By Brittany Ferri
Challenges and barriers are inevitably present in any job field. The particular obstacles may vary from setting to setting, or they may be a result of the job itself. No matter the source, it is important to know what they are before accepting and starting a new job or career. This is especially of note for healthcare professionals, who are often expected to begin patient care soon after entering a facility’s doors.
In part one, we discussed occupational therapy in skilled nursing facilities and acute inpatient rehab. Therapy in those both settings takes place within a facility where a patient is admitted, and is often done at least partly at bedside.
Part two discusses barriers to service in outpatient and home health. Home health and outpatient services are also similar, as patients are living in their homes and the communities they are part of. Therefore, therapy services are implemented alongside the roles they typically assume and occupations they engage in on a daily basis (e.g. work, life, and education). This is a major aspect to understanding how occupational therapy is provided in these settings.
One of the biggest barriers to outpatient therapy is the requirement that patients come to a set place to receive services. This means other appointments, family obligations, car troubles, traffic, and a myriad of items can interfere with timely and regular delivery of services. Patients may have difficulty coordinating your schedule with their own, and they may be late even once appointments are agreed upon. This can impact a patient’s progression towards their goals. Furthermore, lack of progression can cause a decrease in motivation. If a patient is not seeing tangible gains in their function, they may be less likely to continue therapy. However, when the opposite occurs, this factor can be viewed positively for outpatient therapy. If a patient shows up to their therapy appointments regularly and on time, it is quite probable they are motivated to participate which can make therapy markedly easier.
Like attendance, compliance can serve as a barrier. If a therapist provides a home exercise program for a patient to complete outside of therapy, a patient may forget to do so amidst their other obligations and engagements. This also goes for lifestyle recommendations. For example, a therapist may recommends a patient abstain from alcohol due to its tendency to inflame the body and worsen an existing condition. A patient may neglect to comply with this if they are attending a social gathering over the weekend. In short, several external factors can weigh heavily, either positively or negatively, on how a therapy plan of care progresses.
Because they are living in the community while receiving services, those who attend outpatient therapy are usually higher functioning with fewer severe deficits. This makes more time for the therapist to focus on improving smaller issues. When smaller issues are addressed more easily, patients may experience a notable improvement in the ease of their daily tasks, increasing their appreciation and motivation. Similarly, if patients implement therapist recommendations as promptly and regularly as indicated, they will likely see some immediate differences in their condition.
By working on deficits with differing severities, a therapist in this setting can address a different type of a patient’s presenting problem. With a therapy gym and clinic space readily available, there are often more resources to utilize than when treating bedside in a patient’s room. Likewise, the therapist is able to have their patient physically act out certain activities, rather than simulating them to analyze the areas where impairments lie, which is an integral part of occupational therapy practice. For example, a patient can carry a laundry basket up and down the stairs of an outpatient clinic to show their body mechanics, safety awareness, and range of motion, whereas this likely could not be done in a hospital setting.
Home health therapy services are provided to patients considered homebound and otherwise unable to receive services on an outpatient basis. Patients’ conditions are typically more stable at this point, as they have been recently discharged from either acute or short-term rehab for a certain medical diagnosis.
One of the difficulties of home health therapy is the home environment itself, which can often be unpredictable. A therapist often does not know what to expect on a first-time visit, which can make providing services a bit more difficult. There is also the chance of patients not liking providers in their house several times per week, due to what is often perceived as an invasion of privacy. Conversely, therapy taking place in a patient’s natural environment is largely positive. It gives therapists a unique opportunity to practice transfers in the patient’s actual bed, assess for safety risks in real time, and train caregivers or family members. Providing therapy in the home also allows therapists to prevent hospitalization at the most direct level, which is very rewarding.
Being in a patient’s home also makes it more likely for patients to give therapists food, money, or other gifts to express their gratitude. Most companies place dollar limitations on gifts and some companies restrict therapists from accepting them altogether. This may place therapists in an awkward position and cause difficulty drawing the line between therapist and companion. It may make therapists feel good to provide company to the lonely elderly, so this can be seen as a positive for those practitioners who are able to maintain appropriate boundaries.
Another type of boundary which may be impacted is that of the therapist and the company they work for, as there can be a feeling of disconnect between the two parties due to work apart from the office environment. This can be a negative, especially for newer or less confident therapists, who may struggle with feeling a lack of support or inability to collaborate with other staff. If a therapist is feeling this way, the divide can carry over to the patient, who may already be hesitant having many new individuals in their home several times per week. However, it can be a positive quality for those who choose to view it as an opportunity. This independent job role can inspire therapists to become skilled at seeking out resources and collaboration, and advocating for themselves when needed.
Additionally, lengthy documentation and long hours can cause difficulty maintaining an appropriate work-life balance under certain companies. However, the ability to build your daily schedule based on visits means there is much flexibility allowed. There is also significant time spent in the car commuting between many homes, which may be a negative for some therapists. If driving is something you find enjoyable, this factor may be seen as a positive for you, and assist with destressing and processing each day’s work activities.
During the next post in this series, we will cover two remaining major settings of occupational therapy: mental health and school systems. Check in soon for more!
About the Author
Brittany Ferri is an occupational therapy consultant, certified clinical trauma practitioner, and certified light therapist. Her specialties are mental illness, health writing, and complementary modalities. She is passionate about disease prevention and meeting the emotional and physical needs of all her clients.