Is Speech Therapy Underutilized in Home Health?
As a speech-language pathologist, I spent many years advocating for my clients’ need for speech therapy. Even after strongly urging other medical professionals and home health agencies for the appropriate recommended number of sessions, my clients are often provided less speech therapy services than other disciplines.
And, unfortunately, many clients did not receive the benefit from speech therapy services earlier in their healing process. As a result, many experienced longer recovery times and others left with unresolved issues.
In 2019, U.S. News & World Report ranked the speech-language pathology profession 23rd out of the 25 best jobs. As of 2022, the publication ranked speech-language pathologist as the 3rd best health profession and 10th out of the 100 best jobs. In addition, the demand for speech-language pathologists is expected to rise 17.8 percent by 2026. With rankings such as these, it leaves one to ponder why the profession is underutilized.
The question remains, “Why is speech therapy underutilized with the adult population?” After speaking with multiple speech-language pathologists, throughout the United States, the top 3 possible reasons for this widespread issue include:
- Lack of education with physicians, physical therapists, occupational therapists, clinics, and home health agencies.
- Home health agencies limiting speech therapy visits allowing physical and occupational therapy to utilize the majority of the visits within the episode.
- Reimbursement of services for the home health agencies.
Education on Speech Therapy Services
Many speech-language pathologists find themselves consistently educating other medical professionals and home health agencies on the benefits of speech therapy. While the situation appears unchanged, I still encourage all speech therapists to continue this proactive educational approach.
Providing in-service training sessions, regarding the many facets of our profession to physician offices and/or home health agencies, is a great way to carry out this education.
ASHA’s Core Messages provide speech-language pathologists the tools for describing their services and qualifications to other medical professionals and home health agencies. In addition, the following blogs furnish educational information regarding dysphagia (swallowing) and the services speech-language pathologists provide.
Limited Speech Therapy
Even with education, physical and occupational services are often prioritized over speech services, causing speech therapy to be underutilized. For example: A cognitively-impaired client is receiving all 3 disciplines via home health. The home health company typically has a standard number of visits, which are “allotted” during the 30-day episode (secondary to Medicare changes that took effect in January 2020).
Home Health Treatment Example
For the purpose of this blog, let’s say the home health agency requests the combined therapies to not exceed 24 visits throughout the 30-day episode. If the 3 disciplines were to divide those visits among themselves, then each discipline has 8 visits to improve the client’s status.
This is an ideal situation as it is considered treating the “whole” client. This treatment approach decreases the risks of falls, re-admits to hospitals, and longer hospital stays.
However, often times speech-language pathologists are asked to significantly lower their visit count or wait until the next episode to see the client. This occurs in order for physical and/or occupational therapy to utilize the visit count.
In the above-mentioned example, the primary focus of the client’s treatment plan would be physical and occupational therapy, resulting in the client not being treated under the “whole” client model. This can increase the risk of falls, re-admits to the hospital, and longer hospital stays.
Teamwork Among Disciplines
Hypothetically, if the client was being seen by only 2 disciplines, one being speech therapy, the focus is often equal between the two. And, if the therapists are coordinating the client’s care, it may be appropriate for physical or occupational therapy to take the lead. Professionally, I feel its best practice to coordinate care among therapists. Together, they can determine which disciplines are the most important for the client (based off client reports and medical status).
Ask the Patient
Likewise, when the client is receiving all 3 disciplines, I often ask the client, “Out of the 3 disciplines, which 2 disciplines are the most important to you? And, how would you feel about initially focusing on those 2 services and rotating in the remaining discipline?”
Numerous times throughout my career, the client and/or myself felt speech therapy was not the top priority or appropriate. As a result, my recommendation was for the client to receive fewer speech therapy sessions or no speech therapy. This allows for the client to benefit from additional physical and occupational therapy.
Times for Prioritizing Speech Therapy
There are, however, times we must consider speech therapy services as a priority in the plan of care, for example:
- The client has a diagnosis of dysphagia (swallowing disorders can be a life and death situation).
- The client is cognitively impaired (secondary to age, diagnosis of dementia or Alzheimer’s Disease, brain injury, etc.).
- The client has a history of falls.
- The client has a diagnosis of a cerebrovascular accident (known as CVA or stroke), other neurodegenerative disease, or other medical diagnosis resulting in a cognitive impairment.
- The client underwent a recent surgery causing their cognition to significantly decline due to the anesthesia.
When a client demonstrates decreased cognitive-linguistic skills, they often have difficulty recalling when or how to complete their home exercise program, sequence the steps for good safety awareness with a walker/wheelchair/ADLs, and following directives, etc.
If their expressive and/or receptive language is impaired, their communication with the other therapists is vastly hindered as they are potentially unable to understand spoken/written word or express their needs, wants, or thoughts.
According to the Centers for Medicare and Medicaid Services 2020 Physician Fee Schedule, provided by the Texas Medicare Administrative Contractor (MAC), overall speech therapy services (evaluation and treatment) receive reimbursement at a higher rate than physical or occupational therapy; therefore, this should not be a factor regarding the underutilization of speech therapy services. *It is important to note these reimbursement fees may differ from state to state.
E-Integrated SLP Services, PLLC
At E-Integrated SLP Services, our goal is to bridge the gap between our client’s current status and prior level of function. If you or your loved one is not currently on home health services and feel speech therapy may be beneficial, please contact E-Integrated SLP Services, PLLC via our website. Our SLP will, then, contact you to discuss options for speech therapy services.
The 25 Best Jobs of 2020, Whitney Blair Wyckoff, senior editor. Jan 7, 2020 @ 12:01 am
The ASHA Leader Volume 24, Issue 4 April 2019 pages 13-13 published 4/1/19