Home Health & Hospice Week

Are your therapists in the game or sitting on the bench?

Therapists can help improve your patient outcomes and boost your bottom line -- but not if you can't hire them first.

Therapists, especially occupational therapists, are proving valuable tools to agencies'quality improvement efforts and fiscal health (see Eli's HCW, Vol. XIII, No. 20). But it can be hard to woo therapists to your HHA's employment rolls.

"There are geographic pockets of shortages for each discipline, including all the therapies," notes Linda Krulish, physical therapist and president of Home Therapy Services in Redmond, WA.

And to make things even more difficult for HHAs, "therapists do not need to work in home care," Krulish points out. There are plenty of other health care settings where they can ply their trade, and many of those settings give them more clout.

Many therapists shy away from home care because it is so nursing-dominated, believes Cindy Krafft, director of rehabilitation with Peoria, IL-based OSF Home Care. Home care is "where you go when you run out of real therapy," many therapists think. "That's where old therapists go to die. It's like the therapy glue factory," Krafft quips.

To become an attractive employer of therapists, HHAs must empower their therapy staff and show them they are valued in the home care setting, Krafft insists.

Consider these tips when building your therapist recruitment and retention program:

1. Stress comprehensive rehab. Home care furnishes rehab "in the most functional setting possible," Krafft tells prospective therapy employees. With hospitals discharging patients earlier and earlier, "these people have very real rehab issues that we need to address in their home," she emphasizes.

Conducting therapy in the home care setting requires a very high skill level from therapists, she adds.

2. Take a team approach. Occupational and speech therapists often feel overshadowed by their PT counterparts in home care, warns Krafft, herself a PT. Making OTs and SLPs contributing members of the home care team makes them feel valued. OTs "aren't drawn when they are treated like an ancillary service," she says.

3. Make a therapist a manager. "Therapists were very frustrated that everyone they reported to was a nurse," Krafft says of her employer. She came on as OSF's director of rehab 18 months ago and has hired 30 therapists for OSF's six locations since then.

In research Krulish conducted, therapists were happiest in their jobs when "their boss or supervisor was perceived by the therapist to be knowledgeable, and someone they could respect and relate to," she says.

4. Have therapists train nurses. Sending new nurses out with therapists as part of their orientation underscores the therapists'value to the team and helps nurses recognize therapy needs and OASIS coding discrepancies, Krafft points out.

5. Encourage specialties. Home care has moved beyond the typical "hips, knees and strokes" patients, Krafft says. If therapists have a special interest in a relevant treatment area, encourage them to pursue it, she advises.

For example, wound care, incontinence and pain are all areas that therapists can specialize in and help improve home care patients' outcomes, Krafft notes. "Some therapists have stagnated," she says. "You have to challenge them."

6. Avoid these no-nos. A major turn-off for therapists working in home care is being treated as a "cash cow," Krafft warns. Bullying therapists into boosting therapy visits over 10 or keeping them low after that, without regard to patient care, leaves therapists feeling they aren't in control of the patient's treatment. There are plenty of legitimate and lucrative ways to boost therapy use, Krafft points out -- there's no need to pressure therapists to do so when it's not warranted.

In her research, therapists registered low job satisfaction when faced with coercion or threats, Krulish agrees. Also high on the hit list: micromanagement.