How to Choose a Therapy Job in Home Health

What Rehabilitation Therapists should look for when choosing for a Home Health job. Plus a BONUS list of interview questions!


So, you’re looking for a Home Health job. Congratulations!

Maybe you just graduated. Or picking up a per diem side gig. Or maybe you’re transitioning from a completely different setting – a SNF or even pediatrics.

Either way, choosing a Home Health agency to work for is a big decision to make, and we are here to help!



What This Article Will Cover


-Employee versus Independent Contractor
-What Benefits to look for
-Pay (!)
-Medicare Ratings for the Company
-Red Flags
-BONUS! A list of good questions to ask during your interview



Employee vs Independent Contractor?


Depending on your location, you may find job postings for contractor positions. Contractors are also known as “1099” employees, referring to the 1099 tax form they receive at the end of the year.

Independent contractors are typically employed by ‘middle man’ therapy companies. Basically, when home health agencies are desperate for a certain discipline’s coverage, they reach out to ‘middle man’ companies who will then hire a therapist as an independent contractor for the strapped agency.


There are Pros and Cons to being an independent contractor.


Pros

– You will likely be hired. Often shortly after you applied for the position.

– The pay is typically higher per hour or per visit (see taxes in cons, though!)

Cons

– You may not receive any benefits

– You are responsible for paying all of your taxes (called ‘self-employment tax’. As an employee, your company pays half. But as a contractor, you are responsible for all of it. Here’s a link to the IRS Self-Employed Tax Center). That said, you can also deduct job expenses to lower your tax burden. Talk to an accountant for advice!

– It may be hard to get access to other discipline’s notes.

– You may need to buy all of your own supplies, including a tablet, blood pressure cuff, CPR mask, etc.


Travel Positions?


Travel positions are almost always contractor positions. The travel companies are the ‘middle man’ we were talking about earlier. However, travel therapists are sometimes given the option to become a “W2” employee after the contract ends.

Travel companies also frequently incentivize their positions with health insurance, relocation reimbursement, and CEU reimbursement. The travel jobs tend to be in locations waaaaay off the beaten path. Although we have seen some tempting listings in Honolulu…



What Benefits to Look For:


*Please note: major benefits, including health insurance, a 401k, and CEU reimbursement are usually only available for full-time or near full-time employees. And frequently not offered to independent contractors.

– Employer Sponsored Retirement Plans (401k): with a company match

– Health Insurance: with a premium that costs less than around $150/month to cover you

– CEU reimbursement- around $500/year

– Vacation Pay

– Sick Pay

– Paid Holidays

When considering a home health company, ask what benefits they offer. If they have a human resource specialist, she would be the best source of accurate benefits info.


Employer Sponsored Retirement Plan: The Nitty-Gritty


An employer sponsored retirement plan, most often a ‘401k’, is an essential tool to build wealth over time for a comfortable retirement. I don’t know about you, but I don’t plan to spend my golden years working full-time.


A typical company match (across all industries)


A typical company match is 50% of every dollar you contribute, up to 6% of your pay.

In other words, the company pays up to 3% of your annual salary (half of 6%).

For example: let’s say you earn $100,000 per year. You choose to save 15% in your 401k. You will end up saving $15,000 per year. And your employer will put in an additional $3,000 (the ‘match’; 3% of your annual salary).


About Retirement Savings


In order to retire comfortably, retirement experts recommend that you save 10-15% of your income in your 401k. That may sound like a lot, but that 10-15% will actually be untaxed (until you retire, if you are saving in a traditional 401k. Roth 401ks are taxed differently).

This means that you’ll pay less taxes every paycheck. Yay!

Investing can seem super complicated, but it really doesn’t have to be. There are plenty of free resources to help you navigate your retirement planning. Mymoney.gov is a great resource created by the U.S. Government. AARP, bankrate.com, and Investopedia also have great information online (although be wary of advertisements on some of these sites. Go for the info only.)


Health Insurance: The Nitty Gritty


Request a copy of the detailed handbook for the agency’s health insurance company. Again, the human resource specialist would be your best source for in-depth, accurate information about the company plan.

Clarify whether dental insurance and vision coverage is included. And at what extra cost, if any.


Average Monthly Premiums & Deductibles


According to Kaiser Family Foundation’s 2018 Employer Health Benefits survey, the average employer sponsored health insurance monthly premium for an individual was $141 per month.

The average premium for family health coverage was $462 per months.

The average deductible for an individual was $1,573 per year.

While family deductibles averaged between $2,300 and $4,700 per year.

That said, there are many different types of health insurance plans, some that may be better for a family with chronic health conditions, for example, and others that may be better for an individual who rarely goes to the doctor.

** Only you can decide what’s best for you and your family’s unique health and financial needs!


Averages in Home Health?


Just as in every other industry, they vary widely…

Some therapists we’ve spoken to pay less than $50/month to cover one person, have a $150 deductible and are covered at 100%. Other therapists pay over $500 a month for one person, have a $10,000 deductible and will still only be covered 80% :/

Unfortunately, health insurance benefits are typically non-negotiable, as home health agencies have contracts with health insurance companies and can’t change costs or amount of coverage on a case-by-case basis.


Not a Cheap Rate? Negotiate! (it rhymes!)


However, you can ask for a higher hourly or pay-per-visit wage to compensate for expensive or poor health insurance coverage!!



Pay: Wage structures and Averages


Wage structures


The 2 most common wages structures in home health are pay per visit and pay per hour.


Pay per visit employees:

– You receive a pre-determined amount of money every time you complete a visit.

– You typically earn more for OASIS Start of Care visits and evaluation visits than for routine and discharge visits

– You may not receive compensation for driving, completing paperwork, calling doctors, and other admin. Although you may be able to request compensation for special circumstances (Such as a patient who lives significantly farther away. Or if you needed to spend a lot of time speaking with the patient’s medical team. Ask about these special circumstances)

– You may instead receive a flat rate for these essential admin and driving. Again, ask.

 
Pay per hour (“hourly wage”) employees:

– You typically start the clock when you leave your house. Then end the clock when you return back home (clocking out when you take a lunch break).

– To keep track of your time, your company will likely have an online or digital form for you to fill out and turn in.


Average Pay


If you’ve done any Googling, you probably already have a sense of the wages being offered in your neck of the woods.

Below we listed U.S. averages for the rehab disciplines working in home health. Wages vary widely based on region, whether you’re in a city or rural area, and many other factors.

FYI, the SLP wage survey is likely the most accurate, as it was conducted by ASHA. The rest were pulled from the Bureau of Labor Statistics, which tends to report lower wages than the true average.


Speech Language Pathologists


$45.19/hour (Median national hourly wage, ASHA’s SLP Health Care Survey 2017).

$65 per visit; evals and OASIS Start of Care visits typically paid a higher rate (Median national pay per visit wage, ASHA’s SLP Health Care Survey 2017).


Physical Therapists


$92,660 per year (2018 Bureau of Labor Statistics. Wage structure wasn’t specified).


Occupational Therapists


$89,840 per year (2018 Bureau of Labor Statistics. Wage structure wasn’t specified).


Physical Therapy Assistants


$64,600 per year (2018 Bureau of Labor Statistics. Wage structure wasn’t specified).


Certified Occupational Therapy Assistants


$67,800 per year (2018 Bureau of Labor Statistics. Wage structure wasn’t specified).

* Many home health agencies will also reimburse for miles driven (.058 per miles is the 2019 IRS guidelines).


Pay Rate’s Not Great? Negotiate!


Repeat after me, “I am worth it!”

IT IS TRUE.



Finding Medicare Ratings for Home Health Agencies


Medicare designed a survey to measure the experiences of patients receiving home health care from Medicare-certified home health agencies (Link to Medicare’s Home Health Compare). It gives each agency a star rating out of 5, and allows you to see your state average and how the agency you’re checking out compares.

Medicare calls it a ‘patient survey’, although the answers really come from comparing the clinician’s answers on the OASIS Start of Care and OASIS Discharge. You can see where this could get a little convoluted…

It’s….not perfect.

And we definitely wouldn’t recommend making a decision based solely on it’s rating, either good or bad. But it’s useful to look at. And it may bring up some questions you can ask before making any commitments. 


Things to Consider When Looking at the Medicare Rating:


– Not all Medicare-certified home health agencies are included. This isn’t because the agency is bad. It’s generally because it doesn’t yet have enough survey responses to determine a meaningful average.

– Companies may actually refuse to admit patients that are likely to bring their score down (such as when the patient is a re-admit and previously didn’t have good outcomes). Yikes.

– The factors being measured may not have much to do with your day-to-day job satisfaction.



Red Flags


Below we have listed common complaints home health therapists have about the agencies they’ve worked for. Some may be deal breakers for you. All are at least worth considering carefully.

– No on-boarding training

– Your boss isn’t a therapist

– Unpaid documenting and admin time (pay per visit employees)

– For therapists, assistants do all the treatments, so your job is only assessments (this may be a good thing if you love OASIS! And don’t mind not treating patients).

– Insecure schedules: admits added to your caseload day of, which can throw off your entire schedule

– Huge area to cover (especially if you’re paid per visit, not per hour)

– High employee turnover (why is everyone leaving?? And there are likely very few experienced therapists to collaborate with)

– “You will have a full caseload soon… but right now we only have 1 patient referral for you”… Fell for this one! Make sure the agency has at least 3 referrals waiting for you and only you. 

– ”We expect to grow very quickly.” Speak with some other therapists in your discipline to get the inside scoop (stick to your own discipline- other disciplines’ situations may vary widely from yours).

– High productivity expectations. Companies are paid per visit, not per minutes. So some companies may push you to have very short visits and a lot of patients.

– A small or new company. In big cities, home health companies fail often, so keep this in mind.

* With all that said, some of the red flags listed above may not be problems for you at all! Maybe you like doing lots of evals and moving through patients quickly. Or maybe you don’t need or want training or experienced coworkers to collaborate with.



BONUS: Good Questions to Ask During an Interview


You’ve done your research, applied for a promising agency, and lined up an interview.

Here’s a list of shrewd questions to ask:

– Is the position pay per visit or pay per hour?

– What benefits do you offer for my position? (Health insurance, 401k, CEU $, Paid Holidays, Vacation & Sick Pay)

– May I shadow another SLP/OT/PT (your discipline) for at least one week?

– What are the productivity standards?

– Will patients be added on my schedule day of?

– How long is the average routine visit?

– Will I be compensated for necessary non-billable activities, such as scheduling, communicating with other providers, and ordering medical equipment? If so, how many hours can I bill each week? (For pay-per-visit positions)

– What devices (i.e. cellphone or iPad) do you provide for documentation and communication with patients/care providers?

– Will all supplies I need to do my job be provided or reimbursed?

– May I have a list of the support staff’s names and responsibilities before I start working?

– If I have any questions or issues about scheduling, who should I contact?

– If I have any questions or issues with documentation, including how to complete an OASIS visit and how to update a plan of care, who should I contact?

– What is the process for taking vacation days? Will my patients be covered by another SLP?

– Are there any additional job duties expected of me (e.g. mentoring students, unpaid lunch meetings)?

– How many patients can I expect to see each week? How does this number compare to the number of patients other disciplines see each week?

– If it is not a full caseload, then how long do you expect it to take to build up to a full caseload?

– How large do you expect my territory to be? Are there daily mileage limits and drive time limits that can be set?


Bolstered by the knowledge in this article, we hope that you are now MUCH more confident as you research, interview for, and eventually choose a Home Health Agency to work for!

Good luck!

Not yet convinced that Home Health is right for you? Check out 11 Reasons Home Health Therapy is Awesome [GIFs].

The Home Health SLP Handbook: Everything you need to provide speech therapy to adults in the home health setting.