Ah, the Home Health conundrum – do I give up valuable time and productivity to drive to a less than ideal therapy work environment to see a patient I’m not sure is truly “home bound” or do I suffer the wrath of the Home Health Director describing how the lack of therapy visits is making the Home Health Department unprofitable?

Don’t kid yourself, if you have been in a Hospital environment with a Home Health Agency, the above dilemma has crossed your mind. Driving 20 miles outside of town, providing a 45-minute treatment, driving back and completing documentation you’ve just blown a good 1 ½ to 2 hours depending on road conditions, traffic and whether the patient was really ready once you got there (and how much conversation you needed to have to get back in the flow once you returned to the clinic). You could have knocked out a good 6+ units of inpatient/outpatient/swing bed treatment in that time and been in your groove. Sure, you could bundle several home health visits together and strategically map your route, but then you have to block off a whole chunk of time. Maybe you can talk the PRN therapists in the area into squeezing in a few visits at the end of the day around dinner time – how convenient for your patients!?

Let’s face it, in the post acute therapy continuum of care, Home Health is often an inconvenience if not a downright pain in the arse. At the same time, it is a growing area and one, that if properly serviced, can improve patient wellbeing, serve a critical patient need, help patients progress through the continuum and back into outpatient therapy, and provide a financial benefit to both the therapy company and Hospital clients.

The approach I see to Home Health today mirrors in many ways the old way of managing SNFs from a hospital-operations base. Running therapists over to treat the caseload when it was slow at the Hospital, having most patients in High and Medium RUG categories because the minutes weren’t managed or planned, and although it wasn’t the intent, probably underserving the patients, not getting them back to their functional levels as quickly as possible, and providing mediocre financial results for our clients.

The keys to transformation that occurred in our skilled operations are identical to what is necessary in Home Health – information gathering, establishment of benchmarks, analysis of staffing, coordination with nursing staff and HH management, training, planning and management of visits. The saying, “If you fail to plan, plan to fail,” is quite appropriate. The tools are available to manage caseload in a Home Health environment, the first one that needs to be taken out of the toolbox is an open mind.