Sara Cota Daly, PT, MT, CLT, has worked in home health as a staff therapist for 11 years. She has witnessed and experienced first-hand the unique challenges of home health, and how it causes physical therapists to struggle with managing personal energy.
In fact, one of her top frustrations was feeling like she was treating clients too late.
"I wanted to have access to people before an injury or pathology had occurred. As a physical therapist, we are wellness professionals, and I wanted to use my skills earlier in the cycle," Daly explained, noting that she was also concerned with the amount of stress, frustration, and negativity she was seeing in her co-workers.
In 2007, after feeling frustrated from her job, Daly changed careers, shifting from home health PT to owning a day spa and wellness center.
Today, the president of Waterfalls Day Spa in Middlebury, Vt., and director of Vermont Wellness Professionals Network, speaks to home health agencies regarding negativity and frustration in the workplace.
Everyone struggles with managing personal energy no matter what area of work, said Daly. In the home health field, specifically, she ticked off the following common frustrations felt by physical therapists.
The flexibility of the job creates less stability. "The schedule changes quickly and frequently based on client need, geographical location, discharge orders, and weather conditions," said Daly. "This flexibility is wonderful when we are in control of it; however, the reality is that we only have partial control."
The treatment environment can create chaos. "You are not in an environment that you control," said Daly. "You are in homes where the rules, systems and interactions are not yours. Chaos steals our energy. We have all been in a situation where your expectations for a short visit turn into a two-hour event."
Documentation is difficult. "Ask any home health therapist and you hear this answer," Daly remarked. "Medicare and Medicaid require more documentation than other types of reimbursement."
Reduced interaction with other health professionals. "You are on your own and do not have as many moments to connect with your fellow therapists, nurses and management," said Daly. "This relates to personal energy as you are making decisions with less support and completing assessments without the assist of another set of hands."
Clients are sick. "We take this on as therapists and feel their struggle and their concerns," Daly said. "Discharge from the hospital happens quicker than it did 10 years ago, and we are seeing sicker clients.
"As PTs, there is a limit to how much we can modify a house to keep it safe, and it can be difficult mentally to leave clients alone in a situation that we would not leave our own family member in."
To help home health care providers manage their energy, Daly has developed what she describes as "the Weight Watchers program for your personal energy." A quantitative method is used to track and budget the five areas of personal energy - health, commitments, work, environment, and inspiration.
"Everyone is allotted 10 work energy points for the day," explained Daly. "We show the attendees a stack of 10 $100 bills, and explain how these are your energy bucks for the day. How do you want to spend them? Do you want to just throw them up in the air and hope they fall in the right place? Or do you want to pre-plan where you want to use them to ensure your day feels like your best work day ever?"
She runs through scenarios that might be causing energy leaks and helps problem solve to stop the leaks.
"Examples of energy leaks are being ill-prepared for the day, forgetting charts, having an inefficient travel route, and wasting energy on negative conversations. We also talk about chronic energy depletion, and how people who are chronically using more energy points then they have become sick themselves.
"We then show the staff some quick easy strategies for energy recovery, to assess their points, and how they are in control to acquire as much as they need," she said.
Daly noted that stress contributes to many diseases and hopes her talks with home health agencies will help to keep hospice nurses, pediatric therapists, and home health aides balanced and healthy.
Home health therapists, in particular, educate clients to balance energy to get their exercises, housework, and chores complete, and Daly is hopeful that by learning this program themselves, they can pass it along to their clients.
Early Intervention Challenges
Cheryl Hall, PT, DHSc, PCS, MBA, has been an early intervention home care provider since 1998.
Currently an early intervention evaluator, home-based service provider and consultant at Children's Speech and Rehabilitation Therapy in Jericho, N.Y., Hall is also aware of home health's unique set of challenges, and how it affects physical therapists' personal energy at times.
"Sometimes, personal energy might be challenged because of the caseload, commute or feeling of 'being on the run.' There are times when energy can be affected by the energy of others in the home health care setting.
"And of course, the physical requirements of the job can also play into a therapist's energy level," she explained.
To help combat these challenges, Hall recommends doing basic things, such as keeping hydrated, eating healthy foods, exercising, and staying current with all required paperwork and job-related responsibilities to minimize stress.
Hall revealed that there are times when she's seen a need to counter negative situations in home healthcare.
"For example, caregivers of very young patients may deny the extent of the child's deficits or fail to acknowledge the child's very real limitations," she said. "Others may feel like the child is not making progress with treatment. Sometimes they fail to see the good things that are happening. Other times, caregivers don't get involved in treatment - they are more detached than they should be - and that can be due to a variety of factors."
Hall believes effective communication and persistence are the best ways to overcome negativity or frustration. She also feels it's important to get the parents or caregivers involved and encourage them to follow through and participate in activities that will help the child.
"A good tactic is to positively point out how much their input matters," she said. "We're there for a short time during the day a few times a week, but the caregivers are with the patient the rest of the time. I like to reinforce the need for consistency, and explain why that's important."
Making a Difference
Margie Anderson, MPT, transitioned to home health in 1996 and has worked in the inner city and suburbs in home health for 17 years. Currently employed as a physical therapist for Natick Visiting Nurse Association in Natick, Mass., Anderson is somewhat of an anomaly in that she hasn't personally struggled with managing negativity.
She admitted there are some frustrations with changes in documentation rules, but she chooses to focus on what she loves: helping people attain their goals in the environment that means the most to them.
However, that doesn't mean Anderson hasn't observed frustration in others. She said home health PTs can have difficulty managing personal energy as a result of isolation during the day, but a close-knit staff, interdisciplinary meetings and a great manager are key to helping counter that.
"I think that having a manager who supports his or her staff in a positive way has been vital in combatting any negativity or frustration," Anderson said. "Working with therapists who are there for each other makes all the difference. Keeping up with current research, trends in treatment, and constantly staying updated clinically also helps."
Anderson offered the following advice for other therapists in the home health field struggling to overcome frustration.
Get to know your staff - participate in continuing education, attend interdisciplinary meetings and stay part of the team.
Be sure to communicate with doctors, nurses and families. And always remember why you chose this career.
"Home health is the ultimate setting to make a difference in people's lives," concluded Anderson. "You have unique insights that bring reality into the practice of medicine."
Beth Puliti is a frequent contributor to ADVANCE.