Home-Health vs. Private Therapy Settings: A Review

Good morning everyone!

I am back with a monstrous headache today, that as the SLP part of my brain identified, is running from my frontal lobe all the way to my left temporal lobe. The weekend was just a little too crazy (in other words, non-routine) and I think my brain spent most of Monday trying to integrate everything and re-orient to the usual schedule. Man, change really screws me up. Sometimes I really identify with some of my kiddos in that way. :)

Anyways, as I have been fortunate to have been able to dip my toes into several SLP settings thus far, I wanted to give you all a short "review" of home health and compare it to a clinic or private setting if you are curious about switching to either.

First just let me say, I love home-health. But I truly believe (like any setting) that the company, district, or management makes all the difference. It is definitely possible I would not be quite as happy working for another home-health company. And as we all know, every setting has their horror stories. The company I work for, however, is extremely ethical, caring, and an advocate for their therapists on a professional and personal level. I have been with them since my first semester of grad school starting out as an SLPA, through my Clinical Fellowship, and now as a certified SLP. I am blessed to be a part of the work they are doing. We offer ST, OT and PT, but the majority of our therapists are SLPs and SLPAs.

Pros:
- You can set your own schedule.
Only want to work 4 days a week? Only want to work mornings from 8-1? You got it. Provided you stay within the guidelines set by insurance (some require 2 sessions per week from day Y to day Z, cough cough, TMHP) and work with parent schedules, you can make clients fit into your preferred work hours.

- You can work as little or as much as you want to.
This is ideal for therapists who have children or want to split home-health with another setting. You can take on a part-time or full-time caseload depending on your availability. Full-time caseload is currently around 15 kiddos in my world. You can also pick up evaluations for extra money in nearby locations for treating therapists who do not have time to evaluate for whatever reason.

- You can choose to accept or decline a client (within reason).
Even if you choose to evaluate a child, you may be able to decline accepting them onto your caseload if you feel your caseload is too heavy or time restraints currently make it difficult to fit them in.

- Sessions are typically shorter.
In my experience, I found that while all my home-health sessions lasted 30 minutes in length, often my private setting sessions lasted up to 45.

- Compensation rates may be higher, depending on the company.
This may be relative on a case-by-case basis, but I hear many home-health therapists agree with this statement.

- You can target goals in the child's natural setting.
To me, this is one of the biggest pros. I love being able to show a parent how to integrate HEP (Home Exercise Program) into activities using the child's own toys and environment.

- Scrubs.
One word: comfy.

- You can stop at Starbucks in the middle of the day.
Self-explanatory.


Cons:
- You're in the car. All. The. Time.
Sure, you get to have some great car dance sessions, and you better believe I've had the time of my life during the summers belting out some Blink-182 while sipping an Icee on the way to sessions. But believe me, it gets old, and when your friends/boyfriend/husband mentions driving somewhere after work, even if it's 20 minutes away, you'll feel like bursting into tears.

- Some companies may not reimburse you for gas or travel expenses.
My company does not. However, I do believe my session rate is higher to compensate for this. I also use my personal vehicle for visits which obviously puts me at a greater risk for traffic violations, accidents, etc.

- You may not have access to a wide-range of materials or more expensive programs such as Boardmaker, like you would in a clinic.
Seriously, I am dying to get my hands on a copy of Boardmaker.

- The rooms of your home and backseats/trunk of your car will be filled with toys.
As I tell my boyfriend, I am a traveling preschool. I miss having an adult bedroom.

- You are isolated from other therapists/adults.
One thing I definitely miss about the private/clinical setting is daily interaction with other therapists, including OTs and PTs. Home-health can be lonely and you will have to make the effort to stay in contact with friends and other therapists so you don't get too bummed out.

- Parents may take advantage of the fact you are coming to them instead of the other way around.
I have experienced more cancellations in home-health than in private settings, in general. Because my company works with Medicaid only, I believe some families take advantage of the "free" nature of the evaluations, sessions, etc. and will cancel moments before you arrive.

- Every home is different in terms of cleanliness and overall atmosphere.
I have been in homes where I have fought off roaches while reading a story as well as homes that are nicer than those in North Dallas. It really is hit or miss. You just have to be willing to deal.

- You may have to fight the urge to stop at Starbucks in the middle of the day.
You don't need a grande Java Chip frappucino with no whip and extra drizzle every day after that session with Little Johnny but by golly yes you DO.

So there you have it. For me, the pros definitely out weight the cons currently in home-health. I know at some point I will attempt the schools again (I only did my internship there in grad school) but for now I am happy right where I am.

What setting are ya'll a part of right now? I'd love to hear along with a pro/con or two:)