Kim Wiles
While durable medical equipment providers who traditionally employed RTs to deliver clinical services to their patients in the home have had to significantly cut back on those services due to reimbursement issues, there’s no question home care will eventually be a growth area for the profession. Why? It’s the least expensive setting of care and the place where patients prefer to be.
In the following interview, AARC member Kim Wiles, BS, RRT, CPFT, explains how she got into the area and what she believes the future holds for her colleagues who may want to give it a try as well—
How long have you worked in home care and what sparked your interest in the area?
I have worked in home care for 22 years. A local home care company, Klingensmith HealthCare, was advertising for a full time RT and I was working in a local hospital and thought that I needed a change. Visiting patients in their own environment sounded intriguing.
Tell me a little about your company and how you came to serve as VP of respiratory services there.
Klingensmith HealthCare is a large, locally owned home care company in Western Pennsylvania. I started out as a clinical RT going into the home visiting patients. The company has continued to grow over the past 22 years, and my position has grown along with it.
What are some of the biggest differences between working in home care and working in other areas of respiratory care—in particular, the hospital?
The biggest differences are the uncontrolled environment and getting used to being “everything” to the patient. By “everything” I mean the RT’s role requires many hats to be worn—i.e., nurse, physical therapist, social worker, and physician. The home care RT is the “eyes and ears” of the physician. In many cases, the patient relies on your expertise for everything.
What are some of the personal characteristics that you believe it is essential for therapists to possess before working with patients in the home setting?
It takes a special person to work in home care, just as it does in acute care, pediatrics, etc. The home care therapist has to possess strong critical thinking skills with the ability to recognize problems, solve problems, and adapt to the uncontrolled environment, not to mention good driving skills! Every patient, family, and home is unique.
What kind of educational background, credentialing, and/or experience is necessary to make the move from general RT to home care?
I believe it is necessary for a new graduate to spend time in the acute care hospital setting prior to moving into home care. This is where we learn our critical thinking skills and the ability to adapt to different situations. As far as education and credentialing go, this is where there is some disconnect. The curriculum in a lot of the RT schools does not focus on home care. It is more of an introduction or an observational rotation. In many instances it is “on the job training” for the home care RT once he or she leaves the four walls of the hospital. Fortunately, there are more educational opportunities offered by the AARC and various publications that help to prepare the acute care RT for the job.
We have all heard about the reimbursement challenges facing RTs in the home. What are the job opportunities like for home care RTs these days and what do you think the future holds for the area?
Unfortunately, reimbursement has eliminated a lot of “extra service” that home care companies were able to provide via the RT. It is clear that it is less expensive to care for the patient at home, and patients are going home sicker. People want to be cared for in the home. With health care reform, different models are developing across the country involving COPD management where hospital RTs are going into the home to provide care. There are some private payers who are paying for RTs to go into the home. I believe the opportunity for RTs to provide care in the home will continue to climb. The RT may be employed by a hospital, physician, home health agency, or a durable medical equipment company to provide respiratory care in the home.
Do you have an especially interesting or heartwarming story to tell about your work with a home care patient?
Home care can be very rewarding and new friendships are formed that last a lifetime. One of my most memorable experiences was when I was approached by a company to do a study on a new piece of ventilation equipment. I was thrilled with the technology and to be part of a study that would help patients. The device was to be used on COPD patients who had multiple exacerbations and difficulty ambulating due to shortness of breath (SOB).
One of the patients chosen to use the device was a gentlemen who had stage 4 COPD, with three exacerbations in the past year. He would not leave his home due to his severe SOB. He was debilitated physically and psychologically. He did so well on the unit that the manufacturer let him keep it. It has been three years now and he has a new life. He has not been in the hospital in three years and he continues to go to pulmonary rehabilitation and do things he was never able to do. He told me that I had given him is life back! I continue to visit him as a friend and not a patient. These relationships are built every day, which is what makes home care so rewarding.
If you had to give therapists who want to work in home care 2–3 bits of advice, what would they be?
Some advice I would give to the therapist who wants to get into home care is to go into it with an open mind. It requires flexibility and it is not a 9–5 job. Some RTs have the misconception that is a 9–5 job. Unfortunately, patients do get discharged in the evening and equipment emergencies happen in the middle of the night. Don’t go into home care for the shift. Go into it for the passion of providing respiratory care to patients in their home environment.
