Maximizing At-Home Wound Care for Patients

Published on September 13, 2021 by Bill Richlen, PT, WCC, DWC

Having worked in the home health industry for almost 10 years, I learned a lot about how to maximize my impact with wound care patients. I’ve also learned how to help the home health agency become financially efficient and still have good wound healing outcomes.

My goal is to share some general insights on how different therapies are an important part of at-home wound care plans for patients in the home health setting, as well as offer some suggestions on how to manage wound care in the most cost-efficient way.

Keep in mind that each state practice act may be different. In general, physical therapy (PT) and occupational therapy (OT) can provide similar services in the treatment of wounds. However, they also bring unique differences.

The role of speech therapy is more indirect as it cannot physically treat the wound, yet when appropriate, it can be a vital part of a treatment plan. Let’s review each discipline’s unique role and how to integrate them into home wound care plans for patients.

Physical Therapy in Home Wound Care

Physical therapy is allowed in almost every state for wound care purposes. PT can provide a wide variety of treatments from debridement, adjunctive modalities, compression application, complete decongestive therapy (CDT for lymphedema), and dressing changes.

PT assessment skills are vital in developing the correct treatment plan and determining what the patient needs in areas of mobility training, strengthening, balance, and necessary interventions to heal wounds.

We must not forget the importance of functional independence in the grand scheme of comprehensive, holistic care of the patient. Not to mention the impact it can have on reducing the risk of pressure injuries and managing lower extremity edema.

Unfortunately, most adjunctive modalities either cannot be provided in a home health setting, or the infrequency of PT visits makes them ineffective — such as electrical stimulation which requires five to seven days per week. However, there are portable high-volt pulsed current machines available, and if one can be obtained, the PT can train the patient or caregiver to apply electrical stimulation.

Occupational Therapy in Home Wound Care

Occupational therapy’s involvement in the direct care of the wound is more limited in many states per their scope of practice. When it is within their scope of practice, just like PTs, OTs can provide treatments such as debridement, adjunctive modalities, and dressing changes.

Having similar skills in assessment, an OT can also play a vital role in developing the correct treatment plan and determining the patient’s needs in areas of mobility training, strengthening, balance, activities of daily living, cognitive deficits, and the interventions necessary to heal wounds.

However, when direct wound care is not allowed, OTs can still perform compression application and CDT for lymphedema, not to mention addressing functional mobility, ADLs, adaptive equipment, and cognitive treatments.

Speech Therapy’s Connection

Speech therapy’s role in wound management is often poorly understood and underutilized, especially since it cannot provide direct treatment to the wound. However, speech therapy’s assessment and treatment skills in the areas of cognition and chewing/swallowing dysfunction can make an incredible impact on how successful the hands-on treatment will be.

Cost-Effective Collaboration is Key

Working closely with the dietician and/or patient and caregivers to develop nutritional interventions that allow the patient to more successfully reach their daily nutritional requirements will make the overall wound treatment plan successful.

Coordination among therapy and nursing in the home health setting can create a more cost-effective wound care program for the home health agency. Often, nursing and therapy involves visiting the patient on the same day. Unless there is a skill the nurse is providing that is not within the scope of practice for a therapist, why not have the therapist do it since they are already with the patient?

For example, even if a home health patient doesn’t need one of the aforementioned therapists to perform a specific wound treatment during a visit, if the therapist is already in the home working on other goals with the patient, why not have him or her do the dressing change that day and save an additional visit by the nurse? This can streamline the entire process for everyone, without reducing the effectiveness of wound treatment, and can be a more cost-effective approach for the home health agency.

Freeing up the nurse to see other patients could increase the overall caseload of the home health agency as well as its profitability. With the ever-rising costs of care and the struggle to stay financially viable, being open to new ways of doing things is just what we need to do.

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Bill Richlen, PT, WCC, DWC
Bill Richlen, PT, WCC, DWC

Bill Richlen, PT, WCC, DWC, is a licensed physical therapist and has experience in advanced wound care consultations in long-term care, outpatient, skilled rehabilitation and home health. He has served as a clinical instructor for physical therapy students, been the director of several large rehabilitation departments, and has been providing multi-disciplinary wound care education to nurses and therapists for over 17 years. His expertise in diverse settings enhance his role as a clinical instructor. Bill’s dynamic and captivating teaching style keep’s attendee’s attention throughout the course.

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