A valuable guide for determining treatment frequency.
Ahh yes, the age-old question SLPs have been asking themselves for a century: How often should I see my patients?
The ‘right’ answer can vary widely, depending on your area of practice, the company you work for, the severity of the diagnosis- the list goes on and on and on.
But we have answers for you!
Are our answers correct? Depends! Our frequency recommendations are based on: 1) the needs of the patients 2) what’s ethical given payer’s guidelines, and 3) what’s logical given the diagnosis, patient factors, and logistics of home health.
BUT, every therapist’s situation is different, so communicate closely with your manager/payer and use your best judgement.
The Medicare factor
Most of your patients will be covered by Medicare. Medicare (and managed care insurance policies) prepay home health companies for two-month chunks of time. In other words: you have two months to complete your course of treatment. Once those two months are up, you can recommend a *recertification of treatment, if appropriate.
Other policies will pay for specific numbers of visits for each discipline (including Speech Therapy).
In Home Health, YOU Get to Decide How Often to Treat
Unlike many inpatient rehab units, where SLPs are required to see each patient 5-6 times per week, home health therapists have more freedom to decide what treatment timeline is most appropriate for their patients. This is great! In my experience, this leads to a more appropriate and effective course of treatment overall.
Allowing therapists to use their best judgment results in better outcomes? Imagine that! But I digress.
To decide how many treatments you provide, consider your patients’ diagnoses, severity, environmental factors, and how long they are considered homebound, among other factors. Again, there is no set prescription for how long or how often treatment should take place. But here are general guidelines:
1 TIME PER WEEK
(1wX – once a week for X number of weeks): Patients with chronic issues that had a recent exacerbation. These patients tend to have chronic memory deficits, aphasia, dysphagia, or dysarthria.
Examples of 1 Time Per Week Patients:
- Patients with dementia who fell and whose families report worsening memory abilities.
- Patients with Parkinson’s disease whose recent pneumonia caused increased dysarthria
- Patient who have ALS
Why 1 Time Per Week?
These are patients who tend to become overly fatigued or overwhelmed by frequent visits; when Speech Therapy tries to come more frequently, we tend to see less willingness to participate and/or increased fatigue which can be detrimental to progress.
What To Do Each Visit (1 Time Per Week):
Review strategies, complete exercises, monitor progress, and train caregivers to cue strategies and exercises for daily practice.
2 TIMES PER WEEK
(2wX – two treatments per week for X number of weeks): Most patients! These patients tend to have mild to moderate memory deficits, dysphagia, aphasia, and dysarthria.
Examples of 2 Times Per Week Patients:
- Patients with dysphagia who have a mild risk of aspiration and are currently on a modified diet
- Acute dysarthria
- Likely undiagnosed mild dementia
What To Do Each Visit (2 Times Per Week):
Review Speech Therapy recommendations, strategies, and home program. Complete exercises. Provide feedback and tweaks to the treatment plan. Tweaks could include decreasing frequency when your patient is close to discharging or modifying goals to reflect your patient’s progress.
3 TIMES PER WEEK
(3wX – three treatments per week for X number of weeks): These are patients with moderate to severe memory, language, speech, or swallowing impairments.
- Patients with acute CVAs and subsequent aphasia and apraxia
- Patients with acute TBIs and subsequent safety and problem solving deficits
What To Do Each Visit (3 Times Per Week):
Review Speech Therapy recommendations, strategies, and home program. Complete exercises. Provide feedback and tweaks to the treatment plan.
4 TIMES PER WEEK
(4w4 – Four times per week for four weeks): Patients with *LSVT treatment, per program instructions.
What to Do Each Visit (Specifically for LSVT treatment):
Each visit is packed with a solid 50-60 minutes of extensive treatment, again per program instructions.
EVALUATION BUT NO TREATMENT:
Sometimes, if Speech Therapy is not recommended (i.e. if the issue is mild and the patient appears safe in the home) I will do an evaluation only and provide education and a home program on the spot.
What Education and Home Programs to provide (Evaluation but no treatment):
- Read the medical record ahead of time. If it seems possible that the patient may not benefit from Speech Therapy at this time, bring a relevant home program packet, just in case.
- Provide a relevant written list of “red flags” for patient to refer to should issues arise. For example, if the swallowing evaluation you completed ended up being a case of moderate GERD, still leave a list of signs and symptoms of dysphagia and aspiration.
SEEING PATIENT MORE OFTEN FOR FEWER WEEKS:
Sometimes, when my caseload allows it (i.e. I have fewer patients than average that week) and it’s appropriate for my patient, I take advantage of my extra time by increasing the patient’s treatment frequency (number of treatments per week) while decreasing it’s length (number of weeks).
To clarify, my patient receives the same number of treatment hours TOTAL. But those hours are rearranged so he receives more visits per week for fewer weeks. (Example: instead of seeing a patient with motor speech disorder 2w6, I see him 3w4. Both add up to 12 treatments).
Examples of Seeing Patients More Often for Fewer Weeks:
This works well for patients with motor speech disorders, dysphagia, and mild cognitive disorders.
Of course, double check with your employer/payer that this is appropriate for your unique situation.
There you have it!
In summary, how often should you treat home health patients?
1wX: chronic issues that had a recent exacerbation (chronic memory deficits, aphagia, dysphagia, dysarthria)
2wX: most patients. Usually mild to moderate memory deficits, dysphagia, aphagia, and dysarthria
3wX: moderate to severe memory, language, speech or swallowing impairments
4w4: LSVT treatments, per program instructions
Evaluation but no treatment: when Speech Therapy is not recommended or the issue is very mild and the patient appears safe in the home
More visits, fewer weeks: when the SLP’s schedule is light and if appropriate for the patient. This adds up to the same total number of treatment hours than a typical schedule. Works well with motor speech disorders, dysphagia, and mild cognitive disorders.
*recertification: a 2-month extension of treatment
*LSVT: Lee Silverman Voice Treatment. Used for people with Parkinson’s disease and other neurological conditions.
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