patients are more likely to answer the phone in the late afternoon vs before 9am.
• Confirm the address and ask if there are special directions the home. Many times I have been assisted by patients telling me not to follow the GPS directions.
• Confirm what door to enter. This saves time knocking on a door that the patient does not use.
• Inform the patient of the length of the evaluation to set clear expectations.

Review the Patient’s Chart Ahead of Time

• Write down the principle diagnosis, past medical history, hospital admit and discharge ahead of time.
• Confirm with the patient upon initial introductions.  This facilitates trust with the patient.  Before I started this routine I often heard this complaint from patients:  “Why do I have to tell my history to everyone. Don’t you have that written down in my chart?”  In other words, shouldn’t you know this already?

Explain the Evaluation

• Set expectations regarding what you will be assessing.
• Instruct the patient you plan to assess their balance, strength, walking, transfers and safety.  I need to see how you get in/out of bed, on/off the toilet, and generally how you move in your home. This decreases patient resistance to walking to bedroom and bathroom.

Concurrent Documentation

I understand that concurrent documentation is a high priority and employers want us to document as much as possible in the home.  I inform the patient what I am doing.  I tell them that I need to input their vitals and test results into the computer.  I also try to educate them as I input information.  For example, as I am input their TUG, MAHC score, I educate the patient what their score tells me about their fall risk.

Home Exercise Program

• Before you begin to instruct the patient in their exercise program, tell them you plan to quiz them on the program before you leave. This creates the expectation that they know and understand the program.  I often have patients instruct me how to do the exercises, to prove to me they understand.  Or, I perform an exercise and have them point to the exercise on the list.
• I use highlighters to make it easier to read and identify the exercises on the list.

Plan of Care

• Instruct on the frequency and what physical therapy is going to focus on – strength, walking, stairs, etc.
• Write down the frequency for the patient so that expectations are clear.
• Follow up visits: If you will not be following up with the patient, provide the name of who may be seeing them.   This facilitates the next visit.  When I call a patient and he/she says, “I was expecting your call, Jill the RN said you would be calling.”  It saves time explaining why you are calling and shows the patient the agency has good communication and that creates trust.

General Hints

• Make sure you document the patient’s goal and incorporate that into your plan of care. For example, just this week I had a patient tell me their goal, “I want to be able to attend my grandson’s football game.”  What a great motivating goal!
• Make sure you capture the patient’s subjective information in the home. After 4 hours it may be difficult to recall what each of your patients told you.

Summarize the Evaluation

• Tell them the summary of your findings and review any physician precautions such as sternal, total hip or weigh bearing. For example, “Ms. Smith,  based on the balance tests we performed I am recommending that you walk with the 4ww and remember to adhere to your total hip precautions.”
• Review the frequency and plan of care.  For example, we plan to see you twice a week for the next 3 weeks and we will focus on walking, balance and strengthening.

I hope you find these tips helpful and you consider using them in your next Home Health evaluation.  As always, if you have additional tips you found to be successful, please share them!  I am always looking for tips and suggestion to improve in my practice.

In addition, if you are considering working in a home health setting, we talked to a few therapists who have experience, and here is what they said.