The Therapy Evaluation — Home Health Training

The therapy evaluation does two jobs at once: it works out what this patient can do, and it establishes whether they qualify for the benefit at all. Both have to be documented, and the second is the one therapists new to home health tend to under-write.

What the evaluation has to establish

Prior level of function — specifically, with what they were doing four weeks ago
Current function, observed rather than reported
The gap, and whether therapy can close it
Homebound status, in this patient's own circumstances
Skilled need — why this requires a therapist
Measurable goals with target dates
Frequency and duration that follow from the need
Safety risks in this home
Discharge criteria — what has to be true before they no longer need you

Prior level of function is the anchor

Everything is measured against it. "Independent" is not enough — get specifics.

Ask what they were doing a month ago: were they driving, shopping, showering alone, managing stairs, walking to the mailbox, gardening? Who did the cooking? What have they stopped doing since?

A patient who was walking two blocks and now cannot reach the bathroom has a clear rehabilitation target. A patient who has been chair-bound for three years has a different plan entirely, and possibly a maintenance one — see Maintenance Therapy.

Assess in the environment they actually live in

This is the advantage home health has over every other setting, and it is wasted if you assess in the living room and leave.

Walk the route they actually walk — bed to bathroom at night, chair to kitchen, front door to car
Use their real stairs, not a simulation
Their own bathroom — the tub wall height, where there is something to hold
Their own chair and bed — heights that no clinic can replicate
Their own footwear, indoors
Note the surfaces: thresholds, thick carpet, a step down into a sunken room

A patient who transfers beautifully from a firm dining chair may be unable to get out of the deep recliner they sit in all day. Only the home visit finds that.

Homebound and skilled need apply to you too

Therapists coming from outpatient often assume these are a nursing concern. They are not — a therapy-only patient must meet both, and your evaluation is where they are established.

Homebound: both criteria, with different reasons, in observed detail. See Homebound Status — What Actually Qualifies.

Skilled need: the evaluation, the exercise progression, the gait retraining, and the safety judgment require a therapist. Say why. A home programme a family member could supervise unchanged is not, by itself, skilled. See Skilled Need — The Coverage Test.

Build a plan that survives the episode

The plan will be delivered partly by an assistant, on days you are not there. Write it so it can be.

Progression parameters — what to advance, when, and on what criterion
Stop criteria — vital sign limits, pain limits, what would mean don't progress today
Who to call, and for what
Exercises with sets, reps, and specific positions — not "therapeutic exercise as tolerated"

See Supervising LPNs and Therapy Assistants.

Frequency

Follow the need, not the calendar. Front-load where the risk is highest — after a hospital discharge, or where the fall risk is significant — and taper as the patient takes over.

A frequency that never changes across an episode suggests either the plan is not working or the patient no longer needs this level of care. See Frequency and Duration — How to Write It.

Vital signs, every visit

Taken by every skilled discipline at every visit, including yours — at rest and, where relevant, after exertion. See Vital Sign Parameters — When to Call.

For a therapist this is not administrative box-ticking: the exertional response is clinical information about the very thing you are treating.

Discharge planning starts here

Name the discharge criteria in the evaluation, tell the patient what they are, and measure against them every visit. An episode that reaches week seven before anyone mentions discharge has gone wrong earlier than week seven.