If you’re a new home health SLP, you may be looking for some tips for adjusting to your new setting. While I love home health, it is a challenging setting to work in. I’m not perfect by any means, but I’ve learned a few things over the past six years. Given that more people are choosing to receive care in their homes, job opportunities will continue to grow. If you are a new home health SLP, here are some tips you may find helpful.
Free DIRECT download: Tips for the new home health SLP (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- New evaluations.
- Before the session.
- During the session.
- Between sessions.
- Get organized to save time.
- What tips would you offer a new home health SLP?
- Related Eat, Speak, & Think posts.
New evaluations
Take the time to find a truly meaningful goal
The reality is that when we evaluate someone, we are likely to find a number of problems that we could address. We have our own ideas about what we should focus on in therapy, but if our patient doesn’t agree, then therapy probably isn’t going to be very successful.
If we’re lucky, our patient will know what they hope to get out of speech therapy. When we’ve identified a concrete goal that will help them in a meaningful way, they were motivated to do what we ask.
But many times, especially for cognitive-communication therapy, our patient’s goal is vague. Many times, my patient (or their spouse) tells me they want “a better memory”. Well, a better memory for what? How will we know if therapy helped?
I find it very helpful to ask open-ended questions and listen as my patient talks, paying particular attention to problems and concerns. As I sit there, I look around the house and watch how my patient interacts with their family. Being curious and paying attention to what’s going on around me help me notice potential goals that my patient may buy into.
It’s usually not that hard to find something to work on that the patient also agrees would be worthwhile.
Limit yourself to 1 to 3 short term goals
My biggest mistake when I first started home health was to write goals for every deficit I could identify. This lead to having upwards of six to eight short term goals, particularly when my patient had needs in swallowing, language, and cognition.
My sessions tended to be long, as I tried to cover too many things. Even so, I could only spend so much time on each goal area. With two sessions a week to cover six goals, we would be lucky to focus on each goal for 15 minutes a week. As you can imagine, I usually wasn’t able to demonstrate large improvement at reassessment after a month of therapy.
Once I started identifying the specific improvements my patients wanted to see in their life, it made it much easier to focus therapy on those specific activities. This led to much faster improvement and better results for my patients.
Before the session
Try to group your patients by location
New evaluations are a wild card, but you know where your established patients live. I plan my visits for a week ahead, penciling them into my planner with a question mark until I confirm them.
When planning, I take into account where my patients live, as well as any known scheduling constraints. Road Warrior is an app that I’ve heard is helpful in planning your schedule. My territory has been large, so when I get two patients who live close to each other, I work really hard to schedule them back-to-back.
Block off a little more time than you think you’ll need
I tend to block off 15 extra minutes for each session. This give me a cushion, as there are so many unexpected things that can happen:
- Traffic problems.
- Getting lost (even with GPS!).
- Trouble finding a bathroom.
- “Emergency” phone call from a doctor or the office.
- A true emergency when you walk into the patient’s home.
- Unplanned problems you have to address in the patient’s home.
- The session taking longer than expected for whatever reason.
- Allowing a little time to socialize at the start or end of the session.
I usually walk out of patient’s home with five to 10 minutes of free time, which I generally use to finish the visit note.
Having a cushion offers two main benefits. First, I’m rarely late for my appointments even when problems do arise, which eliminates the need to call anyone to adjust my schedule. Second, on quiet days of routine visits, I have most of my documentation done by the time I leave my last patient’s house.
Set your timer before you walk into your patient’s home
One thing I still struggle with is managing my time in my patients’ homes. Even after six years, I still delight in the luxury of being able to spend as much time with my patients as I want. Well, it feels like a luxury until I’m walking into my own house at the end of the day facing two to three hours of documentation and emails.
It’s a painful lesson to me that I have to set an alarm for myself, otherwise I will almost certainly use up my 15 free minutes. Certainly, if there is a clinical need or my patient needs the social engagement, I’m not going to rush off. But I’ve found that I’m at serious risk of burning out if I spend too much time with my patients. I just keep reminding myself that speech therapy sessions are 30 – 50 minutes in other settings.
So I set a 5-minute warning alarm on my phone with the goal of spending about 40-45 minutes for routine, reassessment, and discharge visits and around 60-75 minutes for new evaluations and recertification OASIS visits.
During the session
Structure your sessions
We have a lot to accomplish in a short amount of time. When we walk into our patient’s home, we aren’t there just as speech-language pathologists. We also have to assess the situation, take vital signs, and ask about falls, pain, and medication changes. If there are any changes or problems, we’ll call the doctor and/or other team members. Then, of course, we have our therapy to do.
I’ve found if I’m not mindful about what I need to accomplish, I run out of time. Honestly, sometimes it’s unavoidable that most of the session is not spent on speech therapy. But generally, I find that sessions flow nicely if I have a structure in mind.
If you’d like to read how I multi-task at the start of my sessions, read how I control the flow of my sessions in 7 tips to benefit your home health patients and minimize your workload.
Document POS in small bites
Many of us find point-of-service documentation challenging. We’ve probably all had the experience of being on the patient side. I’ve found some physicians are good at integrating POS documentation into the visit, and others not so much. It’s a skill that can be learned, and one which I am still learning.
I make my connection with my patients the priority, but I also try to do POS documentation in each session. By this point, patients know that this is how health care has developed, so I rarely get any pushback. But I’ve also learned a few strategies that makes it as painless as possible.
And in all transparency, while I do POS documentation well during most types of sessions, I still struggle with new evaluations. With new evaluations, I generally take lots of notes and then write up the reports at home. It’s not efficient, and I’m working to improve it.
That being said, I’ve found that making my patient part of the process is really helpful. I engage them in conversation as I document their subjective status, vitals, pain, falls, and medication changes.
In my current EMR, there are several data fields that only change with reassessment. These fields are easy to complete in short snippets of time, while my patient is engaged in a therapy-related task.
Depending on my patient, I may also include them as I write up summary statements about what we did, the skill I provided, and their response. This is usually the piece that I complete after the session, though, as it requires more thought.
Make phone calls on behalf of your patient during the session
If I’m making a patient-care related phone call, I almost always do it during the session. There are several benefits.
I can:
- Ask my patient clarifying questions.
- Share feedback immediately with my patients.
- Document the phone call in the EMR immediately.
- Assist my patient with next steps, which can be a therapy activity in and of itself.
My patients appreciate that I take their needs and concerns seriously and act on them promptly.
Confirm upcoming appointments
Communication is the key to keeping up with my schedule. At every session, I confirm the next appointment(s) and make sure it’s written down somewhere.
If my patient is working on language or cognitive-communication goals, the act of making or confirming an appointment can be therapeutic. And I can deliberately add challenge to the exercise, if it fits their goals. For example, I could suggest a time that conflicts with another appointment they already have on their calendar.
In addition, I always pay attention to the other appointments my patient has to help me plan next week’s schedule.
Jot a few notes about your plan for the next session
At the end of the session or when I’m finishing up the note, I like to make a few quick notes about what I hope to accomplish in the next session. I make a little to-do for myself, listing any materials I want to bring or information I want to find for my patient.
Between sessions
Avoid social media and take a bite out of your workload
Sure, sometimes we need to decompress a little. But if you have five or ten minutes between sessions, don’t fall into the trap of looking at social media. Those little breaks add up to 30 – 60 minutes of lost work time across a typical work day.
Instead, use those little chunks of time to finish documenting some of your notes, schedule your next patient, do a chart review, or any of the other little tasks we have to do.
Listen to continuing education or speech-related podcasts on the drive
When I transitioned from a facility to home health six years ago, I suddenly found myself meeting people with a wider set of needs. I needed to learn a lot, fast. So I turned my car into a university.
At least two or three mornings a week, I listened to continuing education courses or to speech-related podcasts. Then in the afternoons, I listened to something fun.
If you’d like to support Eat, Speak, & Think, consider using this affiliate link to sign up for SpeechPathology.com for unlimited access to 450+ courses for $99/year. This is what I listened to most often during those first years in home health. I learned a lot, and it helped me earn 3 ACE awards.
Get organized to save time
Save the numbers you call, including menu bypass information
As home health SLPs, we’re on the phone a lot. We call doctors, our supervisors, the office, our teammates, and various vendors and professionals in the community.
When I call a new number, I take 20 seconds afterward to save it to my contacts. If there are menu choices, I add that information after their name so I see it the next time I call. Because, let’s face it, it’s annoying to listen to lengthy menu options, knowing there’s a magic button we can push to get on with it, and yet not remembering what that option is.
Create your own searchable handbook for your job
Something seems to change every week in home health. What we document and how, where it goes in the clinical record, policies and procedures, etc, etc.
It’s a lot of information to keep track of.
What works well for me is to add new information and procedures to a Word document, in outline form, with headings. It makes it very easy to search for what to do when a situation comes up again.
I always add the date and who provided that instruction, because things always change. Which means that not everyone is always on the same page, and I may get different advice depending on who I ask. And after six years of notes, it’s very helpful to know who said what and when so I can hopefully follow the correct procedure.
Plan all your sessions for the week in one sitting
It takes a minute to get into the mindset of planning my next therapy session. I find that I’m more efficient if I plan all my sessions for the week in one sitting once I’m in that mindset. Since I generally jot notes in my planner about ideas for the next session, this process generally doesn’t take long. And I often find that planning for one patient will spark ideas for what to do with another patient. It’s a good feeling to wake up Monday knowing I have everything I need for the week in my work bag.
Put therapy materials on your computer
We have access to a lot of free therapy materials, or online media that can be used as stimuli for therapy. I find it really helpful to have resources available on my laptop and phone.
I have a variety of apps on my iPad, including most of the Tactus Therapy library.
As long as I have an internet connection, I can pull up Conversation Starters World, which offers tons of prompts. I particularly like the This or That Questions.
On Instagram, we can find 5 sets of photos under Name and Tag (nameandtag1 through nameandtag4, as well as nameandtagv for verbs). These photo sets were created by the Centre for Brain Injury Rehabilitation, and there’s a link to a PDF download with therapy ideas.
YouTube offers a wealth of short videos that can be used in therapy in many ways. I wrote about using video in therapy, and an example of how to use a wordless video in therapy.
Check out Free multimedia resources for the SLP for more ideas. Be sure to read the comments for more ideas.
Organize your work bag and planner
I’ve written before about how organizing my work bag and making the most of my planner save me time. Basically, if you find yourself searching for papers or materials, you could probably improve the organization of your stuff. And if you have trouble finding information, if tasks take too long, or if you forget to perform necessary tasks, you could probably improve your executive function skills.
Just like we teach our patients, we can identify our problem, possible solutions, and our specific goal. Then we can make a plan, execute, and assess the results. Addressing pain points in our work day can take some up-front time, but usually will offer a big payout in the end.
What tips would you offer a new home health SLP?
I know there is more I have to learn about working in home health. I’d love to hear your tips! Please leave a comment below, or you can contact me through the contact form or respond to my email if you’re a subscriber.
Related Eat, Speak, & Think posts
I’ve written a large number of posts related to this topic, which you can browse on the directory page. Here are some that may interest you in particular:
- Best gear for home health therapists and nurses.
- 50 questions to ask in a home health SLP interview.
- 5 ways I improved work-life balance as a home health SLP.
- 7 tips to benefit your home health patients and minimize your workload.
- 8 strategies for easier reassessments.
Free DIRECT download: Tips for the new home health SLP (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by rattanakun on Canva.com.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
This was great information that I will pass on to new SLPs
Thank you, I appreciate that!