What No One Tells You About the Dark Side of Home Health Therapy

Working in Home Health: 

 Two Thumbs down?

Have you ever thought of working in home health?  There are tremendous opportunities and many, many reasons why you would want to be a home healthcare provider.  Nonetheless, as the saying goes, there are two sides to every story.  So, if you're contemplating  full time, part time or PRN work as a home health therapist or nurse, remember to take time to consider the pros and cons of the job.


In a separate post, you can find a list of the top 10 reasons why being a home health therapist is like a dream come true, but today, take a look at the downside of  working in the home health industry.

The Top 10 Reasons

 Why You Don't Want to Work
 in Home Health

10.  Your car is your office:
There's no fax machine for communicating with doctors. There's no desk for you to comfortably complete your documentation. Worst of all, there is no bathroom when you're at work. If that's not bad enough, to have them accessible, all of your therapy materials must be kept in your car.


9.  Driving will be a part of your day:

You will encounter traffic jams, lane closures, accidents, detours, slow moving trains, speed zones and all of the things associated with a regular commute to work, but when you work as a home healthcare provider, you will be dealing with it all day long. Depending on where you live and work, it's not unusual for a full time worker to drive an average of 80-100 miles each day.


8.  Medical records are sketchy at best:

More often than not, you will blindly enter a patient's home having very little information about past medical history and wondering why you're there. Primary admitting diagnoses can be random and completely irrelevant to your scope of practice.  For instance, an SLP may receive an order to evaluate a patient with a primary diagnosis of Diabetes Mellitus and a secondary diagnosis of necrotic ulcer to the foot. Eventually, you learn your patient has recently been hospitalized for aspiration pneumonia...that's when it begins to make sense.


7.  You work by yourself:

It can be lonely out there. If you enjoy socializing with nurses and like to have lunch with your therapy friends, then home health is not for you. You will spend the entire day by yourself. In fact, weeks may pass and you don't even get a glimpse of  a coworker. Because they're not around, those same people that make work fun or interesting are not available for you if you need a quick sounding board. Getting fast help with clinical problem solving or collaborating with other professionals  just isn't possible.


6.  Visits are not always easy to schedule:

Without a doubt, scheduling is difficult in any setting, but it can be particularly challenging once patients are back home.  In addition to routine therapy and nursing visits, you also have to deal with: showers,  hair appointments, visiting relatives, favorite television shows, medical appointments and naps. All of these things can and will get in the way of you scheduling your visits. Also keep in mind: visits before 9:00am are almost unheard, nap time is from 1:00-3:00pm for patients of all ages, and visits after dark  are almost always out of the question.


5.  You treat patients in their homes:

No matter how hot, how dirty, or how dangerous the neighborhood appears to be, the show must go on when providing home health services- you don't get a choice. Furniture may be covered with cat hair or it may be completely absent. A lack of air conditioning in the home may leave sweat rolling down your back. Roaches are a fairly common. Patients sometimes make inappropriate advances. Generally speaking, home health work is not for the prissy, weak or faint of heart.



4.  Missed visits mean lost income:

When your patient isn't home or cancels a visit at the last minute, you will find yourself with nothing to do. While a missed visit can be a welcome break in the middle of a busy day, it can really wreck that schedule you worked to hard to create.  Keep in mind, you're not making money unless you're sitting in front of a patient. That means, sitting in your car is not only wasted time, it's also lost wages.


3.  Documentation- Ugh!:

Everything must be documented according to the strictest of Medicare standards. That's usually the case anywhere you go.  It gets tricky and complicated when agencies  have their own specifications for documenting your work. They tell you to complete all of your documentation in the presence of your patient, but, unless you like long, awkward silences while you look at your computer, it's just not possible. You will spend hours at the end of each work day completing your paperwork so that it can be submitted by the deadline.  Evals, re assessments and visit notes are expected to be completed within 24 hours. Believe it or not, sometimes that's not easy to do.



2.  It's not an environment for rookies:

Working in home health is not recommended for new graduates. There are no professional safety nets available and the type of experience you gain is somewhat limited.

1.  You have to maintain a tight schedule and stick to it like glue:

The time related pressure of working in home health can sometimes be the most difficult thing. In order to get the most done, visits are often scheduled back to back.  When that happens, your schedule has to be executed with precision...down to the minute on some days. Getting off schedule by just 5 minutes in the morning can cause you to be late every where you go, all day long.


Working as a home healthcare provider definitely has it's dark side, but it's not all that bad. In fact, nothing is really that awful if you are prepared for it. Hopefully, this information is an eye opener for you and helps you make the best decision possible as to whether or not a job in home health is for you.

Your dream job doesn't exist...you have to create it.
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