What do Occupational Therapists do in home health…

A diary of an Occupational Therapist in home health…

I am an Occupational Therapist (OT), working for a small home health agency in America.

8:10am- I sit down at my computer and clock in.  I usually look through my e-mails.  I will then proceed to do the chart review for any patients that I might have to see that day. 

8:40am- Clock out. Go to the bathroom before I head to my first patient’s house.  This is crucial for a home health OT!  Then, I get in my car and head to my first patient’s house.  Since I don’t get paid for the time or mileage to my first patient, I try to schedule it close to my house if possible.  

9am- I see patient #1 of the day.  Let’s say it is a Monday.  It is probably an evaluation.  My standard evaluation begins with vital signs and a subjective conversation about what has happened to get the patient to this point.  I have already done the chart review, but I like to hear it in my patient’s perspective.  There is also a part of my standard evaluation documentation that asks for what the patient’s goals are.  Then, I proceed to an assessment of their ADLs (activities of daily living).  I like to make evaluations in the morning, so I can see how they get dressed/do their ADL routine.  If they are already ready, I ask them about how dressing goes and it is more of a conversation than visual assessment.  Then, I like to see a toilet transfer and shower/tub transfer.  This allows me to see their balance and endurance.  I make a lot of AE/DME (adaptive equipment/durable medical equipment) recs for safe bathroom activities.  I close it out with educating on a HEP (home exercise program), if indicated.  I update them regarding what OT frequency will look like, whether the COTA (certified occupational therapy assistant) will be taking over treatments, and anything else they might need to know.  I always check to make sure that they have no questions or concerns and that they know how to get in contact with the agency 24/7.  

10am- Get in my car.  Check/send e-mails, look-up my next address of my patient, and call the doctor for the verbal orders from the last eval. 

10:30am- See patient #2.  Let’s say it is a patient who I am seeing for an OT treatment and it is a shower.  I start with vital signs and enter into my computer.  I always do as much documentation as possible during direct patient care.  Depending on the patient’s needs, I will provide supervision or actually provide physical assist with showering.  My patients are normally pretty independent, so my role is to provide as much safety as possible.  I do a lot of routine modification.  I say frequently, “The less time you’re naked, the better.” I encourage energy conservation techniques during getting clothes out of the closet, dressing/undressing, and showering.  

11:30am- Get back in my car after the treatment ends. Lookup my next address.  Eat lunch while driving to the next patient.  Check my e-mails before I go into my next patient.  

12:15pm- Start patient #3.  Let’s say it is another evaluation.  I do the same routine as listed above, modifying to what the patient needs.  Maybe they are more of an orthopedic patient, like a younger person who had a hip replacement.  So I would talk about hip precautions, and how that impacts dressing, toileting, and showering.  

1:15pm- Finish up with patient #3.  Look up the next patient address.  Check email.  (Are you noticing a pattern?)

1:30pm- Start patient #4.  Let’s say they are a patient who is pretty baseline, but I am doing a lot of caregiver education to their child or spouse.  I do some education regarding where to buy things like chuck pads, diapers vs briefs, or anything else that might help life be a little easier.  Families are usually so thankful for anything that makes life a little easier.  

2:30pm- Finish up with patient #4.  Check e-mail.  Look up the last patient’s address.  Make a phone call to a physiotherapist about a patient on my drive.  

3:00pm- Start patient #5.  Let’s say they are another evaluation.  They just got out of a rehab and live in an ILF.  I do the same routine as patient #1 and #3, assessing ADLs and IADLs (instrumental activities of daily living).  Sometimes our patients in ILFs (independent living facilities) have some different issues with navigating through the doorway so they can get their meals.  Most ILFs that I see patients in require a 14 day quarantine upon returning home, so getting their meals delivered outside of their apartment poses an interesting challenge.  I also like to touch on a routine/daily schedule to help provide structure to their day as they are quarantined in their apartment.  This is how I incorporate mental health into my practice.  

4:00pm- End patient #5.  Clock out.  Drive home. 

4:15pm- Arrive home.  Strip my clothes in the garage.  Sanitise my phone and keys.  Take a shower.

4:30pm- Sit down at my desk.  Look at my schedule for the next day and call those patients to set up their appointments.  Send any e-mails I need to.  

5pm- Go be present to my husband and son.  Being a mum and wife are important roles for me, so putting work aside and being present for the time I do have with them is important.  

7:15pm- Go back to my computer.  Finish any documentation that I have to do.  Since I work for a contract therapy company, my patient time and mileage has to be entered in a different computer program, which I like to do all at once at the end of the day to ensure that it is correct.  When all that is done, I am able to go engage in activities that are important to me.  Well, maybe not important because it is usually loading the dishwasher, laundry, and prepping for the next day.  But, they make my desired role of wife and mom a little easier.  I go to bed about 10:30pm and start the day all over.  

What do I love about my job? You cannot ask for more occupation based interventions.  We aren’t simulating ADL item retrieval, toilet transfers, or showering.  We are doing it in real life.  

What is challenging about my job?  You can be very isolated.  Sometimes the PT (physical therapist) and I are able to line up our drives so we can talk about things other than work and build community.  

Author: Beth Willett

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