These past two years have been exceedingly eye opening for the medical world and the home health sector in particular as we are clearly still involved in a public health emergency. The COVID-19 pandemic escalated the importance of home health care as a needed and valued alternative to institutional and facility based care settings. In addition, as Valued Based Purchasing (VBP) will come onto the scene in early 2022, many agencies have had to shift the way they admit and care for higher acuity patients in a more efficient, cost effective, and responsive manner.
Another lingering problem is that skilled nurses are becoming scarcer throughout the nation, with an estimated shortage of 1.1 million by 2022. As the home health industry continues to rapidly progress, physical, occupational, and speech therapists have taken on a more active role with an increase in utilization and completion of home health start of care (SOC) admissions. A significant shift has occurred in the industry from this task being primarily a nursing function to also being a relevant role of therapy clinicians.
Historically, physical therapists have completed more start of care admissions than occupational and speech therapists. There are many benefits for a physical therapist to perform a home health start of care admission. A key advantage of physical therapy admissions is that the patient’s initial plan of care, consisting of multiple interventions, will take place entirely in the same environment in which the patient will function and live a majority of their time. Upon admission, physical therapists can make home modifications, assess level of function, perform applicable standardized tests, and then implement a plan of care that optimizes the patient’s probability to achieve their goals and function independently.
Occupational therapists can now perform the initial assessment visit and the start of care comprehensive assessment on therapy-only patients for whom occupational therapy “establishes eligibility” (Conditions of Participation, 42CFR484.55). However, for the initial admission, the patient must have either physical or speech therapy ordered as well. Utilizing occupational therapy can now assist home health agencies in increasing the number of available home health clinicians that can perform start of care visits. Another benefit of utilizing occupational therapy for start of care admissions is that based on their specialized training, occupational therapists can narrow the focus and provide a unique perspective for specific OASIS questions pertaining to functional capabilities and activities of daily living. Accuracy of this OASIS assessment is critical to ensure appropriate reimbursement and to maximize clinical outcomes and star ratings.
Speech therapy is also involved in many specific home health start of care admissions, especially when the patient has a neurological, swallowing, speech, or memory impairment as part of their diagnosis. Speech therapists in home health are involved in preventing, assessing, diagnosing, and treating speech disorders that can include language, communication, cognitive, and swallowing disorders. Speech therapists can help establish a recommended or modified diet, provide communication tools, strengthen oral motor and pharyngeal muscles, and assist with memory impairments surrounding orientation, home safety, medications, etc.
There are numerous benefits of the therapy team performing start of care admissions. It will allow for a more focused plan of care that is geared towards the individual needs of home health patients. Therapy disciplines are skilled in providing support in areas that have historically been more of a nursing focus. All therapists can perform medication management. All therapists and their assistants can support management of chronic disease processes such as diabetes, heart failure, cardiopulmonary complications, cognitive issues, etc. Therapists are also able to perform home health aide supervision and management of the home health aide care plan. Physical and occupational therapy can also assist an agency with certain types of general wound care, which often times is viewed as a nursing-only function and can again help ease staffing shortages that may be occurring. Overall, therapy is an invaluable asset and should be used more frequently by home health agencies to perform start of care admissions.
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