Therapist

Pros and cons of home health physical therapy

Think back to when you decided to go to PT school. What initially drew you in to pursue a career in physical therapy? Maybe it was the opportunity to help others heal or the fact that you yourself were an athlete who enjoyed physical activity. Perhaps you were exposed to the power of physical therapy early on in life or simply held a profound interest in the human body.

Now, fast forward to today. How are you liking your physical therapy career up until this point? Is it everything you ever wanted? Or, if you’re getting ready to graduate PT school, are you confident in the career path you’ll take?

Whether you choose to work in a hospital, clinic, or in patients’ homes, there are so many ways to work as a physical therapist. Today, we want to help you explore the pros, cons, and possible alternatives to one of your PT career options–home health.

What is Home Health Physical Therapy?

Home health physical therapy is a form of physical therapy that relies on physical therapists who typically work under a staffing agency or contracted facility to deliver PT care to patients in their homes on an assignment-by-assignment basis.

Here are just a few of the pros and cons associated with a career in home health for physical therapists.

The Pros of Home Health Physical Therapy Jobs

Less Stress

Outpatient clinics are notorious for overbooking physical therapists to keep up with the demands of the modern healthcare system. One physical therapist sums up the stress of outpatient work well, “…I hated having 13+ patients to treat in an 8-hour day. It was hectic and I felt like it was hard to maintain quality care because you’re rushing to get all your patients in.” 1 Many physical therapists find the setting, pace, and one-on-one nature of home health care less stressful.

Higher Pay

According to PT Progress, the average salary range of a home health physical therapist is between $77,000 and $88,000. Compare this to the average salary of an outpatient physical therapist at $79,629. The amount you make as a home health physical therapist depends on a number of factors like where you’re located, how you’re paid (hourly, per visit, or salary), and more. Because patients are paying more for the added benefit of care being delivered in their homes, home health jobs can offer higher pay than other types of PT careers.

Schedule Flexibility

For some physical therapists, home health can feel like a welcomed reprieve from the grind of working in a typical PT clinic. Here’s one physical therapist who found balance in his schedule with home health: “I start at 9:30-10 and end my day between 2-3pm. Take off when I need to for appts, car maintenance, skiing half a day, etc. without my pay being affected.” 1 This kind of schedule flexibility is not typically possible when working at a clinic or hospital.  

The Cons of Home Health Physical Therapy Jobs

More Paperwork

While paperwork is an everyday reality for most physical therapists (but not all!), home health assignments require even more documentation than other types of PT jobs. To meet stringent compliance demands and justify high prices compared to clinic visits, home health physical therapists are managing anywhere from three to four times the amount of paperwork compared to other fields of physical therapy.

“Keep in mind the amount of paperwork is ungodly – I spend more time calling doctors, updating charts, documenting and trying to get equipment for patients than I do actually treating the individual. That and you usually have to answer to family members, adjust your day to your patients time constraints and sometimes spend your weekend catching up.” 1

Limited Patient Profile

Keep in mind that many home health patients can’t leave their homes. Some have undergone surgery while others are bedridden and nearing the end of their lives. Treating this type of patient can be exciting and fulfilling for some physical therapists, but for others, it can feel like a heavy burden. Because these patients are typically inactive, treatment options are limited and PTs won’t have the opportunity to apply the same type of problem-solving that they can on other types of patients.

Potentially Shady Agencies

While there are plenty of legitimate home health businesses out there, many of the agencies that hire physical therapists are not-so-legit. Many have been caught up in false billings, fraud, and scams. If you choose a career in home health physical therapy, do your due diligence and vet the agency before signing anything.

So, do the advantages of home health outweigh the disadvantages? Only you can decide. It’s all about choosing what’s best for you and your physical therapy career.

Is There A Better Alternative to Home Health?

Historically, home health has been the only available alternative to more traditional outpatient or hospital physical therapy roles. If you don’t want to work in a clinic but aren’t willing to settle for the more limited patient profile and hours of paperwork associated with home health, we’d love for you to consider Luna.

Luna is offering something completely new to physical therapists by combining the best aspects of outpatient and home health. Our physical therapists serve the outpatient patient population in their homes while enjoying total autonomy. You can check out the top reasons why physical therapists are choosing to work with Luna right here.

1. RevolutionaryPost6. “Pros and Cons of home health: Comments” Reddit. Reddit, Inc. Web. 2019 March 3.

home health physical therapy

When I first learned about home health physical therapy I wasn’t sure if I was cut out for it.  To be honest, the idea of going to someone’s house as a home health physical therapist made me feel a little nervous because I wouldn’t have the security blanket of a clinic and all the equipment I was used to having. 

But like so many outpatient physical therapists, I reached a point in my career where I wanted to earn a little extra on the weekends.  So when the opportunity became available to work as a weekend home health PT, I thought it was a great way to test the waters in home health. Eventually I added more home health hours because it was so much more flexible than my clinic work. 

(I realize you might be an occupational therapist, speech language pathologist, or even a nurse considering home health. When I reference “home health physical therapy” I really believe all of these points can cross over to OT, SLP, and nursing. It’s just that I’m a PT, so I’ll reference home health this way during the article 🙂 )

Should I Do Home Health Physical Therapy?

I asked myself the same thing…for almost a year actually. I was an outpatient PT through and through. I never wanted to do any other kind of physical therapy.  But after making the switch, I’m glad I did. For me I ended up working part time as a home health physical therapist and part time in the outpatient setting (eventually going down to PRN at the outpatient clinic.) 

But I get it.  It’s a difficult decision to go into home health, especially if all you know is outpatient ortho PT.  

Hopefully this article will answer the questions you have about becoming a home health physical therapist and give you an idea what it’s like to make the jump. 

Why Do You Want to Work in Home Health?

You’ll probably hear this question in an interview, so it’s important to have an answer (besides the usual answer “because I’m burnt out of outpatient PT”).

The truth is, a lot of outpatient PTs become burnt out and want something different. So they learn about home health and eventually make the jump for various reasons.  

Here are some of the reasons I wanted to work in home health:

1. Ability to Treat Patients One on One

From a treatment standpoint, the best part of home health is the ability to work one on one with your patients. There’s no overlapping or having two patients at once.

2. I’m a team player, but enjoy working independently.

You’re flying solo as a home health PT, but it doesn’t mean you won’t work with a team of therapists. Sometimes you have to cover someone’s patient or you may be asked to adjust your schedule on the same day. But for the most part, you manage your area and patient load without the extra drama you might have in an outpatient clinic. 

Don’t get me wrong…you can still have some drama in home health. It’s just significantly decreased.

3. Schedule Flexibility – Hooray for Shorter Days 

In home health, you definitely have more of a flexible schedule to take care of personal things throughout the day. The ability to stop at the store between patients or to swing by the post office in the middle of the afternoon is a pretty nice perk of the job!  While most agencies allow you to make your own schedule, it’s very common to have last minute add-on evals or treatments if you’re working with a team of therapists. 

4. Increased Pay! 

Let’s face it, you make more money in home health. While it’s not the first thing I’d say during an interview, it’s nothing to be ashamed of.  The ability to provide one on one care and also feel like you’re being fairly compensated for the skilled treatment you provide is a beautiful thing!

Other Perks of Home Health:

Time for Audiobooks & Podcasts -I enjoy driving and listening to podcasts and audiobooks, so you’ll definitely have the time to do this as a home health PT!

Home early, but….  You’ll probably be home by 3 or 4 in most places but if you didn’t keep up with your notes, you’ll probably spend an hour or more typing at home. (More on home health documentation below).

Avoid Rush Hour Traffic – Yes, you’re driving all day, but I found that my day usually started around 9 and ended around 4, which meant I missed the traffic. 

Home Health Physical Therapy Jobs

Not all home health therapy jobs are created equal. You’ll find a wide range of agencies, from small family owned practices to moderate and even large agencies with 1,000+ employees throughout the country.  I’ve worked for both a smaller regional home health company and even one of the largest home health companies in the U.S. There are pros and cons to both.  

Small to moderate agencies can often move quickly with changes (which happen a lot in home health).  For self starters and people who like learning material on their own, this might be a good match as they usually don’t have a lot of resources like an entire education team.

For larger home health agencies, you’ll probably find some with dedicated education and compliance teams with in person training and constant updates via email or webinar.  Larger agencies definitely have more support for field workers, but they might also be a little more strict in terms of documentation as the agency is large target for insurance companies that like to nit-pick notes and refuse or reduce payments (don’t get me started).

Here’s a Look at a Day in my Life of a Home Health Therapist!

What About Home Health for New Grads?

You might have heard someone tell you that you should work in an outpatient or acute setting before going into home health.  You don’t have to, but you better have some good references from clinical instructors. The home health agency wants to make sure you’re ready to be independent on the field since it’s not easy to call over another therapist like you can in the clinic setting. 

A lot of home health therapy job descriptions will say you need one year of experience before applying for the job.  But if you’re a confident therapist right out of school with no experience or less than 12 months of experience and you’re 100% sure you want to do home health, I’d encourage you to apply.

The agency might extend an extra week or two of mentoring or even have a new grad program available!  

Part of why I created the home health documentation templates and exercise flowsheet templates is to help new grads and existing therapists who are intimidated by entering a ‘new field’ of PT.  It’s like a fast track to feeling confident with your documentation, organizational skills, and treatment progression.

Part time, weekend, full time positions

If you’re looking to get into home health but only see a part time position, still apply.  The position may expand into a full time role, but honestly, I really enjoyed working part time in home health and part time in the outpatient clinic. It gave me a well needed change of pace and I think it’s a great way to transition into a bit of variety within the field. 

Home health also gives you the chance to pick up weekend shifts. Some positions are strictly weekend, while some agencies require you to work 10-12 weekends a year.  

There’s a trade off in any career and with home health, working weekends is one of those tradeoffs.  Unless you’re trying to pick up weekend shifts to pay off your student loans faster, then it’s nice to have the opportunity to earn a little more!

Home Health Physical Therapy Salaries

So how much does a home health physical therapist make.  You can see exactly what I make in the video below.

Typically home health agencies pay one of three ways:

  • Per patient visit – This is my preferred method of pay in home health. You’ll often earn more when performing an evaluation or start of care appointment compared to a follow up visit.  Some therapists prefer to only do evaluations or start of care visits, which can take longer, but pay a bit more.
  • Hourly – I found many PTAs in the agencies I worked for were paid on an hourly basis. This isn’t a bad compensation model by any means, but you can expect to have your productivity standard monitored closely.
  • Salary – While it may seem like an attractive option to earn a salary in home health, it may place a cap on your earning potential.  There’s definitely a balance here because on a salary, you will likely have less control of your patient volume and how many you see per day.  When paid on a per visit basis, it’s nice to have the option to choose to add a patient visit to your schedule. When you’re paid on a salary basis, you won’t have that luxury to say no when the scheduler asks you to add someone to your schedule.

Home Health Vehicle Stipend vs Mileage

Some home health companies provide vehicles to their field workers while others simply have you drive your own vehicle and pay you for your mileage.

Since every company is different, I’ll share my experience with mileage reimbursement for home health vs using one of the provided vehicles.

Company Vehicle Stipulations:

If you wanted to drive one of the company provided home health vehicles (which was a base model Jeep Cherokee for our company) you needed to be a full time employee.  They also required you to meet a certain level of productivity in order to be eligible for the vehicle. You were allowed to drive the car for personal use and the company paid for the fuel in the vehicle. 

While this may sound like a great deal (and plenty of people drove company vehicles) you could also choose to drive your own car, which had other benefits as well.

Mileage Reimbursement: Driving a Personal Vehicle for Home Health

The mileage rates for the company were based on federal mileage reimbursement standards ($0.58 as of 2020), however, the mileage did not start until 30 miles were already driven that day.  Some days I wouldn’t even drive 30 miles, so no mileage was collected. Other days I would drive 100 miles, so I’d see approximately $40 added to my paycheck. Of course, mileage was my only option as a part time home health PT. 

How to Choose: Mileage or Company Car

If you are more comfortable with your own car, drive it.

If you’d rather put miles on a company car, drive the company car.

There’s not one answer, because every company is different. But it’s smart to do a little math before choosing between options.

Before signing up for the company car, make sure you consider the productivity requirements and any stipulations that may result in lowered pay to cover the lease payments if you don’t meet the productivity standards.  

If you choose to drive your own car, consider the gas mileage of the vehicle, the reliability, the cost for accelerated maintenance, and even the possibility of increased insurance premiums for driving your vehicle more miles for work. 

Why I Drive My Own Car

Personally, I enjoy driving my own vehicles, so regardless of the cost savings or extra benefit of a company car, it wasn’t worth it for me. I’d rather drive my own car and accept the fact that miles will rack up and the reimbursement on long drives pretty much turned into a wash for the gas I used and miles added to my car. 

It’s also important to check with your accountant because there are rules about claiming mileage for work purposes, and you cannot claim mileage twice on your taxes and through work reimbursement. 

Low Census: Is there Guaranteed Pay?

If you’re not familiar with “low census” it simply means the volume of patients in your area is down and there may not be enough work to keep your schedule full.  When that happens and you’re salaried, it’s not a huge issue because you’ll still get paid. But if you have low census in your region and you’re paid per visit, your paycheck will decrease as you see fewer people for the week. 

The pay for hourly employees can also fluctuate if there is low census because the scheduler may ‘send you home’ early if there isn’t anyone to treat.

I bring this up because every region is different and every company is different.  

Ask the recruiter about the company’s history of low census and how they’ve managed fluctuations in volume over the past year.

Not only will that set you apart from other applicants, you’ll learn a lot about how they handle changes in volume and what to expect. 

Don’t be afraid to ask “what percentage of the time would you estimate the therapists are able to meet their recommended productivity standards?” 

This will help you as you estimate the volume and even pay potential if you are compensated on a per patient basis. 

Home Health Physical Therapy Pay Example:

For example, if a part time PT earns an average of $65 per visit and can expect to provide 15 treatments a week, their weekly pay will be approximately $975 a week.   

Many times a ‘full time’ status field worker will see 25 to 30 patients a week, earning between $1,625 to $1,950 a week in our example above. That’s approximately $84,500 to $101,400 a year. 

But, let’s say the company has a history of meeting productivity standards 90% of the time.  

I would personally calculate my expected annual earnings based on this 90% and maybe even 80% to be safe.

So even though meeting full production could result in me earning $100,000 as a home health therapist, I would use $80-90,000 as an estimate for potential earnings.  This is especially helpful when you’re trying to decide between jobs or other opportunities like travel PT. 

Home Health Physical Therapy Pros and Cons

If you’ve made it this far, you’ve had a glimpse into some of the pros and cons of home health.  Let’s dive into a few more pros and cons because I’m pretty sure you won’t find too many people sharing these kinds of details in other places.

Pros of Home Health:

Hour Flexibility – There’s nothing better than having flexibility in you schedule, especially if you need to work around daycare, school, or managing other tasks that are difficult to do with a standard 9 to 5 job.

Job Autonomy – I love home health for the autonomy I have as a PT to provide treatment as I see fit based on the patient’s need that day. I don’t have to make a clinic manager happy because I billed 4 units or provided heat and e-stim (which I haven’t done with a patient for 3 or 4 years now in the outpatient setting anyways…)

Increased Pay – When you realize that you can earn just as much as an outpatient clinician but work 60% fewer hours, it’s hard to dislike the increased pay potential of home a health. 

Cons of Home Health:

Home Health Documentation – I’ll go into more detail below, but the #1 downside to home health is the documentation. It takes longer, it’s more cumbersome, and it can feel like you’re learning to write notes all over again if you’re just starting out.

Entering Filthy Homes – Not all homes are like this, but I would say 50% of the homes I entered on a daily basis were pretty gross. You always need to think about where you’ll place your bag and where you’ll sit. Look for hard kitchen chairs to sit on and avoid couches or soft furniture (you never know who or what has peed on them).  

Schedule Management – If you’re an organized person, this will be a piece of cake. But the issue I found most frustrating is when you show up to a person’s house and they aren’t there or they refuse PT because they’re not feeling well.  Plus, when you have someone cancel in the middle of the day and want to move people up so you can be done early, you need to call them and make those arrangements yourself. It’s not a huge issue, but it’s just one of those ‘little annoyances’ of home health PT.

Equipment Shortages – Sometimes you forget to restock your supply of therabands or exercise handouts and you have to figure something out on the fly!  While a little preparation can help with this, it’s still a challenge to make do with what you have because you don’t have access to an entire gym like you do at an outpatient clinic. 

Home Health Physical Therapy Documentation

I started my first home health job working weekends within 6 months of graduating PT school.  I quickly learned that providing treatment was the easy part. Writing home health documentation was the real challenge.

Why Home Health Documentation is So Bad

First of all, home health is reimbursed at a much higher rate than other services. So with this increased reimbursement comes increased focus on making sure the services are skilled and necessary.  The best way our current system does this is by requiring extensive documentation, especially for home health.

Secondly, most home health documentation systems feel outdated and clunky.  There are so many sections to fill out during a standard visit compared to an outpatient clinic visit.  In the outpatient setting, a typical visit follows the standard SOAP note format. Sure you might add a few extra items, but the SOAP format covers most of what you need to document.  In the home health setting, you’re required to document so much more on every visit, from identifying home bound status to environmental barriers, the documentation becomes very long for standard visits and even longer for evaluations. 

Thirdly, most of the time you’re using a tablet with a tiny keyboard and navigating a new documentation system can be hard to get used to.  Even after 6 months, I used my own documentation cheat sheets to help speed up my notes.

How I Saved 30 to 60 Minutes a Day on Home Health Documentation

While it is nice to be done with patients by 4:00 every day, the challenge was finishing my notes for a full day of patients within two hours!  I eventually started to figure out how to become more efficient with my documentation and created a system for speeding up my note writing. It ended up saving me 30 to 60 minutes a day, which is huge for any therapist who understands how painful it can be to take notes home with them after a long day.

You can read this article if you’re interested in seeing my system of speeding up home health documentation.

Home Health Physical Therapy Companies

I’ll end with a word on Home Health Physical Therapy Companies. There are a lot of home health agencies out there and just like outpatient clinics, some are great and some are not so great. 

When you start the process of applying for home health jobs, realize that you are interviewing this company just as much as they are interviewing you!

Come prepare with questions that help you understand what you’re about to get involved with.  Here are a few questions you can use during your home health job interview:

  • What makes your agency different than other home health agencies?
  • How much time is spent with on boarding and mentorship for new employees?
  • Over the past 2 years, what has the turnover rate been with the agency?
  • What percent of the time do you estimate field staff are able to achieve their productivity goals each week?
  • How much weekend or holiday call is expected of full time / part time field staff? How is this determined each year?
  • What educational opportunities are available to stay current? 

Conclusion: Is Home Health Right for You?

I have no doubt that any licensed PT/OT/SLP or nurse can figure out how to do the daily work of a home health clinician.  Sometimes the work is repetitive and sometimes you might feel like it’s not as exciting as an outpatient clinic.

But you are impacting people when and where they need the most help – in their home!  You have the unique opportunity to make such a huge difference in their lives and to see firsthand how your work impacts their ability to live in their home. 

Sure, the work isn’t glamorous and the paperwork is a real headache at times, but it’s an area of healthcare that makes a huge impact in your community.  

If you’re not sure about making the jump, try a weekend home health job before completely quitting your current job.  If you find the pros to outweigh the cons, then consider making the switch. 

It’s not for everyone, but I do think anyone can do it – even the PTs like me who never thought they’d work anywhere other than an outpatient clinic. 

What questions do you have about home health physical therapy?

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