By: Lana Dorffer, M.A. CCC-SLP, DCS
Jean Facteau, OTR/L, RAC-CT, ATPOur mission at Blue Sky Therapy has always been to provide the highest quality of care to the patients we serve, and in doing so, produce the best possible outcomes. In analyzing our patients’ data and needs, we found that many expressed a desire for the convenience of in-home therapy for many reasons including difficulty with transportation to an outpatient clinic, preference of the privacy of their home, or still needing and/or desiring care after they were discharged from a facility. This brought us to develop our new service line: In-Home Therapy.
What is In-Home Therapy and How Does It Work?
The best way to explain “in-home therapy” is to describe it as “outpatient therapy in-the-home.” It can be billed as a Medicare Part B benefit, through private insurance, or as cash pay. Patients who receive in-home therapy are not home bound, and they cannot be receiving Medicare Part A (skilled) benefits. The focus of the program is to bring dynamic, therapeutic intervention to the patient’s doorsteps.
Who can benefit from In-Home Therapy?
Skilled Nursing Facilities
Typically, when a resident leaves a SNF, they return to home and need some additional therapy from a home healthcare agency. In-home therapy picks up where home care finishes. Often, these patients do not require additional nursing care, but they may need a little more therapy after returning home that is not within the bounds of home care. This is where Blue Sky’s in-home therapy team steps in.
Assisted Living Centers
Often patients will experience a fall, acute disease, or a minor setback that does not require a hospital trip or a skilled stay. These patients can see a functional decline that ranges from minor to major. They already have nursing care in assisted living but may require additional therapy treatment. This is where in-home therapy can help! Utilizing Blue Sky’s experienced physical, occupational, and speech therapy teams, we can get those patients back to baseline and back to enjoying life while remaining in their homes.
Senior Centers/ Organizations
Seniors that attend centers and that are active in organizations are some of our most involved members of society. They volunteer their time and keep up with the latest trends affecting their lives. Even though they stay active, sometimes they have added aches and pains and can experience additional setbacks. In-home therapy brings convenience to their front door by helping these seniors experience less pain and remain active!
Doctors and physicians will now be able to give their patients the option to refer to our in-home Therapy program instead of going into a clinic for their therapy needs. We work directly with physicians to support those patients that are seeing a decline or have recently received a new diagnosis. We keep an open line of communication with these physicians as we continue through the patient’s plan of care. We have treated patients in-home that range from increased difficulty with daily tasks, post-surgery and recovery, ambulation issues, and through the different stages of dementia. Blue Sky Therapy has developed a clinical program, MIND, that focuses on the patient’s best ability to function based on their cognitive stage. We have seen success with this program for both the person with dementia and their caregiver. Read more about our MIND program here.
An area that is often overlooked is hospice. Many families require additional training and support with loved ones at the end of life. Whether your loved one is at home or in a hospice care facility, therapy can often be beneficial. This can be with family training for transfers, splints, range of motion activities or diet texture modifications to keep your loved one comfortable.
Benefits of In-Home Therapy
Now more than ever, convenience is essential for our vulnerable patients. We have been able to treat patients who struggle with a ride to therapy appointments or those that just want to be in their own home because that is where they are most comfortable. Home to most people is a safe setting and a place that they can feel relaxed. It benefits the patients greatly to be seen in their home when they are working on getting things out of the cupboard, putting something in the fridge, cooking in the oven, walking up their front stoop/garage door, getting into their bed, or using the shower. These day-to-day functions are what some patients need the most help with, so practicing in their home with a therapist coaching them through is extremely beneficial.
No Additional Cost
With In-home therapy and its flexible model, no brick and mortar buildings are required. Our therapists come directly to their patients. The fact that we operate within the home, keeps the cost related directly to the therapy service being provided. without any hidden charges. In-home therapy is billed under a patients Medicare Part B benefit and all related costs are discussed with patients prior to treatment beginning. For those with a secondary insurance, often nothing out of pocket is required. At Blue Sky Therapy, we credentialed our therapists for in-home therapy service so that we have a pool of therapists to be able to tend to those patients.
Insurance Verification and Billing
As a part of our in-home therapy program, we handle all the insurance verification through our third-party billing company. This eliminates the need for referring physicians and doctors to have to answer those administrative questions. Our billing experts ensure that the patients understand their benefits and alert them if any co-pays are required for the service. All of this is completed prior to treatment taking place, and we handle all of that to ensure a seamless transition to in-home therapy.
Blue Sky Therapy has a recruiting and operations team that handles staffing based on the patient’s needs. We coordinate the schedule of the evaluating and treating therapist based on the patient’s individualized plan of care. Our team communicates with the patient and will handle all appointment cancellations and any other issues that may arise. We operate a unique model with the opportunity to provide therapy services on a flexible schedule so that it is convenient and conducive for the patient.
Acquiring Physician Order
If patients do not already have a prescription for therapy treatment, our therapists have been trained to help with that process. We are happy to call the patient’s primary care provider or specialist to facilitate those orders for them. We try to take as much of the administrative burden away from the patient so that they can focus on what matters most about in-home therapy – the clinical treatment programs so that they can get on the road to recovery.
Programs for In-Home Therapy
Our clinical programs at Blue Sky Therapy are called the Centers of Excellence (COE). These comprehensive care pathways are based upon years of clinical research and data compiled by experts in the industry. Our COE currently has seven programs: Cardiac, Pulmonary, Orthopedic, Balance, Incontinence, and MIND. Read more about the programs here.
We have several other diagnosis specific tracks that we have developed over the years based on patient trends and clinical needs. According to Stubbs and Haslam, 50-65% of falls occur in or around a patient’s home. With that in mind, our therapists use the associated clinical protocol in our Balance program to determine the underlying cause of the balance impairment and identify risk factors in the patient’s home. Once those are determined, our therapists then provide evidence-based treatment pathways to improve the patient’s balance and reduce fall risk within the patient’s home.
According to Medicare, 20% of beneficiaries who are discharged from a hospital are rehospitalized within 30 days, and 34% are rehospitalized within 90 days. Utilizing in-home therapy services can prevent those rehospitalizations by implementing preventative measures and condition management for the patient. In-home therapy provides patient support, monitoring, and oversight to mitigate risk for adverse events post-discharge.
Our in-home Mind (Dementia) Program begins with determining the patient’s cognitive level and best ability to function while also focusing on general safety considerations including fall and accident prevention, bathroom, medication, kitchen, food, and firearms.
Our dysphagia program focuses on identifying the patient’s swallowing difficulties and trigger points. Our treatment plans vary based on patient need, but center around dietary adjustments, compensatory strategies, and pneumonia prevention. Our clinical speech experts have designed programs to make following dietary plans simple at home. We clear away the confusion and give functional, specific ideas to empower your loved ones to have the safest, and most convenient diet options. Yes, a medical professional knows what a puree diet would be, but does a spouse? We ensure that caregivers and patients are educated on the safest and best practices.
At times, a patient does not need to be experiencing a decline in function to warrant the need for therapy. Functional maintenance programs are designed to maintain a resident’s functional status and wellbeing. Our therapists routinely provide maintenance therapy, as well as educational programs to keep the patient active, healthy and functioning at their highest ability level.
After our therapist determines the diagnosis specific needs of the patient they are treating, they determine if one of our current programs will help them achieve the highest level of function, or if they will need to regroup with our clinical team and create a customized pathway. We have specific protocols in place for patients with Multiple Sclerosis, ALS, and Parkinson's that incorporate the latest techniques and treatment to get patients back to their highest level of function. All COE programs promote the use of standardized functional outcome measures benchmarked against industry standards to advance the quality of patient care.
Custom Wheelchair Program
Wheelchair seating and mobility is an important aspect of in-home therapy as it relates to patient posture, functional mobility, activities of daily living, skin integrity, and fall prevention in the patient’s home and community. Our therapists work with certified Assistive Technology Professional (ATPs) to provide a thorough wheelchair seating and mobility assessment and then make recommendations for equipment and training based on their findings.
Patient Success Story
At Blue Sky Therapy, we had a patient that refused to participate in therapy and other activities. The spouse of this patient was concerned about his withdrawal at home, prompting their request for an In-Home Therapy consultation. After addressing environmental modifications and visual cues with him, he had several refusals to participate in therapy but still needed to work on his balance, strength, and safety to maneuver around his home safely. The patient was staged in speech therapy and we applied the can do, will do, may do model, and found out he used to make grandfather clocks in his home. We were able to motivate him and decreased behaviors by initiating a “grandfather clock” book to start each session. He would tell us what the parts were and name them. We had a clock he could put the numbers on, and we would “come to his level” and gain trust and agreement through use of something he was interested in. The best part, no psychotropic medications needed! This is a part of the Blue Sky promise – we get to know the patient and treat them to ensure they function and recover at their highest ability level in the comfort of their own home.
Future of In-Home Therapy + Teletherapy
As we continue to grow our in-home therapy service line, we will begin to expand into different markets and include additional focused areas of treatment such as post-surgical and sports-focused injury recovery. Technology provides us with a platform to incorporate virtual visits, the ability to monitor and advance an in-home exercise program, and most importantly provide services to a wide variety of patients.