The Home Health Care Perspective
Rick Dressel is an Occupational Therapist for Bayada at Bayhealth in the Adult Division in Central and Southern Delaware. He has practiced in a variety of clinical settings including acute care and skilled nursing. He holds specialty certifications in LSVT-BIG and CAPS. His primary area of interest is implementing evidence-based interventions to address Parkinson’s disease. Rick lives with his wife, Kathy, and their two dogs, Lexi and Nugget, in coastal Delaware. They can be found poolside or with their feet in the sand.
Home health care has significant implications to enable older adults to successfully age in place; after all, home is where the heart is. A clients’ home contains the chapters of their life story under one roof. Walking into a client’s home is a physical journey into their personality; the home’s condition, physical set up, and decor are all tangible aspects of the client’s lifestyle. Homes are information-rich environments providing clinicians vital and subtle underlying information. As a result, home health occupational therapists (OTs) are well-positioned as a holistic discipline to champion older adults’ personal desire to age in their homes.
Home health care is the ideal setting for an OT to improve a client’s occupational performance and quality of life. It enables OTs to collectively address the person, environment, and occupation in the most natural forum. The OT community has been afforded the opportunity, through home health, to implement evidence-based interventions and provide individualized education to affect positive client-driven outcomes.
OT personifies hybrid practitioners. We intertwine our assessment of human behavior, psychosocial factors, and environmental concerns to yield clinical impressions. A client’s home is stripped of the acute inpatient rehabilitation accessibility, ADL simulation suite, and the rehab gym’s array of newest technologies. A client’s home does not have a nursing home’s 24-hour supervision and care with medical staff outside their door. The client’s home is simply where and how that individual lived prior to a change in their functional status. For some clients, home may be the endpoint in the continuum of care as clients discharge back to their home. To successfully facilitate a client’s livelihood in their home is one of the most fulfilling and gratifying rewards to the client and OT.
The caveat of home health care is the quintessential unknown. I have fallen through bathroom floors due to weakened floorboards and crawled through windows to access medically fragile clients. It is not unusual to encounter roaches, mice and black mold. Sadly, Adult Protective Services must be notified in particular situations. I have fended off the smallest attack dogs and embraced the largest lapdogs. A lack of hot water due to the inability to pay the electric bill can be common. Family dynamics are amplified in the home. The constellation of structural defects, poor living conditions, and unsafe environments can be the norm on any given day. The widely varied homes, unique experiences, and wildly bizarre interactions are absolutely the most thrilling part of home health. At the end of the day, I embrace a multitude of challenges. ‘Truth is stranger than fiction’ is the mantra for most home health practitioners.
As one can surmise, home health has no shortage of trepidation. Clinicians’ mettle can be tested client home after client home with a garden variety of challenges. A home health clinician does not have the luxury of a facility’s four walls nor do home health OTs have the immediate support of physicians and nurses should an emergency arise.
Our cars are our offices and the clients’ homes are our clinics. We must possess a good understanding of our client’s medical histories and be prepared to apply interventions based on their disease processes. An OT’s keen ability to decode and deconstruct the interplay among the client and their home is intrinsic to this particular setting.
As American Healthcare evolves into a new normal due to COVID-19, OT among other healthcare professions is re-writing their histories thus redefining their daily roles. Across the United States, healthcare operational procedures are amended daily to prevent the transmission of the virus and to protect clients and employees. Home health care has ventured into uncharted territory amid the anxieties of this pandemic.
We utilize presence and compassion now more than ever to lift our client’s spirits among the fear and uncertainty. With older adults being a vulnerable population, protection from COVID-19 is paramount, and disseminating information based on fact, not fiction is critical to quell hysteria. As time marches on, the unknown of COVID-19 is ever-present in 2020. Lately, I have echoed a common sentiment with my clients; we are not stuck at home; we are safe at home. Be well all.
