Physical, Occupational, and Speech Therapy
ContentsWhat is rehabilitative therapy? The benefits of in-home therapy The rehabilitation process Types of in-home professional therapy When to get professional therapy How long does rehabilitative therapy last? Therapy costs Paying for therapy Choosing the right provider Professional therapy FAQs
Rehabilitative therapies are often a vital part of recovering from acute illnesses like strokes, falls, and traumatic brain injury. This overview will cover the unique benefits and approaches of each therapy, along with cost estimates, advice on choosing the best provider, and answers to some common questions.
What is rehabilitative therapy?
Home-based physical, occupational, and speech therapies function similarly to a treatment plan in a rehabilitation center. A licensed medical practitioner will visit your loved one’s home and perform specific duties as outlined by a doctor. Their duties are confined to medically necessary tasks and will not include personal care assistance or help around the house. Typically, the therapist will visit your loved one in their home one to five times per week and will adjust their visit times as necessary.
The benefits of in-home therapy
Many patients prefer the idea of in-home professional therapy because it gives them more control over their treatment. Home-based therapy allows seniors to age in place as they recover with few changes to their environment. Their loved ones can oversee their long-term care, and they can recover where they are most comfortable. While rehabilitation centers can offer the same caliber of care, home care is usually preferred by patients since it allows for treatment with minimal life disruption. For some patients, this means they are more compliant with their therapist, less prone to relapses, and recover more quickly.
As a caregiver, you may prefer home-based care for your loved one so you can oversee their progress. You can ask to participate in your loved one’s therapy exercises and can ask the therapist any questions you have whenever they visit. In addition, you can still care for your loved one as you do normally, and you won’t need to concern yourself with how they are handling their stay at a facility.
The rehabilitation process
The main goal of rehabilitation and therapy is to reduce the impact of illness or injury on a patient’s life and wellbeing. In order to achieve this goal, physicians and therapists work together using a basic a standard rehabilitation process. Before your loved one sees a therapist, their doctor will talk to them about their problems and help them identify their needs. Your loved one will then work with their therapist to target their primary struggles, and the therapist will create a care plan. Once a care plan is in place, your loved one’s therapists and physicians will work together to assess their progress as they are rehabilitated, and will adjust their care plan as necessary.
This process will continue until your loved one feels comfortable living without therapy and their physician determines it is no longer needed. If you have any questions about the rehabilitation process and your role in your loved one’s recovery, talk to their doctor or their therapist. As a caregiver, understanding the rehabilitation process can make it easier for you to provide care and help you feel informed as your loved one recovers.
Types of in-home professional therapy
There are three main categories of home-based rehabilitation: physical, occupational, and speech therapy. Your loved one’s doctor will determine which type of therapy is best depending on their health and well-being issues and the type of aid they’ll need to fully recover. Physical, occupational, and speech therapists offer services specialized to their fields, and your loved one may require the assistance of more than one therapist to meet their needs. If it is the case that your loved one needs multiple therapists, they will work together to coordinate their session times and create a multi-faceted plan for recovery.
If your loved one has had an illness or injury that prevents them from completing their daily activities, they may need physical therapy. Physical therapists help their patients relieve pain, and work with them to improve their mobility. Many times, patients can avoid surgery or further disability following an illness or injury by partaking in physical rehabilitation. Physical therapy can also help your loved one improve their balance, manage age-related problems, and help them learn to prevent falls so they can avoid future injuries. Physical therapy can reduce chronic pain on a day-to-day basis without painkillers.
Physical therapy can provide relief from a wide range of ailments, including (but not limited to):
- Broken bones and sprains
- Traumatic Brain Injuries (TBI)
- Heart conditions
- Lung diseases
Your loved one’s doctor will determine if physical therapy may help them recover from their health issues, but you can reach out to them for advice if you believe rehabilitation may be beneficial.
Occupational therapy services can help with many of the same ailments as physical
Speech therapy is commonly associated with children, but adults and seniors can benefit from it as well. When an individual is having difficulties communicating, speaking, or swallowing, their doctor may advise them to partake in speech therapy. Speech therapists use goal-oriented exercises to help their patients learn to speak or swallow again. Most importantly, speech therapists are trained to distinguish between aging-related speech and swallowing issues and those caused by illness or injury.
Speech therapists commonly help with disorders caused by a stroke, brain injury, and Alzheimer's disease and dementia. These mainly include Aphasia, Apraxia, and Dysphagia, but can encompass dozens of other ailments.
Recovering at home vs. a rehabilitative center
In-home therapy and rehabilitation facilities offer many of the same services but each delivers a different recovery experience. Patients recovering in a rehabilitation center receive 24-hour care, and typically share a room with another person for the duration of their stay. Rehabilitation facilities offer a clinical environment and may not feel as comfortable as a home setting for your loved one, but they have a variety of resources which may help with their recovery.
A physician may require your loved one to stay at a rehabilitation center if they require 24-hour supervision or special equipment for their recovery, but many individuals qualify for in-home care. Home-based care operates differently but offers many of the same services. If your loved one wants to recover at home, they may choose to do so with in-home therapy. A therapist will visit their home as directed by a physician, and help them recover through exercises and activities. Patients who are rehabilitated at home don’t have to undergo the stress of transportation and don’t have to adapt to a new environment during their recovery period. This can make recovery simpler for them, and make rehabilitation easier.
When to get professional therapy
Many people need time to re-adjust to life after a Traumatic Brain Injury (TBI). Sometimes these adjustments are minor and will happen without the need for professional help, but other times rehabilitation is necessary for recovery. As your loved one ages, they may have more trouble than usual recovering from both major and minor health events and may need light therapy to recover.
Only your loved one’s physician can determine if they need physical therapy, however careful observations on your part can help them make the right decision. Have you noticed your them struggling to walk, speak, or otherwise complete daily tasks? Are they having a lot of ongoing pain related to their illness or injury? If so, they may need therapy and they should speak to their doctor.
Consider seeking physical therapy if your loved has trouble with mobility after their illness or injury. They may need to re-learn how to walk after a stroke or a traumatic brain injury, or they may have trouble balancing after a broken bone. Physical therapy can help with these ailments, along with any others which may diminish your loved one’s ability to move around. It can also help if your loved one has chronic pain linked to their illness or injury. Physical therapists are trained to help manage chronic pain and can give your loved one the tools they need to manage it.
Your loved one may experience trouble with some of their daily living tasks once they return home from a hospital stay. Many illnesses and injuries cause damage to the parts of our brain and body which are responsible for day-to-day tasks, and occupational therapists specialize in helping their patients overcome these newfound challenges as they recover.
Occupational therapy is right for those who need assistance with basic daily living tasks following an illness or injury. An occupational therapist can help your loved one:
- Bathe or shower
- Partake in hobbies
Speech therapy targets different goals than physical and occupational therapy. Patients most commonly need speech therapy when they suffer from dementia, strokes, or head injuries, as these ailments are the most likely to cause issues with their ability to communicate. Speech therapists also help patients learn to swallow, which can be necessary to prevent choking or aspiration as a result of dysphagia.
Your loved one’s doctor will prescribe speech therapy after a stroke or head injury that’s serious enough to impact their communication skills. However, you may need to approach your their physician about speech therapy if you begin to notice them having any trouble swallowing food. Sometimes swallowing trouble can be the result of serious health conditions like Multiple Sclerosis or Alzheimer's disease, and can lead to aspiration. Aspiration can cause choking or pneumonia, making it very important that your loved one get professional help as soon as possible if they are showing any symptoms of dysphagia.
How long does rehabilitative therapy last?
Therapy can last from a few days to a few months. Your loved one may need ongoing therapy beyond what they’ll need during their initial days of recovery, which could make therapy sessions necessary for years. Typically, short-term rehabilitation is defined by a length of care lasting up to 100 days. However long they need therapy will depend on the types of therapy they need, the type of illness or injury they are recovering from, and how quickly they are recovering.
Without insurance, the cost of physical, occupational, and speech therapy can vary widely. Most providers charge a fee for their initial evaluation, and they charge each patient by the hour or by the session.
- Initial evaluations for physical therapy can cost up to $200, and each session usually costs between $50 and $350. They may cost more or less, depending on the state.
- Occupational therapy typically costs between $150 and $200 for an initial evaluation, and between $50 and $400 per hour thereafter. These costs vary, depending on the provider and the services included in their hourly rate.
- Speech therapy typically costs between $200 and $250 for an initial assessment, and between $100 and $250 per hour thereafter.
For each type of therapy, sessions held in a hospital environment generally cost more than those conducted in-home.
Paying for therapy
Therapy qualifies as health care and is generally covered by private insurance and Medicare. If your loved one’s physician determines it is medically necessary for them to receive physical, occupational, or speech therapy, Medicare will cover the associated fees. Their coverage is limited, and there are “therapy cap limits” for those using Medicare to pay for rehabilitation services. The Medicare therapy cap limits are currently:
- $2,010 for physical and speech therapy services combined
- $2,010 for occupational therapy separately
These limits mean your family member’s Medicare plan will bundle physical and speech-language therapy together when calculating their coverage but will cover occupational therapy services separately. If your loved one’s therapy costs are higher than the limits outlined by Medicare, they will be responsible for the remaining fees unless they qualify for an exception.
To qualify for a Medicare therapy cap limit exception, your loved one’s physician must note their need for therapy is “medically reasonable and necessary” in their medical record. If Medicare approves their claim for assistance above the therapy cap limits, they will receive coverage for more of their fees, but will still incur limitations:
- $3,700 for physical and speech therapy services combined
- $3,700 for occupational therapy separately
Medicare does not cover any physical, occupational, or speech-language therapy which is not deemed medically necessary by a doctor. If your loved one wants to take part in optional therapy, it will be their responsibility to pay their fees.
Medicaid covers therapy in 39 states, but most have limitations as to what they will cover. Some individuals may require prior approval to use Medicaid to pay for therapy, and most plans require a copayment of some kind. To determine whether or not your loved one’s Medicaid plan will cover their therapy costs, use the Henry J. Keisler Family Foundation’s Medicaid Coverage Tool located on their website. This tool lists each state, whether or not their Medicaid program covers therapy, and what services the coverage is limited to if therapy is covered.
Choosing the right provider
It can be difficult for your loved one to determine which therapy provider will best suit their needs. There are many factors to consider, including the illness or injury that requires therapy, which services are necessary for rehabilitation, and how long therapy is needed. While the process of choosing a therapy provider can be challenging, there are some questions to ask a potential therapist that can make the process easier:
- Does the provider offer programs and services specific to your loved one’s needs?
- How does the provider develop and use a treatment plan to help your loved one recovery from their illness or injury?
- How often will the therapist visit your loved one’s home to provide rehabilitation services?
- How long will the therapy sessions last?
- Will the provider answer questions about insurance and help your loved one make the right choices to suit their coverage?
- Can family members be involved with your loved one’s rehabilitation experience?
Your family member’s doctor may recommend a rehabilitation provider when they prescribe therapy, however, you may wish to find some nearby on your own. The American Physical Therapy Association (APTA) offers a free online service to find physical therapists, and The American Speech-Language-Hearing Association (ASHA) offers a similar service on their website to find speech-language pathologists by location.
Professional therapy FAQs
1. Will physical, occupational, or speech therapy prevent further complications of my loved one’s illness or injury?
The goal of rehabilitation is to reduce the impact of an illness or injury on someone’s life, and reducing your loved one’s risk of future complications is part of achieving that goal. In some cases, rehabilitation can eliminate any further complications of any injury by helping your loved one recover properly and quickly. However, some injuries and illnesses may cause issues that can’t be entirely treated by therapy, so it’s important to talk to their doctor about realistic expectations for recovery. For example, if your loved one broke a bone, they may recover entirely with the right care and oversight, but ailments like strokes and brain injuries can have long-lasting effects despite therapy.
2. What do I do if my loved one isn’t compliant with therapy?
Some patients struggle to accept physical therapy as part of their recovery and refuse to comply with their therapist. Typically, this is less common for those receiving in-home rehabilitation, but it can happen to anyone who feels frustrated with their situation.
Your loved one may be non-compliant with their therapist because they feel like their privacy is being invaded. This is particularly common for those with cognitive dysfunctions, as it can be challenging for them to understand who is coming into their home and why their presence is necessary. They may even feel fearful of their therapist, which can greatly hinder their recovery.
Your loved one may also refuse care because they feel as though it is a loss of dignity. It can be difficult for them to come to terms with learning how to walk, talk, dress, and use the bathroom again, so they may refuse help in order to prove their independence.
The best way to help your loved one if they are non-compliant with care is to talk to them about their concerns. Ask them why they are feeling resistant, and explain to them why therapy is necessary for them to enjoy a better quality of life. Explain to them their path to recovery, and how therapy plays a crucial role. Don’t brush off their concerns, but truly listen to them and let them know they are being heard. By reassuring your loved one that their voice matters and they have a say in their care, you can encourage compliance during their rehabilitation sessions.
3. How can I make sure the therapy provider will respect my loved one’s wishes and my wishes as a caregiver?
It’s important to know your voice is being heard when your loved one goes through rehabilitation. Before any therapist begins working with them, they will need to create a care plan with you to determine the best route toward recovery.
Sit down with your loved one and write down their preferences and concerns before anyone creates a care plan. Be very honest about your concerns, and clearly explain what you expect from their therapist. Discuss this list with their physician and the therapy provider to incorporate as they create your loved one’s care plan. In addition, it’s important to check in with them as they undergo therapy to get an idea of how well their therapist is respecting their wishes. If you have any concerns, bring them up with your loved one’s therapist early in order to clear up any confusion and make any necessary changes.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.