Speech-Language Pathology in a Home Care Setting

Introduction

Today, the settings in which a speech-language pathologist can practice are as varied as the patients served. From the skilled nursing facility to outpatient treatment to acute care, speech-language pathologists (SLPs) provide services in more settings than ever before. One setting that is growing in need is the home health setting. The home health setting provides many benefits to an SLP and to the clients receiving services. This article describes the current home health population and the benefits and challenges encountered by an SLP delivering services in a home health environment. It also provides information regarding evaluation, treatment, and carryover of intervention skills. Finally, the article will shed light on this interesting but rarely discussed service delivery setting.

Overview of Home Care

According to the National Association for Home Care and Hospice, approximately 7.6 million individuals currently receive care in their homes from 17,000 providers. (National Association of Home Care and Hospice, 2008; U.S. Census, 2002). Care is provided due to acute illness, long-term health conditions, permanent disability, or terminal illness. Home health care is considered to be a cost-effective strategy for many families and insurance companies while maintaining the highest quality of life possible for the individual. With the onset of shortened hospital stays and the strong desire by individuals to remain in their homes for as long as possible, many older adults and their families are turning to home care providers to receive rehabilitative services, including the services of a speech-language pathologist. Home health agencies typically provide the skilled services of registered nurses, social workers, physical and occupational therapists, speech-language pathologists, registered dieticians, and home health aides for their patients (U.S. Department of Health and Human Services, 2009).

There are a number of reasons why a patient may need or would benefit from home health care. These include post-surgery care (such as following a hip or knee replacement); post-acute rehabilitation (such as after a stroke); treatment of ongoing, progressive illness (such as Parkinson's disease, Alzheimer's disease, or cancer); or following injury (such as a hip fracture or head injury). The overall adult population seen in home care is typically more medically acute and fragile, is more culturally diverse, and can have a wide range of disorders. Referrals to home care agencies may occur upon discharge from a hospital or a long-term care facility, or can come directly from a physician (American Speech-Language-
Hearing Association, ASHA; 2008).

According to ASHA's 2009 Health Care Survey, 39% of speech-language pathology (SLP) services in home care are provided to infants & toddlers, 14% to preschoolers, 11% to school-age children, and 37% of services are with adult clients. According to ASHA (2009), the top areas of intervention for adult clients seen by home care SLPs include swallowing disorders (35%), aphasia (26%), cognitive-communication disorders (16%), and motor speech difficulties (9%). ASHA (2008) also identified that most adult home care clients are age 70 and older (70%) and that a cardio-vascular accident (CVA) or stroke is overwhelmingly the top medical diagnosis (63%) seen by SLPs in this setting.