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We have begun the process of having my mom evaluated for physical therapy in-home to help increase her core strength. We are using a home healthy agency who have physical therapists, occupational therapists, medical social workers, nurses and aides in their employ. We are currently only pursuing the services of a physical therapist to come to my mom and dad's home for a finite period of time per doctor's orders. The scheduling of such services has been frustrating but I eventually navigated it and my mom had her first appointment (an evaluation) yesterday (Friday). My sister was able to be there with them for the appointment.


My question involves the SCHEDULING of the appointment. This is how it went down. First I called the agency, who then assigned a clinical manager to my mom's case. The clinical manager called me, I sent her the doctor's orders per her request, she asked what day we requested for the first appointment which is an evaluation, I said that my sister would like to be there and she needs to drive from a couple of hours away, that Friday would be best but it would need to be in the afternoon. She created a chart for my mom and submitted doctor's orders along with our request for the date and time preference to the Intake department. She said there's no guarantee it can be Friday but they usually try really hard to honor requests. I was told that I would receive a call, probably the day before, for what time the appointment would be. I asked how, since there's no guarantee it will be Friday, how would I know what day "the day before" is and she just said they generally honor the date requested. So, I waited. I believe what transpired while I waited is she submits the data to the Intake department which processes the case through insurance and they pass the case along to the Scheduling department. In one phone call I made to check on the progress while I waited, I was told it would be someone from the Scheduling Dept who would call me "the day before" to schedule the physical therapist. Another phone call, I was told it would be the Physical Therapist calling me to schedule the appointment "the day before". I always got the general response that it I would hear "the day before" but still did not have any confidence that Friday would be the day! I got nervous when at 5 pm eastern time Thursday, I still did not hear from anyone. I called again and was told that the scheduling department works until 5pm and then they pass on the various clients charts to the various physical therapists and that they will call me, probably around 6 or 7pm. I said that I still didn't have any confirmation that the meeting was going to happen the next day. Again, I was told they usually honor the requested date. I finally got a call, not from the physical therapist, but an "evaluator" who said he would be at my parents' house at 10am the next morning. I told him that I had requested afternoon time because my sister needs to drive from a couple of hours away to be there. He said he would change it to 1pm and hopefully schedule someone else for the 10am time slot.


Needless to say, this was stressful but I thought maybe that's just the way the first appointment works. My sister and mom and dad managed to make it work yesterday and had the meeting. The evaluator made his recommendations for future appointment frequency for Mom. But apparently, each appointment time is scheduled the same way! I won't know until 6 or 7pm the night before each session.


What am I missing? Why can't future appointments be scheduled? I realize that therapists get sick, clients get sick, new clients come on board, life happens, but therefore appointments need to be re-scheduled sometimes. I'd like to know if anyone who has scheduled temporary in-home physical therapy (or any temporary in-home care) has experienced this or who works for a home healthy agency and can shed light on what's happening behind the scenes that explains this scheduling method.

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My scheduling experience with Home Health PT was all done directly with the assigned therapist. Mom was able to take his calls and plan for the next therapy day after his initial evaluation.
PT would then text me with questions or updates.
The only regret I have is that often mom would cancel her appointment.
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Further thoughts:  I don't recall ever dealing with a clinical manager.  This agency may be large, or it may be a franchise abiding by terms of the franchise owner.

It does seem as if there was a bit more bureaucracy than necessary.   But it's also possible they were trying harder to cater to your needs, especially the times constraints involved with your sister's transit.

There may be some uncertainty about the first week, but my experience has been that after each of the various home care workers comes, he/she establishes a schedule for 2 - 3 weeks.  

I would be unhappy and insist on changes if notices weren't provided until the night before.   That's not something I would tolerate.  

But they're just getting started.  I would have a nice chat with the clinical manager to make sure "you're all on the same page."
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SibInTheMiddle Jan 2021
Thank you for your response. I will do that.
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Siblin, I just lost an entire post due to trying to deal with site malfunctions.   I've had this problem before, and lost other posts as well.   I don't have the patience right now to retype everything, but I'll just share a few observations, based on the dozen or so home health care experiences I've had.

1.  A hospital social worker or doctor writes a referral and faxes it to an agency.   You do have a choice of agencies though.  Over the years, I've learned that some agencies are top notch; others are not.  I have never been given a script and had to contact the agencies for initial interviews.  

2.   I found that the Alzheimers' Assn. kept lists of various home support companies, and it was an excellent list. I received their lists by e-mail w/i 1/2 hour to 45 minutes after a phone call request. The Area on Aging also maintained lists; I received them no sooner than one week after request. I never bothered to call them again after this happened a few times.

3.   Initial contact from the selected home care agency was with a nurse, who interviews, assesses and creates a plan, which agency staff implement.   You wrote that you've only hired PT.   If balance and strength are issues, and OT could offer excellent insights.   I myself learned a lot from an excellent OT.   That's something to consider.

4.   The nurse leaves a packet of information, including a blank calendar on which she and the other therapists, after calling and making an appointment, write down their planned visitation times, generally for that week and the following 2 - 3 weeks.     

If your sister plans to be at the home as well, that's something that can just be factored into the entire schedule so that all parties have enough transit time.

Occasionally delays occurred; either  my father or I was notified, and appt. times were readjusted. 

5.  The initial nurse assessment is just that; the actual treatments begin when the therapist comes.   My experience is that they are timely, w/I 1/2 or so, but will call if a significant delay arises.

6.   There was one agency with what I thought was a great reputation, but there were numerous problems so they were terminated within 2 weeks.  You do have the right to address scheduling and other issues with them.

7.   If you want to select your own agency, or if this one doesn't work out, make checklists of what you expect of an agency and discuss those issues when you call to screen them.  One of the best I found had staff that visited hospitals and interviewed patients before they were released.  

I have the impression that your doctor selected this particular agency.  

8.  During my father's last hospital stay, a very reputable geriatric doctor made a recommendation for hospice care, at the hospice at which he previously worked. I respected and liked him as a doctor and as an individual, so I contacted his recommended hospice but felt that the person with whom I spoke was arrogant and rude.   

I made my own choice based on interviews and meetings with other hospice companies I contacted, and chose one with a religious affiliation. It was an excellent decision.

I don't know if I've allayed your concerns, so please feel free to ask if I haven't, and if you still have concerns.
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I live in a small town that has maybe one or two home health agencies that billed Medicare.

My story is Mom was released from the hospital on Thurs afternoon and came to live with me. She had Dementia. I get a call not a half hour after we got back from the Health Agency asking to come the next day, Friday. (hospital set this up) I said no that Mom is not in her home but mine. That I needed the weekend to get us both on some kind of schedule and her used to being here. The Nurse was not happy. I am not a morning person. I had no idea what time my Mom got up. Which turned out to be 8am. I then had to dress and feed her. The Nurse wanted to set up first thing in the morning for Monday, I said no. I couldn't do it before 10am. My house, my convenience. I actually let the OT guy go. I helped Mom with all her ADLs. She wasn't going to be cooking. She didn't need to learn everything all over because of a stroke. There wasn't anything he could do. TG Mom only had PT about 2 weeks. Only thing I missed was the aide who bathed her.

I think what you experienced is the right hand not telling the left hand all the particulars or even caring what you want. Most of the time they are dealing with the client only. Not family members that need to be there. And the client isn't their only one. They can estimate how long it will take with each client but there can be problems that come up.
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SibInTheMiddle Jan 2021
Thank you JoAnn29. I do feel they were fairly flexible in that they ultimately did honor the Friday afternoon request so I appreciate that. I just don't understand all the scheduling details that would cause them to wait until 5pm the night before to give my Mom's case to the therapist, even though they've had her case for over a week. I realize there are new clients showing up all the time and other things that affect the schedule, but seems like a "first come first served" approach could be at least considered with the understanding that if a more urgent case appears and the "best" physical therapist for that more urgent case happens to be the one assigned to my mom (maybe lives close to the urgent case?), that there would be changes. I would think that the clinician (therapist or OT, or whatever) would surely appreciate getting their cases before 5 pm the night before! That's the part that just doesn't make sense to me. But I'm sure I'm missing something. Thank you for your response.
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