For me, Wednesday is my Day 3 in Home Health. It is one of the days of the week that I drive the most and see patients the furthest from my home.
I have to admit, being a home health SLP is the first job I’ve had that I’ve had to take vitals for my patients. Every clinician for our company is required to take blood pressure, temperature, respiratory rate and pulse. We also assess pain and ask about blood sugar for our patients with diabetes.
At first I wasn’t too keen on having to take vitals. I’m not a nurse nor am I a doctor. After sending my first 2 patients to the hospital, I realized the importance of vitals and even though they do take some of my treatment time, I know they are important for patient care.
We finally made it to Wednesday. Wednesday is not my favorite day. Mostly because we have team meeting on Wednesday. Not that it’s bad to meet with everyone, but it starts at 8 in the morning. I just find this way too early. We use our team meetings to discuss patients that are nearing the end of their episode (60 day certification period) and who needs to be discharge or recertified. We discuss any patient admitted to the hospital or any person that needs to be discussed.
After the meeting, I use the bathroom at the office and head out. I have an hour and twenty minute drive to my first patient house. I don’t mind this drive and usually listen to an audiobook during the drive. If I don’t listen to an audio book, I listen to podcasts or sometimes I listen to continuing education courses. I absolutely love Audible and maintain my membership to have something to do on those long drives.
I also have the MedBridge app to listen to continuing education on my drive or listen to Apple Podcasts.
Patient Number 1
I arrive to see my first patient. We sit out in the garage because that is her new favorite place to sit. This patient has aphasia and has been working diligently on her speech. She is making slow gains, but gains in her speech.
Recertification for Patient Number 2
My next patient lives about 20 minutes away. This is a recertification. I have to do the recert since I am the last discipline left with the patient. I can usually get this done in 45-50 minutes. We also have to call the doctor for any new evaluation or recertification to receive a verbal order for the patient. I usually call the doctor during my visit so that I don’t forget later. I also can go ahead and type that I received the verbal order while I’m typing my note. This person is another aphasic patient and has a global aphasia. We will continue working on comprehension and increasing expression. The fun part with this patient is that they have a bird. One that talks and often answers when I ask the patient a question.
Patient Number 3
I then have to drive about 45 minutes to see my next patient. Another aphasic patient. I have to just walk in the house because I have to wake this patient up when I arrive. Everytime I go in, I am greeted with a “Oh crap”. This person will look at pictures and name them, but will not go any further with speech. When I try to start more difficult tasks with this patient, I am told “no, no, no I just can’t.”
Patient Number 4
I drive 15 minutes to my next house. This is a patient that had a CVA and now has dysarthria and dysphagia. She is NPO and has a PEG tube. She didn’t have any food or liquid trials while in the hospital or nursing home. We have been trialing ice chips and pureed using the McNeill Dysphagia Therapy Program (MDTP). She has progressed from swallowing with signs/symptoms of aspiration 70% of the time to 30% of the time. She is thrilled to be able to eat at least a small amount by mouth and is finally encouraged that she may be able to resume a po diet at some point.
Patient Number 5
My next patient lives about 25 minutes away. This is a patient with dementia that lives alone with a caregiver present 7-8 hours per day. When I arrive, I ring the doorbell and walk in as she is unable to get up to answer the door. I walk in and she has walked back to the bathroom and is basically stuck on the toilet. I have to help her put her brief and pants on and then walk her to her chair, which takes us several attempts to get her up from the toilet and multiple rest breaks during the walk to her chair. She then tells me that she got up out of bed around midnight, fell on the floor and had to lay there until her caregiver arrived at 7 am. I had to document the fall in the chart and call the doctor to let them know. I also had to email my supervisor and our social worker to let them know what was going on and that this patient is unsafe to be home alone as there is no way for her to evacuate the house in case of emergency, she has difficulty getting to and from the toilet and there is nobody with her at night. Most of the session is problem-solving ways to increase her safety in the home. Most of which involve the family looking into hiring 24 hour care.
Patient Number 6
My last patient today lives about 10 minutes away. This is another aphasic patient. I seem to have an abundance of aphasia right now! This is another relatively young patient with a stroke. He tends to get “stuck” as he says on words and fluency decreases as he attempts to recall the word. We are working on naming pictures and describing pictures with sentences using word finding strategies and with fluent speech. I like to use my iPad for many of these tasks and often use Tactus Therapy Apps or SmartyEars apps. I love using iScreen Aphasia through SmartyEars to screen my patients and to measure increases in accuracy in receptive and expressive language skills. I use this screen during assessment as the only standardized assessments I have are the RIPA-2 and the RIPA-G and at reassessment.
I have all my notes completed, as I completed each one in the home so I just have to put my hours into Ultipro and I get to head home!