An Effective Physical Therapy/Physical Therapy Assistant Team in Home Health

by Jyomo
(San Jose CA)

Jyomo's Submission

Dear Marcia,

What do you think are some factors that make a Physical Therapist - Physical Therapy Assistant team successful in home health?

What can Physical Therapists do to make the best use of the Physical Therapy Assistant in home health?

Marcia's Answer:

These are very good questions and worthy of considerable thought before venturing out in honor of our frail, elderly companions.

The most important factor is the integrity of both the physical therapist and the physical therapy assistant. Unethical work practices of one will ruin the utmost integrity of the other.

I've worked with many physical therapy assistants over time but only have only found two that I was willing to work 40 hours a week with. This was because I knew that they were going to give my patients the best and highest quality of care.

There are several things a PT can do to make the best use of a PTA in the home health setting.

Too often a PT will pass off a patient to a PTA simply because the PT does not want to go to that part of town, house, treat that diagnosis or has personality conflicts with the patient. When in fact, this patient may not be a suitable match for the skills of the PTA.

To pass a patient off to a PTA so that the PT can 'get on with their day' is unethical when that patient requires skills that the PTA may not have or be strong in. We must remember what is best for the patient.

My physical therapy assistant and I used to divide the territory as best we could. Our number one rule, though was meeting the patient need first - and whoever had the skill to do that, did that.

Dividing the territory, however, saved on time and fuel and made the day more efficient without sacrificing the
quality of care delivered to the patient.

Other thoughts include:

Allow the time for PT's and PTA's to discuss each patient. Productivity requirements may need to be lowered in order to allow for this.

PT's need to read the note they are signing and I would suggest a PT revisit every 5th visit. If a PT revisits at the 10th visit and sees that things aren't going right or that progress does not match notes or that the plan of care needs to be changed, this saves 5 or so visits of wasted time and money.

I would suggest that an agency spend the time and orientation money to allow a PT/PTA team to shadow each other for an entire month. The team will work better together when get to know each other better and gain a better insight into their treatment philosophy.

I think that PT's and PTA's should shadow another PT or PTA at least one day a month to gain fresh treatment ideas and continue learning. In home care, there is no clinic that I can bounce ideas or even questions off of my co-workers - this is the best way to allow for and encourage professional growth and development.

Another excellent source of field staff development and growth is monthly case studies. Each month a PT/PTA will present a difficult patient to the entire team (RN's, OT's etc...) and allow questions and ask questions.

These last two ideas are highly marketable and keep an agency on the cutting edge - letting prospective patients know that you encourage professional growth and discourage stagnancy.

Physical Therapist Assistants are highly competent as are Physical Therapists, however, the home health arena has seemed to fill up with a lot of fraud over the last 15 years. It just takes a bit more looking to find the Physical Therapy/Physical Therapy Assistant teammate that works best with you!

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