How often should I treat home health patients? The answer to this question can vary widely depending on your area of practice, the company you work for, the severity of the diagnosis—the list goes on and on and on.
Below are the 3 useful steps to consider when making your decision.
* Every individual’s situation is different, so communicate closely with your employer/payer and use your best judgment.
Base Treatment Frequency On:
1) The needs of the patients
2) What’s ethical given payer’s guidelines
3) What’s logical given the diagnosis, patient factors, and logistics of home health.
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The Medicare Factor
Many of your patients will be covered by Medicare
Medicare (and managed care insurance policies) prepay home health companies for two-month chunks of time. In other words, you have two months to complete your course of treatment. Once those two months are up, you can recommend a *recertification of treatment, if appropriate.
Other policies will pay for a specific number of visits for each discipline (including Speech Therapy).
In Home Health, YOU Decide How Often to Treat
Unlike many inpatient rehab units where SLPs are required to see each patient 5-6 times per week, home health therapists have more freedom to decide what treatment timeline is most appropriate for their patients. This is great! In my experience, this leads to a more appropriate and effective course of treatment overall.
Wait, allowing therapists to use their best judgment results in better outcomes? Imagine that!
To decide how many treatments you provide, consider your patients’ diagnoses, severity, environmental factors, and how long they are considered homebound, among other factors. Again, there is no set prescription for how long or how often treatment should take place. But here are general guidelines:
How Often Should I Treat Home Health Patients?
1. Treat One Time per Week
Patients with chronic issues that had a recent exacerbation. These patients tend to have chronic memory deficits, aphasia, dysphagia, or dysarthria.
Examples of 1 Time Per Week Patients:
- Patients with dementia who fell and whose families report worsening memory abilities.
- Patients with Parkinson’s disease whose recent pneumonia caused increased dysarthria
- Patients with ALS
Why 1 Time Per Week?
These are patients who tend to become overly fatigued or overwhelmed by frequent visits; when Speech Therapy tries to come more frequently, we tend to see less willingness to participate and/or increased fatigue which can be detrimental to progress.
What To Do Each Visit (1 Time Per Week)
Review strategies, complete exercises, monitor progress, and train caregivers to cue strategies and exercises for daily practice.
2. Treat Two Times per Week
Most patients! These patients tend to have mild to moderate memory deficits, dysphagia, aphasia, and dysarthria.
Examples of 2 Times Per Week Patients
- Patients with dysphagia who have a mild risk of aspiration and are currently on a modified diet
- Acute dysarthria
- Likely undiagnosed mild dementia
What To Do Each Visit (2 Times Per Week)
Review Speech Therapy recommendations, strategies, and home program. Complete exercises. Provide feedback and tweaks to the treatment plan. Tweaks could include decreasing frequency when your patient is close to discharging or modifying goals to reflect your patient’s progress.
3. Treat Three Times per Week
These are patients with moderate to severe memory, language, speech, or swallowing impairments.
Examples of 3 Times per Week Patients
- Patients with acute CVAs and subsequent aphasia and apraxia
- Patients with acute TBIs and subsequent safety and problem solving deficits
What To Do Each Visit (3 Times Per Week)
Review Speech Therapy recommendations, strategies, and home program. Complete exercises. Provide feedback and tweaks to the treatment plan.
4. Treat Four Times per Week
Patients with *LSVT treatment, per program instructions.
What to Do Each Visit (Specifically for LSVT treatment)
Each visit is packed with a solid 50-60 minutes of extensive treatment, again per program instruction.
5. Evaluation but no Treatment
Sometimes, if Speech Therapy is not recommended (i.e. if the issue is mild and the patient appears safe in the home) I will do an evaluation only and provide education and a home program on the spot.
What Education and Home Programs to provide (Evaluation but no treatment)
- Read the medical record ahead of time. If it seems possible that the patient may not benefit from Speech Therapy at this time, bring a relevant home program packet, just in case.
- Provide a relevant written list of “red flags” for patients to refer to should issues arise. For example, if the swallowing evaluation you completed ended up being a case of moderate GERD, still leave a list of signs and symptoms of dysphagia and aspiration.
- Here’s a free Aspiration Risk Factor handout:
6. Seeing Patients More Often for Fewer Weeks
Sometimes, when my caseload allows for it (i.e. I have fewer patients than average that week) and it’s appropriate for my patient, I take advantage of my extra time by increasing the patient’s treatment frequency (number of treatments per week) while decreasing the length (number of weeks).
The patient will receive the same number of treatment hours in total. But those hours are rearranged so that theyreceives more visits per week for fewer weeks.
For example, instead of seeing a patient with motor speech disorder two times per week for six weeks, I may see him three times per week for four weeks. Both add up to twelve treatments.
This condensed schedule is also known as a massed practice schedule. There’s evidence supporting both a massed practice schedule and the more typical, spread-out schedule (distributed practice schedule).
See our post on the 9 Principles of Motor Speech for Speech-Language Pathologists for more information.
Examples of Seeing Patients More Often for Fewer Weeks
This can work well for patients with motor speech disorders, dysphagia, and mild cognitive disorders.
Of course, double-check with your employer/payer and always choose the schedule that’s best for your patient.
In summary, how often should you treat home health patients?
Once per week. Chronic issues that had a recent exacerbation (chronic memory deficits, aphagia, dysphagia, dysarthria)
Twice per week. Most patients. Usually mild to moderate memory deficits, dysphagia, aphagia, and dysarthria
Three times per week.Moderate to severe memory, language, speech or swallowing impairments
Four times per week. LSVT treatments, per program instructions
Evaluation but no treatment: When Speech Therapy is not recommended or the issue is very mild and the patient appears safe in the home
More visits, fewer weeks: When the SLP’s schedule is light and if appropriate for the patient. This adds up to the same total number of treatment hours as a typical schedule. Works can well with motor speech disorders, dysphagia, and mild cognitive disorders.
*recertification: a 2-month extension of treatment
*LSVT: Lee Silverman Voice Treatment. Used for people with Parkinson’s disease and other neurological conditions.
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