So you’re considering jumping into the deep end of the home healthcare profession. Before getting your feet wet, your brain may be filled with a barrage of unanswered questions. We sat down with some home healthcare pros to find out what it takes to thrive and survive in this unique field.
Name: Jennifer Tunich
Occupation: Home Healthcare Occupational Therapist
Company: PRN for Georgia Home Health
On the qualities needed to work in home health care:
I would say if you choose the home health setting, you need to be independent with what you’re doing, because oftentimes you’re your own person on site. There isn’t another staff member working with you. You need good problem solving skills, and you need to be insightful about the environment around you. You need to be able to relate to people on multiple levels. Going into a home, you’re literally walking into someone’s life. This requires flexibility and the ability to adhere to the different cultures we see. Being an outgoing person is essential, because you’re really putting yourself in a situation where you have to contact someone and walk into their environment. You have to be able to engage with them to build a rapport and trust. Not everyone wants a stranger in their home. You can’t take it personally when older people find it offensive when their doctor is ordering a therapist to come and change their environment or have them do things they don’t necessarily think they need to do. You have to roll with some of the behaviors you may encounter.
On some of the most significant findings she’s had while working in home health care:
With home health, we work with the aging population. Sometimes family members aren’t able to see that people who are aging in their homes may not be in the safest environment. Maybe the home hasn’t been modified to fit their needs or they’re no longer able to go up and down the stairs. There may be multiple things that could encourage a patient to have falls. And there’s also the cognitive portion of it, too. Some of the elderly patients are living alone and cognitively aren’t taking care of themselves as far as remembering to eat properly or take their medication. You have to make sure these people are safe in their own environment. Research supports that aging in place is one of the most beneficial things the aging population can experience. But in order to do that, you have to modify their environment. Another revelation I’ve had working in the field ties back to dementia and cognitive decline. Most of these people have lived in these facilities or their homes for years. So they don’t transition well if you take them out, because everything is routine and familiar. When you remove that from their routine or schedule, they become a little bit more confused and you see more of a cognitive decline.
On the lure of the profession:
It’s an amazing field, being able to head out on any given day and meet new people. Each day is different from the day before. You face different challenges when you go into these different homes, because everyone lives differently. So you have to be able to expect the unexpected. It can be fun, sad and sometimes scary. We go into different neighborhoods and sometimes into family dynamics that aren’t quite stable. It’s a mix of settings and experiences. Most people will know if they have the skills to do it. I found that when you do it, you fall in love with it.
Name: John Stuart
Job: Home Healthcare Physical Therapist
Company: Pruitt Health
On the reward of facing challenges:
“Home health is different. In the home health setting, orthopedic patients are oftentimes also sick. They’re typically older patients who are weaker, more debilitated, have a lot of other things you have to work with. So your skill set has to be different. You don’t do treadmill running and burpees with 90 year olds. I’ve been in the field for almost 10 years, and I’ve done pretty all you can do physical therapy wise. I’ve done the educational process through my clinical rotation. I’ve managed outpatient clinics. I’ve done sports and spine rehab, and manual therapy. One thing that I found that was missing for me as a clinician was a lot of the challenges with having a medically complex patient. An 18-year-old rowing athlete with a rotator cuff injury is obviously a very different person than an 88-year-old with a hip fracture who has dementia, congestive heart failure and diabetes. That’s two very different worlds. And I’ve missed that challenge. In the outpatient setting, the pace your progress patients is typically a lot faster. You have more patients per day. So you don’t spend as much time with those folks than you do with a lot of the older, sicker populations that I work with. And I really enjoy spending that quality time with those patients and getting to know who they are as a person and a patient. I think that leads to considerably better outcomes overall. You have the intellectual challenge as a therapist working with someone who might have a cardiovascular, a pulmonary or a metabolic issue. All of those factors have to go into what you do and how you modify how you approach that patient as opposed to how you approach a young athlete. I tend to find it much more rewarding.”
On entering the home healthcare field as a physical therapist clinician:
It has long been my opinion that students who are coming out of PT school and taking a license probably don’t need to go into home health straight out of PT school. I think you need a year or two of diverse patient care to really get a feel for who you are as a clinician, and what your strengths and weaknesses are before you decide if working with that patient population is for you. Your results are going to be slower. To me one of the most gratifying things about being a PT is when you look in the mirror each morning you know you’ll have the opportunity to make a profound difference in someone’s life that day. And at the end of the day you will know if you did that or not. So there’s that immediate gratification day to day that what I do makes a difference. I don’t think a lot of fields can necessarily say that. The pace at which you see those returns is often slower in the elderly population, but you can certainly see it. For example, somebody’s primary goal for the day may be being able to get out of bed, get to their favorite chair and then get from the chair to the bathroom successfully. This can be a marathon event for some of these elderly, deconditioned patients who are extremely weak. They may have oxygen issues related to COPD or CHF, and getting around the house may be the same to them as running the Peachtree Road Race. Being able to impact on that immediately is really cool stuff. As a new grad coming out of school 10 years ago, I don’t think I would have been adequately prepared for the complexity of those patients. I needed to see a few thousand people first. My advice to new therapists coming in would be to go out and do some time in a hospital. You’ll have the opportunity to work with diverse patients with challenging issues, but you have a huge hospital system around you as a support team.
Name: Molly Lewis
Job: Home Health Nurse and owner of Giving Care Education Center
On finding her place in the home health care:
After nursing school, everyone tends to bounce around to see what area suits them best or what type of patient they enjoy working with. And I like home health and geriatrics. It’s more personal. You develop a relationship not only with the family and the patient, but anyone else who is taking care of that person. It gives you the opportunity to teach them ways of doing things, about diseases and medications, and things they don’t normally get in the hospital. Once someone is discharged from the hospital it’s our job to have a healthcare team readily available to cover every need that person might have. If someone comes home after having a stroke, my job would be to make sure they don’t have another one, manage their medication and make sure the family is able to take care of them. The physical therapist is going to try and restore that’s person’s mobility as much as they can. The occupational therapist is going to come in and try and make sure the person can still put on their socks and do other things at home. The speech therapist is going to make sure that person can swallow and help them with their speech. We have a home health aid come in and help them take a bath or teach the caregiver how to give the patient a bath. So it’s a huge effort from a whole care team to take care of that patient’s needs.
On what to expect as a home health nurse:
When a person goes into the hospital, it’s because of something that happened that may be considered traumatic or is a huge change in their health. They go to the hospital, the doctor tells them what’s wrong, they treat them, they get them to a point where they consider them semi-stable, and then they go ahead and send them home. Usually it’s with just a few pieces of paper with information. If you want to go into home care nursing, your first job would be to take away the stress. You would pick up where that hospital left off. So our job is to go in, explain things, help them understand the disease or condition, the signs and what to look for; everything from medication to how that caregiver is going to effectively manage to take care of that patient. What kind of person does it take to get into this field? You have to be very detail-oriented. You have to know all of the diseases, and all of the signs and symptoms. You can’t turn around and talk to a doctor, because there’s no one there but you. Home health nursing takes a lot more training, a lot more common sense and a lot more time. My colleagues and I average four extra classes or tests every month to keep up with all the new technology, all the new diseases, and learn how we can take better care of our patients and keep them out of the hospital. When you go into home care it’s more person-centered. You’re not just dealing with the disease, you’re dealing with the person and how they react to that disease. There are so many things to focus on in home healthcare. You have to focus on the home and ask yourself if it’s safe for the patient. You have to focus on how they take their medication, when they take it and where it’s stored. You have to focus on the disease. Let’s say they have diabetes. You have to talk about the signs and symptoms, how the patient knows when they’re in trouble, what they have to do to manage it, what to eat, and what other diseases go with that disease. We have to make sure the patient is as healthy as can be. It’s the whole person, the whole family and the entire home. That’s home care. …I feel like [home healthcare] is constantly evolving. There are new rules and regulations, and at the same time you have to be able to slow down and find new, innovative ways to teach people how to take care of themselves or manage their own care.
