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Challenges of Providing Home Health Care Services

Leandre Gerwin, MA, CCC-SLP, Kirsten Keppner, MS, CCC-SLP, Katie Mikkilineni, MS, CCC-SLP

November 15, 2016



What are some challenges of providing home health care services to the pediatric population?


Some of the challenges that occur with home health care services are similar to what is seen in other settings:

Scheduling, for example, is very challenging because the children who are receiving home health care are very medically complex.  They may have up to five disciplines or clinics following them when they are initially discharged from the hospital.  They may be getting monthly follow ups from OT, PT, speech and early intervention services.  Some of these children, depending on the medication they are taking or the strict feeding schedule they are on, may only be available at certain times of the day. 

Hospitalization and acute illness are also challenges.  These children are seen at home because they are typically very sick. If they are hospitalized then they don’t receive our services. 

There may be a need for an escort.  If you are seeing a child in a high crime area you may need an escort to go with you.  That is the policy in some hospitals.  Escorts may only be available at certain times of the day. Again, this can make scheduling a particular patient very difficult. 

The environment can be very challenging.  Some children may have more than one address.  The child may be at their mother’s house one day and at their father’s house on another day.  Perhaps they stay with a grandparent.  Environment and social situations can really impact home care services.

Finally, there are non-compliance challenges.  Similar to other setting, sometimes there are parents who are not on board with the therapy plan.  They may not see the importance of our services and simply will not agree to intervention.  

leandre gerwin

Leandre Gerwin, MA, CCC-SLP

Leandre Gerwin is a graduate of the University of Cincinnati and has been a practicing Speech Language Pathologist at Cincinnati Children’s Hospital Medical Center for 17 years. During that time she has served medically fragile children, treating both oral motor feeding and language disorders through Home Health Care, the Neonatal Follow up Clinic and the Eosinophilic Disorders Clinic. She is the liaison for the Speech Pathology Department to Home Care for Cincinnati Children’s Hospital Medical Center and has presented at ASHA on the topic of creating and maintaining a successful Speech Therapy service program for Home Care patients.

kirsten keppner

Kirsten Keppner, MS, CCC-SLP

Kirsten Keppner is a graduate of the University of Wisconsin and has been working as a Speech Language Pathologist at Cincinnati Children’s Hospital Medical Center for 10 years.  She currently works as a home health care therapist and an inpatient therapist on the oncology/hematology unit and bone marrow transplant unit. She treats patients with a variety of feeding and language disorders and performs video swallow studies.  She has presented at ASHA on providing services to children undergoing bone marrow transplant and on Home Care speech therapy services. 

katie mikkilineni

Katie Mikkilineni, MS, CCC-SLP

Katie Mikkilineni is a graduate of Miami University has been working as a Speech-Language Pathologist at Cincinnati Children’s Hospital Medical Center for 8 years. She is currently at the Drake Campus and Home Health Care. Her area of interest and expertise is working with children and families impacted by apraxia, autism, speech and language disorders, and dysphagia. Katie has been with the Division of Speech Pathology for 8 years.

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