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Occupational Therapy is a specialty that aims to develop, rehabilitate, or help manage a patient's ability to perform activities required in daily life. Common for patients of all ages, Occupational Therapists work with individuals such as impaired/injured children and adults, or the elderly.
Home Health OTs are unique because rather than working out of a clinic or nursing home, care is provided at the patient’s individual home.
To become an OT of any kind, you’ll need your Masters Degree or Ph.D. in Occupational Therapy, with a Ph.D. requirement on the horizon for 2027. This will take about 2-4 years post-baccalaureate, depending on your school and degree level. This time will also include your Clinical Fieldwork, where you will spend 3 months each working full-time at 2 different facilities, training under a Clinical Supervisor. Once you have passed, you will move on to your NBCOT exam. People usually study for about 6-8 weeks, although this varies widely on the person. While it is possible to get a temporary license while you await your results, most apply for licensure once they have verified that they passed.
At present, Occupational Therapy does not have any compact state licensure like some other healthcare disciplines. This is when state boards join together and only require one license to work in that group of states.
The difficulty of obtaining licensure varies incredibly between states. Your approval could take anywhere from 48 hours to one year, so plan accordingly. If you wish to obtain more than one state license, you will have to prove your good standing with all of your other licensure boards. For this reason, if you intend to work in more than one state, it is highly recommended that you apply to each state you think you may work in at the same time.
Home Health is considered a ‘setting’ in healthcare where providers attend to patients in their home. It is generally the step between the hospital and outpatient treatment (if needed). To qualify for this service, the patient must be safe and independent enough to take care of themselves at home with the help of their household members, but not able to get to an outpatient facility safely.
As a Home Health OT, our responsibility is to first make sure the patient is safe, by checking their vitals, medication management, and home for any safety hazards. Once general safety is addressed, we help our patients with what we call ADLs and IADLs. What are IADLs and ADLs? Those are terms that you will use every day for the rest of your life, my friend.
ADLs stand for ‘Activities of Daily Living’.
IADLs stands for ‘Instrumental Activities of Daily Living.’
ADLs include anything the patient needs to be able to do to take care of their basic needs. Examples include toileting, bathing, dressing, self-grooming, and eating. Think for a second. What would someone need to do to be able to brush their teeth? Use a toothbrush? Yes. But what about getting up from where they are sitting? Or getting to the sink. Or being able to stand there for several minutes while using 2 hands to reach for the toothpaste and get it on the brush. This is how an OT’s mind works. ‘What is everything this patient needs to be able to safely complete this task?’ We do this by improving the patient's abilities or modifying the task/environment to suit their capabilities.
IADLS can be thought of as the next step. After a patient can safely take care of their basic needs, we take the same approach to the next level of independence needed. IADLs can include cooking, cleaning, money management, medication management, transportation, and anything else that the patient values in their daily life. I often approach patients’ IADLs in this way. I tell them that I am there to help them with whatever they need and ask what that is. When the patient chooses the activity they are both accomplishing something that has been bothering them and exercising without even realizing it.
I once had a woman with a diagnosis of obesity in conjunction with many other comorbidities, who lived in what was approaching being considered a hoarding house. When I asked her what I could help with, she asked me to help her set up for a garage sale. Why is this considered OT and covered by insurance? Because safety is our first goal, and by helping prepare for the garage sale, she was not only exercising but clearing a path to her kitchen and bathroom to be able to complete her ADLs easier.
As a Home Health Therapist, you are mostly on your own and will probably only see the office when you need supplies. You may run into your co-workers at patients’ houses but generally try to schedule around each other to keep you both on schedule.
First thing in the morning you’ll check your company-issued tablet for email updates, software updates (yes, there are that many), and then your patient list. You will have scheduled your patients the evening before to make sure each would be home before you start mapping your route for the day. You will also organize your medical bag and make sure you have the supplies you need.
Most facilities are lenient on what we wear, ranging from khakis and a polo to scrubs or scrub bottoms and a t-shirt, which is what I usually wear.
On a typical day, you might see 4-8 patients and drive anywhere up to 150 miles between patients’ homes. Don’t worry, your drive time is considered and there are only so many hours in your shift. Generally, facilities expect you to complete 5-6 visits per day. Expect that deviations in your schedule will happen, and some days this productivity level is not possible. Your patient may have a medical issue, and you need to wait for EMS or your patient could be not home, or they are with another provider. Schedules change and you will have to be very adaptable.
After an evaluation, or if there are any concerns for the patient or updates to their plan of care, you will need to call their overseeing physician for approval.
Regular visits last for 30 mins to an hour depending on their needs that day, while an evaluation can take an hour or more. When you walk in, you will take their vitals, check their medications, and ask a series of required questions. If there is nothing abnormal in your findings, and your patient is responsive and attentive, completing this and documenting it will take a minimum of 10 minutes. With the rest of your time, you can work with the patient and family on their goals and are expected to also document point of service (POS). Personally, almost all of my patients require my assistance for the duration of the session, so I document part of the note in my car after leaving the home. I often finish my documentation at home that evening. You will also need to track your drive time and mileage for reimbursements later.
After a few patients, you can schedule a break for lunch, although many of us prefer to eat in the car and complete the day earlier.
After I have seen my last patient, I will change out of my scrubs, finish documentation and call my patients to schedule the next day.
- Pack food and water so you can eat between patients.
- Lean on your team. The other providers treating your patient are usually happy to talk to you about concerns and goals.
- If you don’t know, call the nurse/case manager. If you can’t get ahold of them, call the doctor.
- Always document who you talked to, their title, and day/time.
- Get familiar with where you can stop to use the restroom.
- Stay organized by tracking your miles and important details at POS.
- Call your patients the night before to confirm their appointments and try to schedule them en route to each other.
- Give your patients a window of time that you will be there, not an exact time.
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