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Experiences as a Home Health OT in Multiple States

During my travel therapy career, I have worked in California, New York, and am also licensed in/planning to work in Colorado. So far, I have worked in subacute inpatient rehabilitation and home health settings, with more placements in home health at this time.

To be as transparent as possible, my time in home health in California was less than desirable. Not because of the setting itself, but because of the company I was working for. This was my first job after passing the OT board exam. My best friend and long time education partner, Sydney, and I drove from Rochester, NY to San Jose, CA to start travel therapy together.

The company I signed a contract with required me to cover two areas, including but not limited to: Antioch, Orinda, Vacaville, Vallejo, Rio Vista, Concord, Bethel Island, and Oakland. San Jose was a halfway point (or so we thought) for both Sydney and myself to commute to our respective work areas. Sydney was working in school-based pediatric, covering a county. Unbeknownst to the both of us, California traffic is no joke, especially in the Bay Area. I had to commute approximately an hour and a half to two hours to see my first client, and then repeat that for my drive home. I had to see six patients a day, with most of them being evaluations, revisits, and discharges. My orientation consisted of a three day in-class lecture series and no field training. At the time, I had no understanding of the coveted home health point system, from which your productivity is calculated. Thankfully, productivity was never mentioned for me, so I would be safe to assume I was meeting their requirement. We were provided with a bag including wipes, soap, sanitizer, barrier sheets, a laptop, a work cellphone, charging cord, theraband, and theraputty. Though I am thankful for the resources provided, the laptop was cumbersome to carry around and needed to be charged 2-3x per day. As a practitioner that is focused on providing quality, evidence-based, and client-centered therapy, I took most of my documentation home with me. Another part of home health is regularly scheduling patients, calling MDs or related providers, and coordinating with schedulers and office staff. So, with the daily commute to and from the areas, patient care, and documentation, I regularly spent 16-18 hours per day doing work or completing work-related tasks. In retrospect, I was in the perfect environment for burnout and that’s exactly where I landed. I specifically remember breaking down on the phone with my recruiter because I just couldn’t do it anymore. We were able to work a new system out with the OT supervisor due to an opportunity for me to move my area to San Jose. My commute drastically decreased and I was spending 8-12 hours per day on work and work-related tasks, though I was almost always behind on documentation due to a high-level of burnout. I made an effort to battle the burnout with weekly trips to various National Parks and hikes in Northern California, and completed daily documentation outside at parks or near the beach as much as possible. The contract was originally for 13 weeks, and we extended to 16 weeks to take us right up to Christmas time. There was an offer to return after the holidays, but I knew that my time with that company needed to end. Sydney also experienced burnout covering an entire county of under-served pediatric populations and decided to stay at home and not return to travel therapy. I am so thankful for having her with me for that journey, I really don’t know how I would have made it out of their with the little bit of energy that I had left without her.

A year later, I finally encouraged a close friend Sara to jump into the travel therapy world with me. We got lucky with an offer of two contracts with the same company, in the same area of NY. I was resistant to accepting another home health contract due to my previous experience, but I knew it was fair to give the setting another try with a new company. Due to gained experience both as a practitioner and interviewer/interviewee, I was able to determine that this company had an ethical outlook, manageable coverage area, and manageable productivity expectation. With the added bonus of working for the same company, Sara and I jumped on the opportunity and were both offered contracts with the company. Their orientation was a full week, with class time and field time. It was refreshing to have training under an OT preceptor, just to learn the ropes of the tablet and company operations. We were provided with the same protective equipment and bag, a balance pad, cones, a gait belt, a car charger, a tablet (instead of laptop), theraband, and theraputty. I covered one area that consisted of a cluster of 5-6 towns within a 30 minute radius, which seemed rather easy when compared to the 60 minute radius that I covered in California. I worked with a few COTAs in the area who took over a majority of my routine visits. Halfway through the contract, I moved to an area closer to where my partner and I were living and worked with one COTA, Shekera, who is out-of-this-world amazing. I extended my contract to mid-may with the company, though my contract was cut short due to PDGM. I was served a 30-day notice per my contract, and recently ended my contract on March 20th. The caseload was much more manageable, the scheduler and certain patient care managers were incredibly supportive. I was lucky to work with an amazing COTA, and didn’t have much experience with COTA supervision during my time in CA. The change to the Patient Driven Grouping Model (PDGM) did make working in the home health setting in general more difficult. The home health company I signed on with was bought out by a larger home health company shortly before my contract began. The company that shall not be named did continue to seek financial gain and stray from quality patient care in response to PDGM, in my opinion. The frequency of therapy visits was cut, there were conversations regarding cases being OT or PT only, and that OTs/PTs could cover each other’s scopes of practice, and OTRs became evaluation and discharge machines, while COTAs took over most routine visits. Through persistent advocacy and discussion, were were able to get the director to agree to providing the necessary visits per the practitioners discretion in order to meet each individual’s needs.

Pros: I enjoy the home health setting due to the fact that we get to evaluate, assess, and plan to provide interventions in an individuals natural environment. As an OT, what is better than that? I love the creativity that is required to use available resources and collaborate with a client to complete tasks they need to get through each day, with the greatest level of safety and independence. I love the change of environment throughout the day and ability to binge music or podcasts during the commute to each patient.

Cons: Even with a mobile tablet, I found that I continued to take work home with me. I don’t know about you, but when I get home I want to be completely done with work that is required of me. I found that I cannot compromise on maximizing direct client and face to face time during visits, as home health visits are not always lengthy in nature. If you own a car, expect to rack up some serious mileage. Though not an issue in California, hazardous weather can affect productivity and ability to see patients, especially in a state like New York during the winter months. The time spent on technology, whether it was my phone or tablet, was frustrating. In a time of technology, I found it difficult to step away from my phone or tablet and enjoy parts of my day. As someone who is 6’1″, the time in the car and looking at technology throughout the day definitely took a toll on my body.

Overall, I don’t think home health is my happiest place. I am thankful for my experience in the setting. As someone who strives to enter academia in the future, my experiences will allow me to share valuable information and speak on the reality of the setting.

References of OT practice guidelines and COTA Supervision:

California: https://www.bot.ca.gov/forms_pubs/supervision_faqs.shtml

New York: http://www.op.nysed.gov/prof/ot/part76.htm

AOTA:https://www.aota.org/~/media/Corporate/Files/Advocacy/State/Resources/Supervision/MSRSOTA.pdf

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Make The Pronoun Promise

What are pronouns and why are they important? Pronouns refer specifically to people who are being talked about or to. Pronouns are a part of our identity, we all have and use them. Common pronouns are they/them/theirs, he/him/his, she/her/hers. We (society) often place the burden on the individual, especially those within the LGBTQIA+ community, to announce their ‘preferred’ pronouns. We’re going to change that today, and each day from here on out. Make the promise to help everyone feel accepted. We can lead the conversation! I’ll start: Hi, I’m Devlynn (or Dev), and my pronouns are they/them/theirs.

Promise to honor and correctly use each individuals pronouns, it is one of the most basic ways to show your respect for their gender identity. Our intentional use of language can facilitate a change in levels of dysphoria, depression, anxiety, trauma, and more. Promise to do your best and to try, it’s okay to make mistakes. Promise to educate others and protect those who may be affected. Promise to make a conscious effort.

Here’s the challenge: Identify your pronouns in your bio, next to your name (refer to my profile), in your email, in your personal introductions, in patient interviews, and in your conversations. If you’re able, send a screenshot to me or use the hashtag #pronounpromjse and join the chain of support in my highlight on instagram. Let’s normalize the use of pronouns. Let’s start the conversations, so others aren’t forced to. Regardless of religious beliefs, culture, race, sexual orientation, gender, etc., pronouns are literally for everyone. Be open, be kind, and lead with love. *This campaign and challenge is not ONLY for the OT community, this is for everyone*

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LGBTQIA+ 101: What Do the Letters Mean?

L represents Lesbian. The term or identity Lesbian, describes an individual that identifies as a woman (yes, both cis and/or trans) and is primarily emotionally, physically, sexually, and/or spiritually attracted to women.

G represents Gay! The term or identity gay, describes an individual that identifies as a man (yes, both cis and/or trans) and is primarily emotionally, physically, sexually, and/or spiritually attracted to men. The term Gay is also used generally to describe individuals who are primarily emotionally, physically, sexually, and/or spiritually attracted to those of the same sex and/or gender. 

B represents Bisexual (Bi)! The term or identity Bisexual, describes individuals who are emotionally, physically, sexually, and/or spiritually attracted to more than one gender. Those who identify as bisexual aren’t “greedy” or “confused”, their identity is valid.

T represents Transgender (Trans)! The term or identity Transgender, describes individuals whose gender identity is different from the gender assumed at birth. Fun fact, those who identify as a trans female are equally as female as those who identify as a cis female. Transgender refers to gender identity, not sexual orientation or preference. 

Q represents Queer OR Questioning! The term or identity Queer, is an umbrella term for people who don’t identify as heterosexual and/or cisgender. Queer is also used interchangeably with the acronyms LGBT, LGBTQIA, LGBTQIA+, etc., to represent the community as a whole 🏳️‍🌈. However, Queer is not always a preferred term or identity for those within the LGBTQIA+ community, due to is historical use as a derogatory term.


Q is also used to represent the term or identity, Questioning. Questioning represents an individual that is unsure about and/or is exploring their own sexual orientation and/or gender identity.

I represents Intersex! Intersex is a term for a combination of chromosomes, hormones, sex organs, or genitals that differs from the male/female binary. For example, a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside. A person may be born with mosaic genetics, so that some of her cells have XX chromosomes and some of them have XY. Interesting fact: Intersex is often thought of as an inborn condition, though intersex anatomy doesn’t always show up at birth. Sometimes a person isn’t found to have intersex anatomy until they reach the age of puberty, or finds themself as an infertile adult. Some people live and die with intersex anatomy without anyone (including themselves) ever knowing.
Reference: https://isna.org/faq/what_is_intersex/

A represents Asexual! The term or identity Asexual, describes individuals who experienced little or no sexual attraction to others and/or lack of interest in sexual relationships and/or behaviors. Asexual is also used as an umbrella term, for additional identities within the spectrum of sexual orientation. Myth buster: People who consider themselves asexual may have relationships, but they would not have the interest in adding a sexual component to the relationship. Individuals that identify as asexual can and do have romantic relationships with others.

➕ represents the inclusion of all identities within the LGBTQIA+ community! The ➕ represents identities, genders, and orientations that fall under umbrella terms used within and outside of the LGBTQIA+ acronym.
Some (but not all) of the identities represented by the ➕ include: Pansexual, Fluidity, and Demisexual.
Pansexual (Pan) refers someone who is emotionally, physically, spiritually, and sexually attracted to all gender indentured. As @instadanjlevy wrote in @schittscreek episode 10 of season 1 for his character David that identifies as Pansexual, “I like the wine and not the label.” (see next picture from Andrea Van Sickle on fb)
Fluidity (or Gender Fluid) refers to a gender identity that may shift or change over time.
Demisexual is a term or identity that represents an individual that has little or no sexual attraction to another individual, unless there is romantic connection/involvement. This term or identity is mostly considered to be under the umbrella of Asexuality, though some view it separately.

GQ represents Gender Queer! The term or identity Gender Queer, is an umbrella term for those who identify as Gender Non Conforming (GNC) or Non-Binary. It is a gender identity label that is used by those who may identify outside of the societal gender binary (male/female). Gender nonconformity, is an identity or gender expression by an individual that does not match expected/societal masculine or feminine gender norms.
It is important to note that the term Queer is not accepted by all within the community, due to the derogatory use of the term throughout history. A L W A Y S ask an individual, “How would you like to be identified.”

Hello it’s me! Your NB OT! NB represents Non Binary! The term or identity Non Binary describes an individual who does not identify with the assumed gender binary, male or female. It includes a spectrum of gender identities that are not exclusively masculine or feminine. For all of my OT and healthcare friends, think of gender as a spectrum, just as we view some neuro diversities (ASD) as a spectrum. Real talk, what does this identity mean to me? Non Binary means freedom. Freedom from societal pressure to be X or Y. I can wear makeup, have a beard, wear heels, and engage in whatever occupation I want because all of it is ME. I don’t identify as male or female, I am non binary. I do not engage in occupations because they are ‘inherently’ masculine or feminine, I engage in them because they are meaningful to me and hold no relevance to gender or societal expectations. I am comfortable with he/him pronouns but they/them pronouns best represent ME, to the core of my being. I’m still exploring and adding new pieces to my identity puzzle and I have never felt more true to myself in my whole life. It’s okay to still not know who you are, but know I am a safe space for you and am here to protect, love, support, and include you. Your identity matters. Please note that gender identities and sexual orientations can be dynamic and change or evolve over time, even from day to day. Remember to A L W A Y S ask an individual, “How would you like to be identified.” Don’t argue with their identity, honor it.

C represents Cisgender (cis)! The term or identity Cisgender is a gender description for when someone’s sex assigned at birth and gender identity/ personal identity correspond in the “expected” way. Remember, gender identity does not include sexual orientation or identity. An individual could identify as cisgender and heterosexual, or within any identity of the LGBTQIA+ community.


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My story

I always found the idea of ‘coming out’ as strange or forced, but like many other LGBTQIA+ individuals I went through the same process on my journey to self-discovery and establishing my identity. I came out “officially” at the age of 17, or as I would prefer to say it, I started to let people in to who I am at 17. That is the same age that I decided to pursue an education in occupational therapy.

I applied to 9 schools originally and decided to attend D’Youville College in Buffalo, NY for my combined BS and MS of human occupation and occupational therapy. OT school was challenging, energizing, and fulfilling. I was fortunate to have incredible faculty, family, and friends who supported and challenged me with my crazy ideas like starting a community wellness clinic on campus or creating the official D’Youville OT instagram page – which is where the idea of @therainbowot grew from.

It was during professional development lecture in my final year of OT school where I found enough passion and frustration to start my lifelong mission for enhancing education, inclusion, representation, and advocacy for those within the LGBTQIA+ community, inside and outside of healthcare settings. I was so excited in class when we finally had a lecture where part of the class discussion was designated to address LGBT topics in OT. There was an objective to cover vast cultures including Korean and Latinx culture in a two hour span, leaving little time to cover all of the material, including LGBT+ topics. Without saying any names, it was clear to me that the professor was unprepared to answer questions about LGBT+ topics, especially those surrounding trans individuals – so the spotlight was turned to me (the token gay person). This wasn’t a new situation to me or the first time that I was placed with the responsibility to discuss LGBT+ topics in a class. I remember feeling powerful, frustrated, and concerned. There is a great amount of pressure when discussing topics and identities of the LGBT+ community, especially when my identity of being a white, gay, male (sex) does not come close to representing the entire community. It’s important to note that at the time of this class, I hadn’t really started acknowledging my non-binary identity, so I identified as a male. My concern came from the fact that I was one student, unable to represent or educate on all LGBT+ topics in only one section of the class. What did the other sections talk about? Did they discuss what it means to be trans? Did anyone validate the trans identity or provide definitions for the letters of the acronym? From there, the fire was lit to go on my own path of providing education and resources to anyone regarding these topics and more.

Where are we now? Well, The Rainbow OT has been running for just about a year. I launched my first LGBTQIA+ 101 series, a pronoun promise campaign, and have been a guest on two podcasts discussing LGBT+ related topics and occupational therapy’s role. With the support and safe space provided for friends that I owe the world to, I was able to let others in to who I am, a proud non-binary individual. I’m still in the beginning of my journey to self-discovery, but I am so happy with where I am when I look back at where I was. Where are we going next? You’ll just have to tag along and see.

XX,

Devlynn Neu

They/Them

The Rainbow OT