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  • Minimizing Risk in Home Health Physical Therapy

    A new guidance document from the country's leading provider of physical therapy professional liability insurance offers tips when considering home health physical therapy during the COVID-19 pandemic.

    The provision of home-based physical therapy during the COVID-19 pandemic is a hot topic of conversation for the profession, and now the country's leading provider of liability insurance is offering its perspectives on risk management in the home therapy setting.

    Now available: a guidance document from the Healthcare Providers Service Organization on minimizing risk in the provision of home health physical therapy. HPSO is an APTA Strategic Business Partner, and the official provider of professional liability insurance for APTA members.

    Similar to APTA's guidance, the HPSO resource emphasizes the importance of following recommendations from the U.S. Centers for Disease Control and Prevention on minimizing the spread of COVID-19. And much like APTA and the CDC, HPSO emphasizes the importance of the PT's professional judgment, writing that "As a healthcare provider, physical therapists are in the best position to know what is best for their patient, his or her overall health, and how well their conditions are managed."

    The HPSO document, however, dives deeper into the home health setting, noting that during the emergency, "some physical therapy practices may be considering expanding service offerings to include physical therapy in the patient's home."

    The HPSO resource isn't solely focused on COVID-19-related issues, and moves from considerations around establishing a home care service into a range of considerations that include incident response, standard of care, scope of practice, patient screening, equipment safety, and infection prevention, among other topics.

    "The home care environment presents a wide array of injury and liability concerns for patients, physical therapists, and employers of physical therapists," HPSO writes. "A comprehensive risk control program that identifies and addresses common exposures is essential to enhance worker and patient safety and minimize potential loss."


    • A) Most home health is not "essential" considering the life threatening risk to our elderly patients and staff. I am appalled that my home health employer in Silicon Valley CA would risk our health by sending PTs and OTs out as usual. They are trying to make money, when we are not essential right now. The huge majority of seniors who are home are stable and have caregivers in place. They don't need a home exercise program right now. Orthopedic surgeries have stopped so we're not getting those referrals. The home setting has many more vectors of contact than a hospital-and dynamics we can't control- and therefore pose a huge risk for the clinician, and he/she is much more likely to pass the virus asymptomatically or presymptomatically to other patients. Home health therapists and their patients are exposed to countless caregivers and family members, patients themselves are in or coming from congregate settings where they could have picked up the virus. Continuing nonessential visits as my employer is pushing is senseless and greedy. My home health company is run by young nurses with very little experience, none of which have been in the field for years. They are safe at home, and not listening to the therapists. While nursing care may be essential to a percentage of home care patients right now, I would say that even many home nursing visits are not essential. We are all beneficial under normal circumstances, but right now we are largely not essential and we are endangering lives and lifelong health. It's not just a matter of life and death; many survivors have organ damage, respiratory issues, etc., and will never be the same. B) My home health employer refuses transparency in letting staff and patients know which clinicians are coming from positive patients home. A recent New York Times article showed that PPE combined with hand washing is only 91% effective when used by health care workers. In hospitals positive patients are cared for in separate wings from non positive patients. But in home health, employers are only concerned about the bottom line so they are not telling patients that their nurse or therapist just left a positive house, nor are the letting fellow staff know who is treating positives, and therefore risking our health through cross contamination. This is not fair to seniors, the majority of whom would refuse treatment if they know the clinician coming into their castle has a higher risk of being a carrier because they just left a positive house. C) In the San Francisco Bay Area, CA we have a shelter in place order and many counties are now mandating the use of masks in all public areas. But when I brought this up to my employer, suggesting that patients and their families wear masks for our protection, I was shot down, gaslighted, and asked to move to per diem status. This is surely so they don't have to pay my benefits. The fact is, we are forced to work in close proximity to patients and caregivers during every visit, which isn't safe when they aren't wearing masks. Therapists cannot stay 6 feet away in open air when they are taking vitals, lifting legs, assisting with transfers and gait. Grocery store workers are much safer than home care clinicians since they don't stand close to their customers. The very least the CA PT Board and the APTA could do for clinicians, patients, and public safety is demand: that only truly essential therapy be done right now (again, most is not given the stakes) and mandate that everyone in the homes we enter wear masks (except of course for those few who have respiratory issues at baseline.) We are given only one surgical mask to wear a week. The risk of transmission is high in this setting. I don't care about patients safety anymore- I did at first- but since it's been so stressful at my workplace and my employer has shut down all questions about safety, I am now only concerned about my health and the health of my family. This is only a job after all. I'm now in a profession I want to leave with an employer I don't respect. I'm trapped and don't feel a call to duty. My nursing employers are not listening to the PTs and OTs at our company. Instead they get mad and gaslight us for our concerns. And the CA PT Board and the APTA are not helping us. Shameful.

      Posted by Anonymous on 4/18/2020 7:05 PM

    • I am sorry to hear about your experience, which sounds horrendous. Working without proper PPE and cleaning supplies is not an option for me, either. Unfortunately, I have a couple of family members in different states from each other, and me that I consider needing essential PT in the home due to the extreme decline in physical function. I have instructed my family members to wear a mask for their protection and that of the staff. Ideally, once the initial evaluation and family training are completed, most of the remaining visits would be via telemedicine. I am in Georgia. Our Governor is opening up the state too soon. I was strongly considering looking a home health opportunities until the outpatient clinics can safely open, but you have given me extra food for thought. Thank you for your post. Don't give up on the profession. But, we have to demand universal coverage for physical therapists to be able to perform telemedicine as a norm, not only in a state of emergency. There are multiple free webinars to help PTs transition to telemedicine as an option to provide proper care.

      Posted by Venneisa Williams on 4/23/2020 4:49 PM

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