line drawing of two women. One woman is walking up a set of stairs for physical therapy.
Home works better
by Ed Gasiewski & Michael Gasiewski

Medicare Parts A and B cover medically necessary skilled services like nursing, home health and therapies such as physical therapy, occupational therapy and speech-language pathology. When patients need these services, the natural transition is from the hospital setting to a sub-acute rehab setting and then to the patient’s home—but more and more patients are discharging directly to their homes.

Under Part A, a patient receiving home health services is required to be homebound. Many patients will improve to the point that they no longer meet the homebound requirement, while others show limited improvement, but may still be discharged at the end of the 60-day period of care. Once a patient no longer qualifies for in-home services under traditional Medicare, patients are often encouraged to follow up with an outpatient setting for continued therapies.

The Solution

For home health agencies that do not employ therapists, if a patient has been receiving care in their home, including therapy, it’s important to identify and partner with a therapy practice that can continue to provide services in the patient’s home. Under the Part B benefit, the patient does not have to be homebound. So, regardless of patients’ homebound status, they can receive therapy services in the comfort of their home.

Home Safety

One major factor that is often dismissed when patients are sent home from skilled nursing facilities, nursing homes or sub-acute rehab facilities is a home safety assessment. A home assessment should be conducted before the patient is discharged home. A proper home safety assessment will identify barriers and help put measures in place to overcome them.

While the Patient Driven Groupings Model (PDGM) for home health agencies has made it more difficult for agencies to provide “therapy only” services, agency-employed occupational and physical therapists can perform the initial intake and assessment if therapy is included on the plan of care, meaning they are in a perfect position to provide home evaluation services as part of the initial patient assessment. The therapist will identify the proper location of grab bars, the correct shower chair and the most cost-effective modifications to accommodate the patient. The goal is to have patients safely enter and function in their home.

Home health agencies without a therapist on staff should consider a partnership that will enable them to provide services.

Benefits of Treating Patients At Home

Home health providers already know well the benefits of skilled nursing care in the home. Those benefits extend to physical and occupational therapy services provided in the home. A few therapy-specific benefits are listed below.

  • Convenience—Along with not having to go through the hassle of scheduling transportation and leaving home, patients also benefit psychologically from being seen at home. The comfort of a familiar space can give the patient peace of mind, which leads to greater reception and adherence to their treatment both mentally and physically.
  • Personalized care—Providing one-on-one service and getting to know the patient allows the therapist to take a more personalized, targeted approach to the way they treat them and train their caregiver if needed. This also allows for greater transparency, resulting in better patient engagement and an improved patient experience overall. When looking for a partner in therapy services, seek a provider that can ensure patients have the same therapist for each visit.
  • In-home vs. clinic treatment—Patients are less likely to decline treatment when the therapist comes to them. The therapist also gets to help overcome patient barriers identified in the home, which cannot be done in the clinic. With in-home assessments and treatments, therapists get to treat in the patient’s actual living environment. They get to work on the patient’s own stairs using their railings, do transfers in their bathroom and perform mobility training throughout the home.

Benefiting Partners

As home health agencies look to transition their patients to another level of care or take on a new service line, in-home therapy providers can take the baton and continue with the skilled therapy services.

Ed Gasiewski, PT, and Michael Gasiewski, OT, are the owners of Therapy Choice, a Medicare Part B provider that specializes in in-home physical, occupational therapy and home safety assessments. Visit