Therapy-Only Cases — Home Health Training

A therapy-only case is a full home health episode that happens to have no nursing on it. Everything that applies to an episode still applies — and you are the one carrying it.

What you are responsible for

On a therapy-only case, the therapist:

Completes the OASIS at start of care, resumption, recertification, and discharge
Establishes and maintains the plan of care
Documents homebound status at every visit
Takes vital signs and pulse oximetry at every visit
Notices and reports non-therapy clinical findings
Manages the discharge

If you have come from outpatient, the OASIS is the largest adjustment. It is long, it is consequential, and its answers drive payment and quality scoring for the whole episode. See What OASIS Is, and Why Every Answer Matters.

Ask QA before you guess. A wrong OASIS answer follows the patient the whole episode.

Eligibility still has to hold

The patient must be homebound — both criteria, different reasons, documented every visit
There must be a skilled need requiring a therapist
A physician must be overseeing the plan of care
A compliant face-to-face encounter must exist — see The Face-to-Face Encounter

None of this becomes optional because there is no nurse on the case.

You are the only clinician in the house

This is the part that matters most, and it is not in your scope training.

You will be the only person who sees this patient's home, medication cupboard, skin, and mood. Notice things outside your discipline, and report them.

Call for a nursing evaluation when you see

Wounds, or any skin breakdown — including a pressure injury developing over a heel or sacrum
New or worsening oedema
Vital signs outside parameters — see Vital Sign Parameters — When to Call
Medication problems — bottles untouched, duplicates, confusion about doses, a regimen nobody is managing
Signs of infection, including new confusion in an older adult
Uncontrolled pain
Weight change, or an empty refrigerator
Blood glucose problems in a diabetic patient
Signs of decompensation in heart failure or COPD

You are not diagnosing. You are reporting a finding so that someone whose scope covers it can assess it.

Other referrals worth making

SLP for any patient coughing at meals — urgent
MSW for financial barriers, caregiver strain, housing, or end-of-life planning
Aide where personal care needs have grown
The other therapy disciplines — a PT-only case with obvious ADL difficulty needs OT

Each needs a physician order for evaluation. See Changing the Plan Mid-Episode.

The nursing referral is not a failure

Therapists sometimes hesitate, as though calling for a nurse means they missed something or that the case is being taken away. Neither is true. A therapist who spots a developing sacral pressure injury in week two has prevented a hospitalization.

Discharge

You discharge the episode, so the discharge type matters:

OASIS discharge closes the episode
If another discipline is still on service, that is a different discharge

See Discharge for which applies, and for the notice the patient may be owed.

The practical checklist

At every therapy-only visit:

Vital signs and pulse oximetry
Homebound status, observed and matched to what you write
Skilled therapy intervention, tied to an order
A look at the patient as a whole — skin, medications, intake, mood
Anything outside your discipline reported the same day
Plan for next visit written specifically
Progress toward discharge criteria