Home respiratory care has been around for decades, but because reimbursement for RT services in this setting has been problematic, the demand for home care therapists has ebbed and flowed over the years.
What does the future look like for RT opportunities in home care? Two AARC members who work in the home care setting share their thoughts.
Some insurance coverage
Judy Kochmanski, BSRC, RRT, works for Lourdes At Home/Hospice in Binghamton, NY. She sees home care patients who have been prescribed a new inhaler or have a new diagnosis of asthma or COPD. Their insurance companies note these changes in their medical records and approve an RT case manager visit.
The problem is, not all insurance companies cover the service, and her home care company can’t just provide the service without coverage.
“A service or product cannot be provided at a company’s expense, per TJC, as it is seen as similar to a gratuity,” explained Kochmanski.
That said, she believes the COVID-19 pandemic will increase the need for in home services for patients, and respiratory therapists could be key providers.
“I anticipate the very ill will develop long-term lung problems, either a restrictive disorder or premature COPD,” she said. “If all insurers approve respiratory in the home, we could be that vital link to help prevent re-exacerbations and prevent further lung degradation.”
Here are Kochmanski’s tips for anyone thinking about a career in respiratory home care —
- Are you willing to research various disease states? You will run into health issues we do not know very well in the inpatient realm, such as . . . ALS, Hunter Syndrome, etc.
- You need to be able to read clients’ learning patterns and vary the teaching methods to meet their needs. Protocols can help, and are a new starting point, but they will need tailoring.
- A home visit can be concerning in some neighborhoods, but only in the home can you see the real obstacles to compliance and work through them.
- Stay on top of all the respiratory medications and delivery devices. They keep changing. Know the GINA and COPD GOLD guidelines.
Protocol-driven care
At Integrated Respiratory Solutions in Carol Stream, IL, follow-up protocols are in place that call for respiratory therapists to go into patient homes to track the patient’s progression. RTs use the company’s equipment/disease specific assessments to accomplish that goal.
Company therapists go into local nursing homes as well to help manage the pulmonary patient load, round with pulmonologists, educate patients and families, and qualify patients on home equipment if needed.
Vrati Doshi, MSc, RRT, the company’s respiratory programs director, believes the need for these services is going to increase as more and more respiratory compromised patients are discharged from the hospital with the need for oxygen, CPAP, and Bilvel devices.
COVID-19 is going to create a big push for telehealth visits as well.
“We’re already seeing a pushback on patients wanting RTs in their home,” she said. “They are open to virtual visits coupled with educational videos/PDFs.”
She says her RTs are still going into homes to do equipment set ups for high acuity patients who need noninvasive ventilation, but follow-up protocols include virtual visits and/or phone calls on a quarterly basis or more frequently if a patient needs it.
Doshi has these tips for therapists interested in building a career in home care —
- To be a home RT you need to be flexible, adaptable, patient, and enjoy educating.
- You will see the patients, families, and caregivers in their natural habitat and assess their situation, ability to understand their disease state, and everything that comes with managing their day to day.
- You will educate all parties on what the future will look like.
- These people look to you as a support system. They trust you and depend on your skills to ensure they won’t need to go back to the hospital. We joke that our RTs are psychologists as well as respiratory therapists.
Learn more about home care and network with people like Judy Kochmanski and Vrati Doshi by joining the AARC’s Ambulatory and Post-Acute Care Section.
