Many options are available in home health field

Here’s how some providers work

If you are considering venturing into the home rehabilitation market, you have a number of options.

Here is a look at some home therapy programs and how they operate:

Braintree Rehabilitation Ventures, a wholly owned subsidiary of BHRN, has a staff of about 30 who provide occupational therapy, physical therapy, and speech therapy for home care agencies in the greater Boston area that are accredited by the Joint Commission on Health Care Accreditation in Oakbrook Terrace, IL.

"Braintree’s forte is rehabilitation. We decided to continue to do what we’re good at and to leave nursing and the other components of a full-service agency to the home care agencies," says Susan Saya, PT, MBA, contract therapy service director.

The majority of Braintree’s therapists have full-time or part-time jobs in a clinical setting and carry a caseload of just a few home care patients.

Some therapists choose only to do evaluations and supervise the assistants who do the week-to-week treatment.

Braintree’s home care therapists are paid on a per-visit basis, but all have to meet the hospital’s criteria for full-time employment, including passing a competency assessment for their discipline and an annual evaluation.

Rehab nursing added

The Rehabilitation Institute of Chicago (RIC) is negotiating contracts with established home health agencies to provide rehab services that include rehabilitation nursing specialists.

"We didn’t want to be a one-stop shop for home care. What we wanted to do was to provide rehabilitation services for patients that needed our services. That’s why we looked at partnering with existing home health agencies or existing medical systems, says James Summerfelt, MS, PT, director of home care rehabilitation planning and operations.

When it begins its home health services later this year, RIC will supply physical therapists, occupational therapists, speech therapists, social workers, rehab nurses, and home health aides who are focused on rehab.

The rehab nursing component was added after a survey showed that the staff felt RIC’s former patients were not getting the same level of nursing care from existing home health agencies that they received while they were inpatients. Home care nurses often had little experience in rehab and didn’t recognize the importance of rehab nursing services such as skin care and bowel and bladder training.

RIC’s home health therapists will be full-time employees of the hospital, Summerfelt says.

"We look at it as a quality-of-care issue. If someone is an employee, they are more committed to your mission," he says.

Rehabilitation Hospital of Indiana’s (RHI’s) home based-rehab program is licensed by the state as a home health agency. Therapists are employees of the Indianapolis hospital and are assigned only to the home health service.

RHI’s operation employs two full-time physical therapists, one part-time occupational therapist, one part-time speech therapist, two full-time nurses, one full-time home health aide, and one full-time office coordinator.

The Indianapolis hospital opened its home-based rehab program in 1996 as a response to an increase in managed care in their state.

One-stop shopping

"Managed care is looking for one-stop shopping. We already offered inpatient acute, inpatient subacute, outpatient services, and vocational re-entry services. Providing therapy within the home was the next logical step," says Melissa Dill, MS, OT, outpatient program manager.

The majority of patients receiving RHI’s home rehab services are from the hospital. About 35% are referred by external agencies.

Home health therapists at RHI are paid a salary that is a little higher than the hospital-based staff to compensate them for travel time, facing the weather, going into potentially unsafe areas, and facing a lot of unknowns. They are reimbursed for mileage.

The therapy services department at St. Vincent Health Center provides therapists for St. Vincent Home Care, the Erie, PA, hospital’s home health agency.

The center has three full-time and two part-time physical therapists who work only in the home health setting and has just gotten approval to hire a full-time occupational therapist for home health, says Jeanne Downey, MS, team leader of rehabilitation for the health center.

Staffing home health therapists

Until two years ago, the home health agency had operated for seven years with just one physical therapist providing all of the rehab services.

Speech therapy needs are filled as needed by therapists from the hospital.

Any excess therapy needs are filled by contractors, who work on a per diem basis. Some are moonlighters who work a regular job at St. Vincent’s or another area hospital.

Per diem therapists also cover patients in areas outside the city to save the full-time staff the time it takes to drive to see a patient.

St. Vincent has found that using staff people, instead of per diem contractors, works best, Downey says.

Legend Rehabilitation Services in Houston contracts with home health agencies to provide therapy services. The firm, which is not affiliated with a hospital-based rehab program, employs about 40 people, primarily physical therapists, occupational therapists, and speech-language pathologists. Some are employed full time or part time by Legend. Others are on a contract basis, says Prem Gogia, PhD, PT, president of Legend.

When Legend receives a referral, a therapist makes an assessment of the patient’s physical condition and safety factors at home and establishes a plan of care. The company’s goal is to conduct the initial evaluation within 48 hours of referral. More than 75% are assessed within 24 hours.

Legend provides therapy seven days a week and has staff available 24 hours to answer questions from patients or nurses.