It’s been a minute…or two.

It’s been 7 months since my last post. I guess that’s because I’ve partially forgotten about my blog, and partially because I’ve been at the same assignment since my last post. Even though I’m a traveler, having been at the same facility for 9 months now, I basically feel like a regular employee, minus the actual perks of being a regular employee. I have awesome coworkers. I know the cafeteria specials. I know the lay of the land (more or less). But part of the reason I became a traveler was to…travel. To travel, or not travel? That is the question.

For now, I’m good with my current position. Earning a bit more, paying off a bit more, saving a bit more, and even investing a bit more. All things I can’t do once I’m a regular employee. Plus I just came back from an amazing trip in Thailand, and saving up for another trip to Italy in March. Can’t do that as a regular employee either!

So I’m here until at least mid January. I think ideally I’d like to extend again until after my trip to Italy, and then I should probably move on and explore a new place.

More OT, possibly less readmissions

This is a fairly recent article discussing the association between occupational therapy services and decreased hospital readmission, specifically for diagnoses of heart failure, pneumonia, and myocardial infarction. I love it! It’s articles like these that renew my sense of purpose for the future of OT-not that I don’t have any! But it’s nice to have a bit of validation every so often ūüôā

Abstract:

Hospital executives are under continual pressure to control spending and improve quality. While prior studies have focused on the relationship between overall hospital spending and quality, the relationship between spending on specific services and quality has received minimal attention. The literature thus provides executives limited guidance regarding how they should allocate scarce resources. Using Medicare claims and cost report data, we examined the association between hospital spending for specific services and 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction. We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients’ functional and social needs, which can be important drivers of readmission if left unaddressed.

Six intervention areas are pointed out by the researchers:

  1. Recommendations and caregiver training for patient safety upon discharge
  2. OTs assess severity of disability and its impact upon an individual’s ability to function independently
  3. Provide/suggest accommodations, modifications, compensatory strategies, etc that can be made to address patient safety and independence upon discharge
  4. Perform home safety assessments
  5. Assess cognition and ability to perform important IADLs, such as medication management
  6. Collaborate with PT to intensify rehabilitation, thereby promoting positive patient outcomes

Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016, September 2). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 1‚Äď19. https://doi.org/10.1177/1077558716666981

Recap: Home Health

During OT school, I had zero experience with home health and what it entailed, other than general knowledge imparted to me via textbooks/lectures. After completing a travel assignment in home health, I can say that I’m glad to have experienced it and glad to leave it behind for now. Not that it’s completely awful, but it’s kind of a niche and it takes a certain getting used to.

+Pros of home health:

  • Set your own schedule. This was probably my favorite aspect of home health. Most people want to be seen between 9am-6pm, Monday-Friday.
  • See people in their own element.¬†Treating clients in their homes is very therapeutic, client-centered, and can be so much more occupation-based.
  • Autonomy.¬†In general, being an OT is pretty autonomous. But in home health, it’s¬†even more so. No one to keep tabs on you, other than the occasional reminder if you’re not meeting productivity
  • Easy documentation. My previous employer gave all employees tablets and the documentation system was pretty easy to use. I didn’t really have to worry about billing; just had to keep track of my time (most insurance companies require at least a 30-minute visit for reimbursement.)
  • Variety. No two visits are alike. Being out on the field alone forces you to be resourceful and to assess/think/plan quickly. It definitely keeps you on your toes. I think this is a great asset to being a skilled practitioner.

-Cons of home health:

  • Actually setting your own schedule.¬†My previous company didn’t provide a cell phone, so I had to use my own phone to call patients.¬†For the most part, clients/families were nice, but you get the occasional, “Who ARE you?”, “Why are you calling me?”, etc.
  • A lot¬†of driving. During my busiest weeks I was seeing 6-7 patients each day and drove over 2000 miles each week. (I had a 100-mile round-trip radius.)
    • Tip:¬†download google maps offline, know where the good gas stations and bathrooms are, invest in AAA or some other roadside service, and be sure to have comprehensive car insurance
  • Potentially bad or unsafe homes/environments and/or clients. I would say >50% of the homes I went to were dirty, unkempt, unpleasantly odorous, and/or cluttered. Most people also keep their pet(s) inside all day as well. I only had a handful of clients whose homes were super clean/neat/tidy. There were also a few homes in some run-down neighborhoods as well as clients/family members that were creepy or sketchy.
  • Lack of resources. It¬†was really difficult for me to do home health in a new city with little to no resources. However, this can be affected by the training you receive (I had very minimal training). This was especially apparent when I had to secure DME for clients. There are places that offer low cost or free equipment; you just have to do a bit of research and possibly ask around.

Other things to consider:
–¬†Cancellations.¬†This can be good or bad. Good if you’ve had a long day or if a personal situation comes up. Bad if you’re paid by the visit and you’re relying on the paycheck.
You’re on your own.¬†It can get pretty lonely. Prior to home health, I was working at a large hospital with a large rehab team of 25-30 PTs/OTs/SLPs on any given day.
You will use google maps a lot. Make sure you have a decent phone, good coverage, battery back up, etc.  And even then, some folks live in tiny or unincorporated areas, so their address may not even show up on google maps.
Good time management. Give yourself time to accommodate traffic, bathroom breaks, and whatever else you may need.
Mandated reporter. You never know what can happen. Make sure you know where/how/who to contact if a situation occurs where you need to contact APS.
You will live out of your car. Keep snacks, water, medications, etc handy.
Therapy equipment. When I was per-diem for one agency, I had to purchase everything that I needed. During my full-time assignment, I was provided with all the basics (BP, pulse ox, thermometer, gloves, tablet for documentation , theraband, therafoam.)

 

Recap.

I’m an occupational therapist, recently turned traveling occupational therapist! I’ve been an OT for a little over 2 years now, and it still feels like I was in OT school just yesterday. I decided to complement my journeys as a traveler with this blog.

A few things I’ve learned since graduating OT school:

  1. OTs are definitely in demand. However, that demand changes depending on your geographic location.
  2. I’m constantly learning.
  3. Communication. There’s a certain finesse and it’s often learned through trial and error.
  4. Very few will understand what OT entails. And fewer will care to listen to your explanations.
  5. It’s imperative to remain informed through current research/ evidence-based practices in order to validate this field and demonstrate its meaningfulness.
  6. I’ve come to terms with the fact that I will be probably be paying off school loans for a good majority of my life.
  7. I’m thankful to be in a great career field and to be able to truly enjoy what I do.

I was interested in traveling therapy even before I finished OT school. The idea of working in a new place every 3 months sounded doable and not terribly daunting. Plus, getting a higher salary doesn’t hurt either ūüėČ I’ve had the privilege of working in a number of settings: school-based, inpatient rehab, outpatient neuro, acute care, home health, and skilled nursing. So many other settings and niches exist within OT; I hope that through travel OT, I’ll be able to dabble in other areas that are not well-known yet.

Who doesn’t like making lists? Some of my pros/cons thus far…

-PROS-

  1. Traveling. And getting paid to travel!
  2. Getting paid a lot more. This shouldn’t be THE determining factor, but I have bills to pay and life to live.
  3. Respite. It’s nice to just get away, whatever the reason may be. There’s something cathartic about getting away from it all and being on your own. I’m not exactly roughing it out in the middle of nowhere, but still.
  4. Trying out new settings. Since I’ve only had 1 assignment so far, but I’m anticipating that I’ll be trying out different/new settings in the near future.
  5. Most contracts are 2-3 months. I can put up with most things for 2-3 months.
  6. Living minimally and simply. My traveling¬†life’s belongings consist of items that fit inside¬†1 suitcase, 1 duffel bag, and 1 laundry basket. My other belongings are dispersed throughout my family’s homes.

-CONS-

  1. It gets lonely at times. Especially working in home health, I don’t have colleagues that I see or talk to on a regular basis.
  2. No paid/sick leave accrual. *Praying that I stay healthy*
  3. You don’t really know what the job/culture is like until you’ve started. Well, this goes with any job (duh).
  4. Compared to when I was working at a large hospital, healthcare premiums through my travel agency are expensive.
  5. At the end of the day, you are the only one looking out for yourself. Not the client agency, not your travel agency.
  6. I imagine it can get burdensome/mundane to have to look for a new place to live every few months, and to accommodate all your belongings, plans, etc. Thank goodness for AirBnB and Google.

Other things to remember (and another list while I’m at it)…

  1. Complete all major car repairs before an assignment. Maybe sign up for AAA.
  2. Get healthcare concerns/procedures completed before an assignment.
  3. Not all travel companies reimburse for CPR, physical exam, vaccinations, etc, but still doesn’t hurt to ask. Keep digital records of this info.
  4. Be mindful of when license(s) expire and keep track of CEUs.
  5. Get things in writing. Ex: specific days off without penalty, guaranteed hours/low census pay, notification of termination (in case they hire a permanent employee or you want to quit), breakdown of pay (regular hourly pay, housing stipend, meals & incidentals, overtime pay, holiday pay, on-call pay, mileage, etc).
  6. Ask if you can contact¬†the therapist you’re taking over for, and ask about coverage area/driving radius (for home health).
  7. Housing: if unsure about geographic location, book a motel or another place for 1-2 weeks to get a feel for things.
  8. Check per diem rates on the U.S. General Services Administration (GSA) website.
  9. Check traveltax.com for info re: tax homes and doing taxes as a traveler.