When does occupational therapy come to your home?
It comes to you when the way to the practice cannot reasonably be expected of you, or when the goal of therapy can only be reached in your own flat. Your doctor has to judge that. There is no legal list of conditions for a home visit; the medical reason decides.
The federal ordinance on benefits describes in article 6 what occupational therapy is for: in physical illness it is to contribute, through improving functions, to independence in the tasks of daily life, or it runs within a psychiatric treatment. About the place of treatment it says nothing. The place is settled on the prescription form and has to be defensible on medical grounds.
In practice the reasons almost always come down to two patterns. Either somebody can no longer get away from home, or the therapeutic goal can only be reached in the domestic setting.
- The way falls away: after an operation, with marked unsteadiness, with dizziness, with a need for oxygen, or when nobody can drive.
- The goal exists only at home: the question is whether showering alone works again, or whether the walking frame fits through the corridor.
- The move after hospital: the first weeks at home often decide whether somebody can stay there.
Anyone who walks well and has a clear problem at the hand is usually better off in the practice; the home visit is meant for questions that can only be answered on the spot.
What has to be on the prescription for treatment at home?
The Swiss-wide prescription form has the field place of treatment with three possibilities: in the practice, at home or in an institution. For treatment at home, at home has to be ticked. Diagnosis, treatment goal, number of series and the stamp and signature of the prescribing doctor belong with it.
The insurers expect the standard form. It is to be filled in by the doctor, not by the therapy practice and not by you. These fields decide whether treatment at home can be billed at all:
- Place of treatment: the tick at “at home”. If it is missing, the prescription counts as treatment in the practice, and the travel costs of the home visit cannot be billed.
- Diagnosis or reason for treatment: compulsory under the tariff agreements.
- Goal of the treatment: either improving and maintaining physical functions as a contribution to independence in daily life, or relieving a mental illness within a psychiatric treatment. The wording comes from the ordinance itself.
- Scope: one series of treatment or several. Alternatively a pure assessment over two sessions, if only the situation at home is to be judged.
- Cause: illness, accident or birth defect. Who pays depends on it.
Details for which the form has no field of its own, such as precautions or limits on load after an operation, belong in a separate note to the therapy practice. If you are unsure whether everything has been filled in, you can show us the prescription beforehand; we contact your doctor before an appointment is lost. The way to do that is under contact.
Who pays for occupational therapy at home?
It is a benefit of the insurer that is responsible as soon as a doctor has prescribed it. Per series the prescription covers at most nine sessions, and the first has to take place within eight weeks. Deductible and retention fee run as with any other treatment. Advice on the living situation belongs to the treatment.
In insurance terms the home visit is not a form of therapy of its own, but the same occupational therapy in a different place. The same time limits therefore apply as in the practice:
- Per series, that is per medical prescription, the insurer covers the cost of at most nine sessions; the form may provide for several series.
- The first treatment has to take place within eight weeks of the order. In physiotherapy it is five weeks, which is often confused.
- For further sessions a new prescription is needed each time.
- If the therapy is to go beyond a treatment of thirty-six sessions, the prescribing doctor reports to the insurer’s medical adviser and gives reasons for continuing.
About amounts we deliberately say nothing here. How high your deductible (Franchise) is, how much of the retention fee (Selbstbehalt) is still open this year and how your insurer handles the travel cost of a home visit is reliably known only to your health insurer. Ask there before the first bill arrives.
For whom does treatment at home make sense?
It comes into question above all after a stay in hospital or a clinic, with neurological illness such as a stroke, with progressive loss of strength in later life, and for people who barely leave their flat. A hand injury too can be treated at home if somebody cannot get about.
The question is rarely which diagnosis somebody has, but where the ability to act breaks off. Four situations come up again and again:
- After a stroke: the arm works better in therapy than at breakfast. What was practised in neurology has to find its way into daily life.
- In later life: walking and getting about in general become harder. The subject in care of older people is then safety in your own home, not an exercise at a table.
- After discharge: the clinic practised the transfer, but at your own bed everything is at a different height and everything is narrower.
- With mental illness: daily structure and household are hard to discuss and easy to tackle on the spot. The condition is that the therapy runs within a psychiatric treatment.
Often the home visit is a stage and not a permanent arrangement. As soon as the way is manageable again, treatment moves into the practice, where more material and more ways of measuring are available.
What can an assessment at home do that the practice cannot?
In an assessment at home the therapist sees how high your bed really stands, where the rug slips and how narrow the way to the toilet is at night. Those details cannot be asked for in the practice. Out of the assessment come concrete proposals, a grab rail or a different seat height.
An assessment at home is not a tour with a checklist. It starts from what you actually do in the course of a day, and looks at where the surroundings get in the way.
- We ask which actions are difficult at the moment or cause fear.
- You show these actions as well as you can: standing up, or stepping into the shower.
- We measure and note what makes the action harder: heights, widths, thresholds, handles, light, floor coverings.
- We propose adaptations and try out what works immediately, a different way of doing it or a changed seat height.
- Whatever needs an assistive device or a structural change we record in writing, with a note on who is responsible for it.
There is usable research on the effect of such assessments, and it is more differentiated than leaflets often suggest. Systematic reviews show a marked reduction in the rate of falls in people at high risk of falling, when the assessment is carried out by an occupational therapist and the adaptations are actually made. In older people without raised risk the effect is small and uncertain. An assessment at home as a precaution for everybody cannot be justified with that; one after falls or with marked unsteadiness certainly can.
Why does everyday training work differently in your own kitchen?
Anyone who practises dressing at their own bedside does not have to transfer what they learned afterwards. That transfer is exactly what fails for many people after a stroke or with dementia. At home the cooking is done with your own pans and the practice happens on your own stairs.
In the practice we work with standard material at a standard height. That is enough for strength, mobility and fine motor skills. It is not enough when somebody can only put an action together with many prompts. Then success hangs on details: on the order in which things lie in the cupboard, or on that one step in front of the shower tray.
- Devices are tried out where they will later stand. A shower stool that fits in the catalogue can be unusable in a narrow cubicle.
- Relatives are there and learn along. What they should take over and what they should leave alone is settled best in the situation itself.
- Where home care services, relatives and therapy work together, arrangements can be made directly on the spot.
Where does occupational therapy at home reach its limits?
In the practice a workbench and material for splints stand ready, in a flat they do not. Some findings and certain measures, such as making a hand splint, need that equipment. Travel time also limits how many home visits fit into a day, so the radius of a practice is always restricted.
We drive out from Thalwil to Oberrieden, Horgen, Rüschlikon, Kilchberg, Gattikon, Adliswil and Langnau am Albis. Longer distances would unfortunately exceed our capacity. If you live outside that area we say so openly and help you look for a practice that drives closer to you.
The second limit runs at the money, and it surprises many people. The treatment is covered by the insurer that is responsible; the structural consequences are not.
- A stairlift, a ramp or a rebuilt bathroom are not a benefit of the insurer. For people of working age invalidity insurance may come into question depending on the situation; at pension age other and narrower rules apply.
- The assessment and the advice about it are occupational therapy and can therefore be prescribed. Financing the measure itself is a separate route, which we set out with you but cannot take off your hands.
- Occupational therapy also replaces neither nursing care nor help in the household. Where support in daily life is needed permanently, other services are required.
The third limit is the diagnosis. It is always made by your doctor, never by the therapy. We observe, measure, report back and propose. The medical interpretation is then to be discussed with the doctor responsible. You can ask for an appointment for a first conversation through book an appointment, even before the prescription is there.