As Albertans look for more convenient access to health care, services provided in the home are becoming more popular. In response to this need, many Alberta physiotherapists are providing mobile or in-home physiotherapy services. Providing care where the patient lives may offer benefits for both the patient and the provider. However, whether the plan is to see the odd patient in their own home or to start a home care business, members must be aware of potential risks associated with this type of practice. The goal of this article is to identify some questions members should ask before starting a mobile practice.
Why are patients seeking physiotherapy services delivered in their own homes?
Receiving in-home physiotherapy can provide benefits to patients including, but not limited to:
Improving patient access to physiotherapy by eliminating barriers related to mobility or transportation to a clinic.
Providing more flexibility and convenience by offering appointments outside normal business hours to accommodate the patient's work/leisure schedule.
Facilitating the inclusion of working family members or caregivers during appointments.
Providing an opportunity for the patient to discuss challenges faced in the home.
Why are physiotherapists interested in mobile practice?
Providing physiotherapy services in the patient’s home can also benefit the physiotherapist. Some examples are:
The opportunity to manage their own practice, schedule and business.
The potential to decrease business overhead and operating costs.
The ability to meet the needs of less mobile patients.
The opportunity to meet the patient where they live and observe barriers present and resources available in the home, and to develop real-time strategies to address these issues.
Despite these benefits, mobile practice is not without risks. Physiotherapy Alberta’s Standards of Practice apply regardless of the practice model or practice site and members must ensure they are able to meet these standards. The remainder of this article identifies questions members should consider before starting a mobile practice. By addressing these questions members can ensure compliance with the standards and develop strategies to avoid issues before they occur. Prevention is the best strategy.
While the main focus of this article is on new businesses that are using a mobile practice model of care, owners of businesses considering expanding into this area may also wish to review these questions and suggestions.
What questions should members ask?
What insurance coverage is required? Members should consult with their professional and personal insurance agents to ensure they have sufficient coverage in the event of an adverse situation when providing care in a patient’s home. Does existing professional liability insurance cover this type of practice? What business insurance is required for a mobile or home business? What additional motor vehicle coverage do you need when using your car as a work vehicle?
As with all businesses, Physiotherapy Alberta recommends that members consult their insurance provider, lawyer, and accountant before starting a business to ensure their interests and assets are protected and that tax-related considerations are addressed.
What municipal licenses or fees would your business be subject to? Under the Health Professions Act, no municipality can charge a fee for a business license if you are performing your regulated profession. However, you may need to check zoning requirements to ensure you can operate a business from your home. In some municipalities the answer will depend on whether you have customers coming to your home business or not. As you set up your business and contact your municipality, you will want to consider this question. Will you always go to your patients’ homes, or will some patients come to you?
How will you ensure the privacy of patient records? What policies and procedures need to be developed to ensure patient privacy is protected and your business is compliant with the Personal Information Protection Act (PIPA)? If this is a new business or you are the sole practitioner, you are both the owner and the de facto Privacy Officer as per PIPA. As your organization's Privacy officer, you will be responsible for the appropriate collection, disclosure, retention, and disposal of patient records. Will you be using paper or electronic record keeping? What technical, physical and administrative safeguards must be in place to protect and secure records in your home office, in transit, and in the patient’s home? Physiotherapy Alberta’s Privacy Guide can assist you to answer these questions.
How will you comply with Infection Prevention and Control guidelines? When you are providing services in the patient’s home you will not have control over the physical environment you are working in. The Infection Control Standard or Practice1 includes the expectation that physiotherapists maintain the cleanliness of all spaces, equipment, and devices used during the provision of physiotherapy services. What policies and procedures do you need to employ to ensure that both you and the patient are suitably protected from infectious diseases and hazards?
How will you ensure your personal safety when entering a patient’s home? Do you need to screen prospective patients? How well do you know the patient and the situation you are walking into? Remember that you are entering an environment that you have no control over. You have no idea who else might be in the home or what type of environment you will find. How will you keep yourself safe? Does someone else know where you are and when you enter or leave a patient’s residence? Do you have an action plan to address unexpected safety incidents? How will you access help if needed? You may want to speak to colleagues who work with large home care organizations about the practices they employ for staff safety.
How will you manage critical events? What will you do if a patient falls, suffers a medical emergency, or has an adverse reaction to treatment? If you are alone with the patient, ensure you have access to a cell phone and emergency contact numbers so you can call for help, and that you know the correct address to send help to while in the midst of a stressful situation. If you are concerned about the risks involved with a particular patient, you may wish to have another individual in the home when you are present. The Critical Event Management Plan practice guideline and template will help identify risks and develop strategies to address them.
Finally, what services do you plan to provide? The standards do not prohibit the provision of specific services in the home environment. However, members need to consider the risks associated with treatment interventions and their appropriateness in the home environment. How safe is the intervention and how would you prevent or manage a critical incident? What would a group of your peers consider reasonable? Should some interventions simply not be provided in a patient’s home due to their nature or risks? How would you protect yourself and your patient in the clinic? Can you replicate those strategies in a home environment?
The following resources are available from Physiotherapy Alberta to guide members as they consider any new business venture:
Starting a new business is an exciting and challenging opportunity, and mobile business are no exception. If you have questions about how to meet the standards of practice while offering mobile physiotherapy services, contact the Practice Advisor at 780-702-5390 or by email at firstname.lastname@example.org.
Physiotherapy Alberta (2017). Standards of Practice: Infection Control. Available at https://www.physiotherapyalberta.ca/physiotherapists/resources_to_help_you_meet_practice_standards/infection_prevention_control.
Patient Safety. Every Person. Every Time.
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.