5 ways I improved work-life balance as a home health SLP

I’m sharing 5 ways I improved my work-life balance as a home health SLP (speech-language pathologist). I came close to burning out over the past few years, but I’ve recently made some changes that have made a big improvement in my own life.

My personal goal is to have more days like my best day, and fewer days like my worst day. If you are feeling overwhelmed, then I hope these tips will help you too.

Free DIRECT download:  5 tips to improve work-life balance (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)

Outline:

1. Stop trying to fix everything.
   1. The old way I wrote goals.
   2. The new way I write goals.
   3. Benefits of targeted, functional goals.
2. Be strategic when scheduling.
   1. Why I schedule strategically.
   2. How I schedule strategically.
   3. Benefits of scheduling strategically.
3. Write orders for what the patient clinically requires.
   1. Be creative with your session frequencies.
   2. Benefits of increasing session frequencies.
4. Start re-assessments early.
   1. Benefits of starting early.
5. Plan and organize your materials for the week.
   1. Pre-plan by jotting notes in the moment.
   2. Set aside one time to plan for the week.
   3. The steps I follow.
   4. Benefits of planning for a week.
6. Related Eat, Speak, & Think posts.
7. What strategies do you recommend?

Stop trying to fix everything

For the first two years in home health, I assumed that I had to write goals for every single skill area that was impaired. If someone had multiple impairments, I ended up with 6 or 7 short-term goals.

This led to long sessions (often an hour or longer), since each session had to address 3 or 4 goals. And it turns out that most of my patients weren’t enthusiastic about addressing all these goals.

We’d often reach the end of the four-week period without making much progress on some of the goals. The lack of focus in my goal-writing also meant wasted time on documentation, as I would have to explain why some goals weren’t met.

At some point, I realized that the cause of the problem was the way I approached evaluation and goal-writing.

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The old way I wrote goals

• Determine prior level of function.
• Determine current level of function.
• Do the assessment.
• Go home and write the goals.

I just assumed that if a skill area was impaired compared to baseline, and it was affecting my patient somehow, then they’d want to improve it.

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The new way I write goals

Now, I always find out what outcome my patient wants from speech therapy during the initial assessment. If my patient (or caregiver) can’t verbalize a reason for targeting a skill, then I don’t write a goal for it.

Some patients don’t really want anything from speech therapy. They may recognize that they have an impairment, but they compensate and aren’t really concerned. If we can’t identify a functional skill that they are interested in improving, then I don’t pick them up for therapy.

Some patients have a long list functional outcomes they want to see from therapy. In this case, I only pick the most important two or three outcomes. This allows us to focus our efforts and see real progress in a short period of time.

Ideally, I write my goals to specifically target the functional outcome my patient wants to see. Sometimes the patient and I both know that they need therapy, but we need more than one session to figure it out. In that case, I write more general skill-based goals but I make the therapy activities specific and functional to the patient as quickly as possible.

I rarely write more than two or three short term goals at a time.

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Benefits of targeted, functional goals

• Shorter, more focused sessions.
• More motivated patients.
• Typically see real progress by the end of the month.

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Be strategic when scheduling

I’ve been reading productivity and time management books for the past two years, and one big key take-home message I’ve learned is that I’m in charge of my own life. It’s the whole locus of control issue that we try to help our patients with. When I feel overwhelmed, I feel out-of-control.

There are plenty of tips and strategies for time management, such as this one by Alex Iskold on Entrepreneur.com. I love how it starts with strong advice:

Something Lou Gerstner, former CEO of IBM, once said has stuck in my head: “Never let anyone own your schedule.”

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Why I schedule strategically

I have a relatively large territory, so if I’m lucky enough to have two patients who live within half an hour of each other, I do my best to schedule them back-to-back. I don’t want to drive from one end of my territory to the other and then back again on the same day. I also don’t want to drive to the area furthest away from my house every day, if I can help it.

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How I schedule strategically

First, I block out time in my schedule for important personal activities. I block out time for exercise, social activities, appointments, and working on my website. I know from experience that if I don’t block out time for myself, I’ll fill it with work and my personal life will suffer.

Second, I pencil in my preferred times for when I want to see my patients for the following week. I take  into account what I already know about each patient’s preferences and the appointments they have. It’s easy enough to keep track of their upcoming medical visits, especially since I see most of their calendars during therapy anyway.

Then, as I see each patient during the current week, I offer them the times I hope they’ll take for the following week. If for some reason that doesn’t work, then I have to do some juggling. I always write my appointments down in their calendar (or watch them do it).

Every session, as I’m leaving, I always confirm that they know when my next session will be.

By Thursday of each week, I try to have all of my routine visits scheduled for the following week. This allows me to schedule new evaluations as they come up. Either I have a slot or two open for new evaluations, or perhaps I can tack on a new evaluation to the end of another day and work a lighter day later in the week.

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Benefits of scheduling strategically

• Puts your important personal needs first.
• Reduces cancellations.
• Reduces patients not being home or being double-booked.
• Reduces making phone calls to juggle appointments.

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Write orders for what the patient clinically requires

I know from conversations on Facebook SLP groups that some employers limit speech therapy to a handful of sessions or otherwise set artificial restrictions. I see the benefits of writing orders for what each patient clinically needs, but I recognize that not everyone is able to do this.

We don’t seem to have much research evidence for how frequent or how long our sessions should be. In my area, we’ve adopted a twice-a-week model as a starting point. Until we have better guidelines, I generally see my patients twice a week.

Of course, I follow the therapy protocol if it calls for a specific number of sessions per week (like four times a week for LSVT LOUD). At the other end of the spectrum, I also pick patients up for once a week (or even less) if that is called for.

If I think that my patient won’t be able to accomplish meaningful functional progress with two sessions a week, then I will pick them up for three times a week if they are agreeable.

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Be creative with your session frequencies

My patients often have many therapy, nursing, and medical appointments in the first week or two. Even if they want to have speech therapy three times a week, they just can’t fit it in. In that case, I start off twice a week for two weeks and then increase to three times a week for two weeks.

Other times, I want more frequent visits in the beginning but I don’t see justification to continue three times a week for a whole month. Some examples include:

• Assessment will require at least 2 additional sessions.
• Patient has significant swallowing or communication impairment and would benefit from more support in the beginning.
• I think the patient will need the extra sessions to benefit from spaced retrieval with errorless learning.

I always document my reason for selecting three or four sessions a week. I also don’t hesitate to modify my orders at any time. As far as I know, there haven’t been any problems with reimbursement.

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Benefits of increasing session frequency

• More weekly therapy time means less pressure in each session.
• Patients generally appreciate more sessions.
• Allows more frequent teaching and practice of functional skills.
• Eyes on the patient more often, especially important for those at-risk for re-hospitalization.
• Weekly planning is a little easier.

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Start re-assessments early

Medicare requires 30-day re-assessments (other insurances may differ). We can do a re-assessment at any point, but if we go beyond 30 days without doing a re-assessment, then Medicare won’t reimburse. I find it easier to write my orders for 30 days and do 30-day re-assessments on all my patients.

My company encourages us to not wait until the last session to do the re-assessment. If I’m working with language or cognitive-communication impairments, I almost always start the re-assessment at least one session early.

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Benefits of starting early

• You’ll have some reassessment data if your patient misses the last session.
• It gives you additional time, in case your patient isn’t feeling well.
• If your patient can’t tolerate a long re-assessment, it breaks it up.
• If your patient tests fine on the re-assessment but still has deficits, it allows time to use a different assessment.
• Less work for the official reassessment visit, as at least some of the reassessment was written during the previous visit.

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Plan and organize your materials for the week

I was taught to over-plan for each session, this way I always have something in case we move faster than expected or an idea didn’t work out. I don’t always think fast on my feet, especially towards the end of a day or the end of a week. I prefer to walk into each session with several planned activities, although of course I often change what I’m doing based on how my patient presents.

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Pre-plan by jotting notes in the moment

First, anytime during the week when I have an idea of what to do next with a patient, I jot it down in my schedule on “Friday” of the current week (I don’t work Fridays).

Then, when I’m with a patient, I frequently review the functional outcomes we are working towards and probe for any new problems they are noticing. Often, my patients give me feedback about what they want to work on. I add these ideas to the list.

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Set aside one time to plan for the week

I spend about an hour at the end of the week planning and pulling together materials for the following week for all of my patients, including reading the charts of any new patients.

I use two-pocket folders, with each pocket devoted to a different patient. If a patient has multiple skill areas, I may use a bright yellow sheet of paper as a divider.

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The steps I follow

• Skim the last session note.
• Look at the “ideas” list in my schedule.
• Look at the patient’s folder to see what I already have.
• Decide what else I want for the following week.

This process takes anywhere from 3 to 15 minutes per patient, depending on what the goals are. Sometimes it takes me awhile to think of a good way to address their goals. I may do some research, or I may create something just for the patient. Other times, I know what I want to use and it’s just a matter of finding it.

If I want to use something that doesn’t fit in the folder, I jot a note beside his or her appointment in my schedule. For instance, I might want to remember to bring:

• A specific assessment tool
• My iPad
• A book, clock, money, or flashcard set
• My EMST-150
• Thickener samples
• Calendar/binder/etc

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Benefits of planning for a week

• I only have to think about it once a week.
• Some patients have very similar needs; it saves time to plan for both at the same time.
• Since I over-plan, I often have enough for more than a week.
• As long as I look at my schedule for the “extras”, I always walk into a session with what I need.
• Re-arranging sessions at the last minute doesn’t cause any stress – I’m still prepared.

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Related Eat, Speak, & Think posts

• Tips to benefit your home health patients and minimize your workload.
• Use your planner to lighten your home health work load.
• Organize the materials you carry to save time as a home health SLP.
• 8 strategies for easier reassessments.

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What strategies do you recommend?

I hope these strategies help you to streamline your work-flow and free up more time to devote to everything outside of work that matters to you.

I have plenty of room to improve, so please share your tips about how to improve work-life balance as a home-health SLP.

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Free DIRECT download:  5 tips to improve work-life balance (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)

Lisa A Young M.A. CCC-SLP

Website | + posts

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.

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