Try these 7 tips to benefit your home health patients and minimize your workload. Along with focusing on function, planning sessions, and getting organized, these strategies have been working really well for me.
Free DIRECT download: Tips to benefit HH patients and minimize workload (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
- Set a reasonable limit.
- Set a timer.
- Control the flow of the session.
- Be creative with point-of-service documentation.
- Update short term goals during each visit.
- Make phone calls on patient’s behalf during the session.
- Schedule for longer than you plan and use the extra time to document.
- How these strategies benefit your patient.
- Other ideas I want to try.
Set a reasonable limit
In home health, our sessions aren’t timed. For the first three years of home health, I scheduled routine sessions for an hour and often stayed longer than an hour. Reasons I did this:
- It made scheduling easier.
- Many patients had multiple needs, and I felt like I had to address everything.
- I was reveling in being able to spend as much time as I wanted with my patients after working in a facility.
After nearly burning out, I realized that I needed to let go of the self-imposed guilt and get smart about managing my time. I had to keep in mind that private practice and out-patient therapy sessions are generally scheduled for 30-50 minutes.
Now I schedule routine sessions for 45 minutes. I personally feel this is reasonable for my caseload. I have the time to check vital signs and all the extras that we have to include in our sessions, while still having time to address goals in a meaningful way.
Set a timer
You may be more disciplined than me, but I’ve found that if I don’t set a timer, I’ll end up spending an hour or more with my patients.
Set the timer on your phone for 10 minutes before you plan for the session to end. I do this at the start of my session, while my laptop is booting up.
I make sure the patient knows what I’m doing and why, because this helps them to know that we have a set period of time to get through our agenda.
If my patient has cognitive issues, I’m modeling my own use of an executive function strategy, and I’ll word it that way. Otherwise, I simply say that we have X amount of time and I’m setting a 10 minute warning.
Control the flow of the session
I structure the start of every session to cover all the essentials quickly.
- As I greet my patient, I’m visually assessing them and the environment.
- As I boot up my laptop, I’m setting my timer and preparing my vitals equipment.
- As I start the session in my EMR, I’m asking about any medical changes.
- I enter the subjective information and any updates into the EMR, repeating aloud (or rewording) what I’m writing so that the patient can confirm or add details.
- I assess vital signs, pain, and fall status and enter the data into the EMR.
- I present my plan for the session and ask my patient what they want to accomplish.
- I adjust my plan as needed, and then we address the goals.
Since I’m writing goals to target my patient’s desired outcome, and because I’ve organized my work bag, the session is generally highly productive.
Be creative with point-of-service documentation
I firmly believe in making sure my patients feel like they have my undivided attention. On the other hand, it’s unrealistic to avoid my laptop during the session. First, I wouldn’t remember the details of the session accurately. And second, I’m not willing to work until midnight every day.
Tips
- Sit face-to-face (as best as possible).
- Make frequent eye-contact.
- Talk while typing.
- Engage your patient by asking for input.
- PTs and OTs:
- Try typing during exercises or activities if your patient is safe without you standing beside them. You can potentially keep eyes on them, provide feedback, and still fill out some of the documentation.
- If your patient is resting, use those precious minutes to document.
- One of my PT colleagues writes his entire note at the end of the session before leaving the patient’s house.
My EMR has multiple pages of check-boxes or small text fields that don’t change much from one session to the next. I open a second window to display the previous session.
As I talk to the patient, I slowly fill out the current visit one section at a time. I’m making appropriate eye contact with my patient, which involves glancing away from time to time. Instead of glancing out the window, I glance down at my screen and check the next box or copy and paste the next text field.
It’s amazing how much of the session I can document by using this technique. Every page I finish in the patient’s home saves me time at the end of the day. And best of all, I very rarely have patients complain.
Update short term goals each session
My EMR allows me to add a free-text clinical note to visits. I use this section to copy and paste the short term goals from the previous session, which I then update for the current session.
I’ve seen clinicians simply write a description of therapy without reference to short term goals. I think it would be harder to write up a 30-day re-assessment or discharge summary doing it that way, as I would have to go back through each visit note to pull the data together. (Or perhaps they keep paper records.)
Since I carry enough, I’d prefer to keep my data organized in the patient’s EMR. This also allows me to easily hand-off a patient to another speech-language pathologist (SLP).
If my patient misses their 30-day re-assessment appointment, I can easily amend the previous session to be the re-assessment visit. Of course, I may not have any standardized re-assessment data which is one reason why I often start re-assessments during the session before it’s due.
Make phone calls on behalf of the patient during the session
As home health therapists, we make a lot of phone calls. Calls to the doctor, to a family member, to our scheduling department, to other team members, and to other facilities. Unless I’m calling about a sensitive matter (usually having to do with cognitive impairment), I make the call during the session.
Benefits
- Most patients are openly appreciative of the quick action.
- Your patients can provide additional information during the call.
- Your patients learn the outcome of the call immediately.
- You can type up the communication note in the EMR during or just after the call.
- You can assist with any next steps, such as writing a note or putting an appointment on the schedule.
- If your patient has language or cognitive-communication goals, the call can turn into a therapy exercise.
Schedule for longer than you plan and use the extra time to document
I plan my routine sessions to be 45 minutes, but I schedule for 60 minutes. If my patient really needs extra time, then of course I stay. Otherwise, I spend that extra 15 minutes sitting in my car and finishing the visit note. Before I leave for the next patient, I take a moment and check work email and voicemail.
I’ve found that I absolutely have to do the documentation before checking my work phone. Otherwise, checking my work email leads to checking my personal phone, and before I know it, it’s time to leave for the next patient.
This way, at the end of the day, most of my documentation is done and I’m mostly caught up with email and phone calls. Of course, if I have a day like yesterday with two new evaluations, a 30-day reassessment, and a surprise discharge, I’ll have a fair bit of work to do at home. But even so, I had completed large chunks of each document before I got home, which is a big head-start.
I schedule 90 minutes for new evaluations, and 60 minutes for re-certifications. Sometimes I finish these sessions sooner and can work on documentation, but other times I use the entire scheduled block of time with the patient. I do most of this type of documentation at home.
How these strategies benefit your patients
- Strong focus on the real outcomes your patient wants to achieve with therapy.
- Sessions are productive because you planned for individual needs and goals.
- Session structure is predictable while allowing flexibility to meet patient’s needs.
- Your patient’s needs are addressed during the session rather than put off until later.
- Your patient has immediate feedback on phone calls you make on their behalf.
- You can turn addressing their needs into functional therapy activities.
- You can take accurate data and update the current visit note without your patient feeling neglected.
- Your built-in documentation time provides a cushion to spend longer with a patient who has emergent needs without affecting the rest of your day.
Other ideas I want to try
I still have room for improvement. When I notice that I’m wasting time, I try to think of possible solutions and try them out.
One problem is that I sometimes forget to administer a questionnaire during an assessment or discharge (for example, the EAT 10 or the Neuro-QoL). I’ve started writing down the assessment tools I intend to use for each assessment in my planner, and that’s helping.
I’ve recently solved my second problem by putting together an assessment packet which easily fits into my work bag without adding much weight. It has been so helpful to know exactly what I have with me and be able to quickly find exactly what I’m looking for. I’ll share that in the near future.
The third problem I plan to solve by putting together an organized packet of counseling and education materials. This would be especially helpful for when I only see someone for an evaluation, or when something comes up unexpectedly during a session.
What other problems are you having? Can you suggest any solutions that have worked for you? Please comment below or shoot me an email.
Free DIRECT download: Tips to benefit HH patients and minimize workload (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured photo by Mariia Chalaya on Unsplash.
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.
One therapist commented on this article in a Facebook group with a great tip.
She has nearly every patient do a seated exercise program at the end of the session which allows her to use that 5 minutes to wrap up her visit note.
Another therapist (an OT) in the same Facebook group commented that she tells the patient that she has learned how to talk and type at the same time. The patients take it in stride, and she always finishes her notes in the patients’ homes.
She is even able to do the evaluation, usually including a shower, and complete the documentation in an hour! That sounds impressive to me, as an SLP. I would love to be able to write up an evaluation during a session.
Are there any SLPs who can write the eval in the patient’s home?
I can write an eval for a patient who does not require my services (eval only) within the hour of the eval visit, but usually not for someone who has skilled needs. I try to get as much done during the visit as possible, but generally end up writing STGs and LTGs, the assessment and plan at home.
That sounds very similar to what I can do in a session, too. Eval onlys are pretty quick to write up, but unless the patient needs to go to the bathroom before we’re done, I never have time to write goals during an eval visit.
I’m very detailed in my documentation. It’s helpful to me when I need to refresh my memory when working with a patient, especially if I pick them up again in the future. But I wonder if I’m over-documenting…
Thanks for sharing about the 7 tips to benefit your home health patients and minimize your workload
My pleasure!