By: Jena H. Casbon, MS CCC-SLP and Sarah Castro, MSPT
For many speech, occupational and physical therapy providers, conducting treatment sessions in patient’s homes is part of their daily routine. Whether you are an Early Intervention or homecare provider or work in private practice, there are unique opportunities and challenges that arise from working in the home setting. Because most in home therapy providers often work independently, there can be questions about what to do (or not do) in various situations. While the clinical aspects of working in the home setting are often clear cut, some of the social aspects can be a bit unclear and ambiguous.
The following list of “do’s and don’ts” to consider is a collaboration between a Physical Therapist working in Early Intervention and Speech-Language Pathologist working in private practice.
DO
Provide Excellent Therapy
This goes without saying. No matter which treatment setting you’re practice in, you should provide the highest quality care using evidence-based practice. Therapy in the home often allows for the greatest therapeutic gains and generalization as its taking place in their natural environment. Sadly, some clinicians provide sub-par treatment when they are in homes because they are often alone and are not being supervised. They may also fall into the trap of socializing with parents/family more than working with the patient. You’re only there for a finite amount of time and your job is to provide quality care during that session.
Use the Natural Environment
In home therapy often provides excellent generalization and greater clinical gains than any other setting. You can certainly bring your own treatment materials in, but also remember to use familiar toys or household items as part of your therapy session. You can also train parents/family members to use their toys/items between therapy sessions as part of their home program after you’ve left.
Engage the Family for Increased Generalization
While your direct therapy should be focused on the patient, as much as possible/appropriate, you can involve the parents/family members in the session. If you’re working on communication, use the family members as a communication partner. If the child is learning to walk, have the parent stand across the room and have the child walk to them. Involving the family also increases the chances of generalization and practice while you’re not present.
Accept Small Gestures from Patients (but Not Big Ones)
Because you’re doing something beneficial for the patient, often times family members feel guilty and want to pay you back. If families offer you something small, like water or iced tea, feel free to accept it as long as it doesn’t disrupt your therapy session. You have to be careful that the family doesn’t start to feel obligated to provide the item and that they don’t start offering bigger items as time goes on. In some cultures, it is rude to not accept gifts, but you should still limit this to a small food/drink item. Don’t accept material items and when in doubt, say no.
Practice Safety First
Going into patients homes gives you less control of your environment. If you’re ever in a situation in which you feel unsafe in a patient’s home or their neighborhood, just leave. Your physical safety is extremely important. If you feel that something unsafe is occurring within the home, you have a responsibility to contact either DSS, the police or both. If you fear that the family may retaliate against you, you can withdraw yourself from the case or discharge the patient.
DON’T
Overstep Boundaries
You are a professional service provider and your job is to provide a therapeutic service. While socialization is often part of the therapy session, you need to keep the session focused on the patient, not yourself. Patients and their families may share personal information with you, but you need to be careful about sharing your own personal information. If ever start to feel that we’re getting too personal, I might say something like, “We’re here to work on your daughters walking. Let’s keep focused on that,” or something to that effect. Don’t talk about religion, money, politics, your love life, etc. and please, don’t “friend” your patient or their family on Facebook.
Be Late or Inconsistent
Being late or inconstant for scheduled treatment sessions is extremely unprofessional. It is disrespectful to the patient/family and makes both yourself and the profession look bad. Additionally, delivering inconsistent treatment will mean less progress for the patient. On the rare occasion that you are running late or have to cancel, call the patient immediately, apologize and try not to let it happen again.
Do Anything Questionable/Unethical
Doing anything ethically or physically harmful (or not doing something to help) to your patients can result in you losing your professional license. Because your professional license provides your livelihood, you need to be especially careful to protect yourself from losing it. Additionally, since the therapy occurs “behind closed doors” of the patients’ home, if an incident is ever reported, it will be your word vs. theirs. Just do your job and leave.
Be Afraid to Discharge if you’re Not Comfortable With Something
Occasionally a therapist is not a good match for a patient. If you’re not comfortable in a home therapy situation, discuss it with your supervisor or a close colleague (don’t violate HIPAA though!). If you feel that boundary lines have been crossed or that there is a safety issue occurring, you may need to refer the patient to a new therapist or discharge them from services altogether. Sometimes having a new clinician might eliminate the problem. If you are referring on, give the new clinician a heads up as to what the issue was, so as not to blindside them and never put a colleague into a dangerous position!
Forget to Record Your Mileage
Driving for work is a tax-deductible expense. Many Early Intervention and home care companies will reimburse clinicians a certain amount of money per mile. If you’re an independent contractor, you can keep track of these miles and deduct them according to the annual IRS mileage rate. For 2011, you can deduct .51 cents per mile for business miles driven. Say in one year you drove 8,000 miles for work. You would be entitled to a $4,080.00 tax deduction. Those miles add up so keep track of them!
Treating patients in their homes can be extremely rewarding. We hope that these tips will help you feel more comfortable about some of the do’s and don’ts that often arise on the job. Best of luck!
Featured Contributors: Jena H. Casbon, MS CCC-SLP and Sarah Castro, MSPT
Jena H. Casbon, MS CCC-SLP and Sarah Castro, MSPT are private speech and physical therapists based in New Orleans, LA. In their spare time, they teach SLP’s, OT’s and PT’s how to achieve their dream of starting a part-time private practice on www.IndependentClinician.com. Follow the link to learn more about starting your own private therapy business.