Getting Started in Home Health

The perks offered to home health therapists are clear-independence, rewarding patient relationships, a variety of treatment settings, higher salaries and better job security. So with all that's offered, why aren't home health positions grabbed up as quickly as they're advertised?

"You either like it or you don't," observed Patty Klinefelter, RN, director of home health at Valley Health System in Winchester, VA. While some health professionals thrive on the autonomy and freedom, other personalities are a more comfortable match with the structured stability and hectic pace found in inpatient or outpatient environments. "It all depends on how you enjoy treating patients."

Even if you're convinced that home health could be a good fit for your background, lifestyle and emotional makeup, taking the first step may not be as clear. In the interest of finding out the best way to land a home health position, ADVANCE went to the source.

Klinefelter is responsible for hiring home health therapists at Valley Health, which operates four home care agencies along with hospitals, surgical centers and rehab facilities in the Shenandoah Valley of Virginia. She's continually looking for home health therapists, as evidenced by incentives such as a $5,000 signing bonus for applicants who make the cut.

Do I Need Experience?

The first question typically raised by interested parties is whether they need specific home health experience to land a staff position. As with most job fields, the answer depends on whom you ask.

When Bill Ostola, OTR/L, site manager for Progressive Rehabilitation Associates in Iowa City, IA, sought to bring in a home health physical therapist last month, he preferred a therapist with specific experience in home care.

"It would be the rare case that a home care manager would hire a new grad, or someone with experience in a completely different environment, for a home health opening," Ostola said. "These therapists must be independent and resourceful in the use of their clinical skills." Progressive Rehab Associates, a private rehab agency owned by three physical therapists who manage eight outpatient clinics, provides therapy services to Mercy Hospital in Iowa City and its home health agency.

"We've never hired a new grad for a home health vacancy," echoed Klinefelter. "Because [the therapist is] going to be very independent in the field, we prefer candidates who have operated under those policies and procedures in the past."

The Golden Paradox

Frustrated therapists without experience in home health are likely to throw their hands up and utter the swan song of the aggravated job seeker: how do I get experience if no one will hire me?

Don't despair, the recruiters insisted. "Home health experience is not always obligatory," Klinefelter conceded. "Sometimes experience can even work against you, if it was a long time ago or if the agency was poorly run."

Instead, applicants who are serious about starting a career in home health have a number of means at their disposal. "In most instances, you'll be working with an elderly population," Ostola said. "So working experience in the acute hospital environment, assisted living, or certainly a skilled nursing environment, would be very attractive to recruiters searching for home health therapists."

Complement your work experience with continuing education. "From an educational standpoint, further academic training in gerontology and specialty certification is definitely going to benefit you," Ostola continued.

Another strategy is to get experience in a health system that has a home health component already in place. After stockpiling specialized clinical skills and certifications, begin to look for PRN openings in the home health unit. Most large facilities will allow therapists to rotate in or fill shifts on a PRN basis, which could lead to a full-time role.

"All three of the PTs I've recently hired to fill our home health positions came from within the Valley Health System," Klinefelter acknowledged. Valley offers a two to four week-long mentoring process-depending on therapist experience-of shadowing home health therapists in the field, as candidates gradually shift from observing working therapists to being observed themselves.

If your facility is like Valley Health, you may be surprised to find that it welcomes employees from other practice niches, who are looking to branch out into other challenges. "We look for people who want to explore a niche that will enhance our system," said Klinefelter, citing examples such as incontinence and wound care.

Boosting Your Chances

There are some additional skills you can add to your toolbox to make your resume more inviting for home health recruiters.

 Computer skills. Though traditionally an environment that stresses personal contact, home health agencies are steadily joining their sister facilities in the electronic age. "We're moving into laptop technology for our home health therapists," said Ostola, whose therapists input evaluation and intake information into a centralized computer database. "There's a high-tech side that's coming to home health."

 Regulatory savvy. Today's home health therapist is also a case manager, Klinefelter said. With the advent of OASIS, home health therapists are finding themselves managing financial outcomes as well as functional outcomes.

 Documentation ability. Knowledge of treatment plan development and other regulatory guidelines is essential, Ostola stressed. Also, a strong commitment to organizational skills is vital for therapists who work in this predominantly unsupervised role.

 Communication skills. Home health therapists must blend independent resourcefulness with interdisciplinary compatibility, Ostola said, as they work as part of the entire care team along with PTs, speech therapists and other professionals to meet Medicare timeframes and financial constraints. "For this reason, we've found that rehab therapists generally make very good home health therapists," Klinefelter said. "They've worked in a multidisciplinary mode, and understand the utilization of treatment episodes."

Job Security

Therapists who fill home health positions often stay in them. Ostola's opening was the result of a retirement, and Klinefelter oversees therapists who have been performing home health for years.

Even so, opportunities continue to abound, and competitiveness for many home care openings remains unexpectedly low. "There's always been some fear surrounding home health," noted Klinefelter, such as anxiety over excessive paperwork and spending long lonely hours on the road.

Perhaps this was part of the reason that Ostola was somewhat surprised at the low demand for his home health opening, which has since been filled. "The limited response was something I might have expected 10 years ago," Ostola said. It would appear that home care remains a relatively unexplored avenue for many OTs, and for the right therapist it can be a satisfying journey.

"There is a rewarding aspect and a functional approach to this work that many therapists value," Ostola said. "You're right in the patient's environment, making a real and immediate difference in their quality of life, and they appreciate you for it. It's a very gratifying experience."

Perhaps most importantly, therapists fortunate enough to secure a home health position and thrive in it will benefit from a job market that many analysts believe will only rise in the years to come..

"Everybody in home care management is looking for more therapists," Klinefelter said, due in part to incentives that allow higher reimbursement rates for more home visits. "We always want home care therapists to be available. We just never seem to have enough."

Jonathan Bassett is on staff at ADVANCE.


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