Seeing clients at home is good for us and them (as long as we get the balance right)
Therapists seeing clients at home is good for them and us (as long as we get the balance right)
My company Blue Ribbon Allied Health and I have enjoyed doing home and out of clinic visits in rural and regional areas for over 20 years. I've always seen clients in clinics as well, and often you need the equipment that clinics have to offer, but I always loved the chance to see a client in their home. It always amazed me when I saw a client in their home environment how much 'the clinical puzzle clicked" with extra information we would both realise that wasn't apparent at the clinic visit. It really created a much better environment for shared, meaningful problem solving.
The client with the knee that kept getting swollen I'd see that they had inclines to walk up that they hadn't mentioned. Clients falling over who said their home was free of clutter wouldn't count the dog! And the client with the back or knee getting stirred up who'd not mentioned they were up and down the internal stairs all day with the laundry/bathroom and kitchen on different levels!
You would also get a sense more of the family dynamics and supports, as well as be able to start conversations about the most important things to them in their rehab goals relating to what you could see - the unkempt garden they wanted to be able to get back into etc.
And one of the most satisfying things was the feeling I was helping keep people at home. Nursing homes should be a last resort for people not coping at home, and helping with strategies and equipment was often very effective to keep people at home healthy for longer.
And I'm not alone. I find our OTs esp love the home visits for the same reasons I've given - really knowing whats going on with our clients so we can help them. Ots in our team spend more time on average than the PTs who spend more time in clinics. But both professions definitely gain valuable insights, as well as work variety being able to get out of clinics and see clients at home.
I was amazed just recently to find out even here on the Sunshine Coast where I live, their were very few mental health trained OTs seeing clients at home! We've started seeing a lot more of these clients. For the reasons I listed above, we often get far better results than in clinic. One client we saw recently seeing at home really shone light on a complex relationship between the client and their parent, and also brought to light the fact that they hadn't been taking their medications. If this client was seen in clinic that wouldn't have been discovered.
One issue we came across though from therapists who had worked in other roles in solely community based organisations though was the excessive driving, reports and documentation. It wasn't uncommon to hear horror stories of therapists having a minimum of 7 clients a day to see at home (which for OTs they were only paid 1.5 hours to see client and travel so do the maths - that's a long day!) And there wasn't any extra time allocated for reports either, so therapists would often work unpaid to finish reports at night after a long day, or on weekends to get them done.
Some of this is related to the issue of what therapists are paid for a home visit. It is very competitive in community and home care with a lot of providers so it can be a race to the bottom of quoting with the cheapest provider getting the work. Private clients don't always know how long it takes for us to organise to see them at home, to break up clinic work, cost of fuel and wear on cars, and then see them at a time that suits everyone. This can then lead to companies to work on volume, having to see more clients to break even or be profitable.
My accountant who works with a lot with NDIS tells me that a lot of allied health companies working in NDIS have been going broke, which is one of the reasons they are reviewing the NDIS at present esp pricing.
We're lucky in our organisations that we have a mix of private, community work (which Blue Ribbon Allied Health do) and residential work (which Allied Aged Care do) so we don't need our therapists to see minimum numbers of clients and spend all day driving and writing reports in community settings. Some of our team enjoy one setting more than another, so we try to aim for a different mix for each individual therapist based on their stage of their career and unique needs with family and life. Some of our team like just working in residential care as their is less paperwork, no driving and can see clients when suits the therapist. We all work with older clients, we also see paediatrics, mental health presentations, see clients at pools and gyms, schools, and lots of community settings.
So home visits can be very rewarding for us as therapists, if we keep being aware of the need to have a healthy mix of time spent with these clients, and not getting run down doing too much driving and paperwork.
I did go looking for some stats for this article but couldn't find any relevant on numbers of home visits on average for PTs and OTs. I do know anecdotally in regional and rural areas esp it is very hard to find therapists willing/able to do home visits away from the towns and cities. NDIS and QLD health definitely have recognised this.
Similarly to an article I wrote about knowing your list sizes in residential aged care I believe its important knowing how many home visits you are expected to do on average and how much time you will be given for paperwork.
You might love home visits, but if you spend all day on the road and writing reports, the honeymoon may wear off quickly!
Like life things in life, it comes from not being at extremes, and getting the balance right.
I'd love to know others experience with home visits. Do you find rewarding? Is the mix important? How many is too many clients, too much driving?