Beyond the Visit: What Makes Home Health Therapists Tick (and Stick)? A Comparative Survey of Operational Factors and Job Satisfaction

Introduction

Rehabilitation services, including physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP), are essential in healthcare to promote healing and restoration of an individual’s function following acute injuries, acute illnesses and acute procedures. ¹ Additionally, these therapies help maximize functional abilities and quality of life for individuals with neurodegenerative conditions such as Parkinson’s disease, dementia, Amyotrophic Lateral Sclerosis (ALS) among others. ² Rehabilitation services are provided across the continuum of care, including inpatient settings, skilled nursing facilities, home health, and outpatient clinics. The scope of responsibilities and patient caseloads for rehabilitation professionals differ based on the clinical setting in which they practice.

In recent years, burnout and turnover rate in the rehabilitation field across different healthcare settings has increased significantly due to higher caseloads, increased productivity demands and overall job dissatisfaction.^3-5 The reason for job dissatisfaction in allied healthcare was attributed to lack of support and professional development opportunities, lack of recognition with often being overlooked and/or undervalued and lack of autonomy. ⁶ An average of 11% turnover rate is reported in the field of PT in healthcare in 2024. ⁷ OT clinicians report the highest percentage of intent to leave the profession. ⁶ Burnout syndrome has also been reported globally in the field of SLP. ⁸ Additionally, reducing insurance reimbursements in the past decade has led to increased frustration in the rehabilitation field. ⁹

In home healthcare, rehabilitation focuses on enhancing a patient’s functional abilities to ensure safe participation in activities of daily living at home. When a patient regains the ability to safely leave their home, they no longer meet homebound criteria, and rehabilitation services are typically transferred to an outpatient setting. ¹⁰ In addition to focusing on patient function, home health rehabilitation clinicians perform responsibilities such as medication reconciliation, monitoring vital signs and coordinating care with physicians. ¹¹ Each discipline within home health rehab is vital in promoting independence, safety and function. Therefore, supporting and retaining rehabilitation clinicians is essential to meet the growing demands of home-based care, especially given that turnover rates in the home health setting have risen by 12% in recent years. ¹²

Home healthcare involves 4 core operational components of scheduling, travel, documentation, and the work environment, which is a patient’s home. In order to understand the benefits and challenges of working in a home health setting, Bhimani and Vora (2025, under review) conducted a study on home health clinicians’ satisfaction levels on 4 operational components with the goal to understand the correlation between the operational components and overall job satisfaction. Our study identified a positive correlation between job satisfaction and 3 operational components of scheduling, travel and environment and a weak correlation of job satisfaction with documentation. It was further identified that clinicians are most satisfied with the scheduling component of home health as it comes with autonomy and flexibility as compared to other healthcare settings. While documentation was the least liked component of this job due to the more intensive, time-consuming and repetitive nature of home health documentation. We noted some differences in satisfaction ratings across different disciplines in this study; however, our scope limited us from exploring the differences in depth.

The present study builds upon our previous work and survey data from the project titled A Multivariate Analysis of Operational Challenges and Job Satisfaction Among Home Health Professionals. Specifically, this analysis focuses on discipline-specific satisfaction levels among home health rehabilitation clinicians, including PTs, OTs, and SLPs. The study aims to compare satisfaction across these disciplines to better understand discipline specific unique benefits and challenges and offering evidence-based recommendations to enhance retention and support for each group.

Methods

The Winchester Medical Center institutional review board approved the study, including the survey and informed consent (IRB approval number: 20250301, MAR 2025). The informed consent was provided for review and approval to each participant prior to completing the survey.

Survey development and piloting: The survey was drafted collaboratively by both authors and reviewed by 2 additional home health clinicians for content relevance and clarity. Feedback from these reviewers was incorporated, and the survey was piloted with 3 clinicians outside the study sample to ensure face validity and refine item wording prior to deployment.

Survey content: The final version included demographic and professional background items (discipline, work location, completion of start of care/OASIS assessment, and mode of documentation). Clinicians were also asked to rate satisfaction on 5 key home health components: scheduling, traveling, work environment (patients’ homes), documentation, and overall job satisfaction. Ratings were completed using a 5-point Likert scale (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied).

Sampling strategy and participants: The survey targeted clinicians with current or former experience in home health practice. Inclusion criteria included being a licensed or credentialed clinician (Registered Nurse [RN], Licensed Practical Nurse [LPN], Physical Therapist [PT], Physical Therapist Assistant [PTA], Occupational Therapist [OT], Certified Occupational Therapy Assistant [COTA], or Speech-Language Pathologist [SLP]) with home health experience. Exclusion criteria included clinicians without home health experience or those not credentialed in one of the listed professions.

Recruitment and dissemination: The survey was created in Microsoft Forms and disseminated through multiple channels to maximize reach, including professional forums and social media groups specific to home health. Distribution channels included the authors’ place of employment, the American Physical Therapy Association (APTA) Home Health newsletter, the American Speech-Language-Hearing Association (ASHA) Special Interest Groups, and the American Occupational Therapy Association (AOTA) forum.

Data collection: Data were collected between March 11, 2025, and April 15, 2025. Completed survey responses were exported into Microsoft Excel for data management, and tables/graphs were generated. Statistical analyses were conducted using Jamovi software.

Appendix: The full survey instrument is included as an Supplemental Appendix to this paper to enhance transparency and replicability.

Data Analysis

Responses provided by PTs, OTs, and SLPs were extracted from the survey. For PT and PTA responses, as well as OT and COTA responses, data were collapsed into single PT and OT categories. This decision was made because assistants and therapists within the same discipline often share overlapping roles and responsibilities in home health practice, and collapsing groups allowed for clearer comparison between the 3 core rehabilitation disciplines while maintaining adequate sample sizes for analysis.

The responses were totaled and converted into percentages to provide an overview of trends across disciplines. These percentages represent descriptive statistics, which were used to summarize satisfaction levels before conducting further inferential tests. Responses were then analyzed to identify similarities and differences among the rehabilitation disciplines.

Quantitative analyses included comparisons between satisfaction levels across the 5 key components. A 1-way Analysis of Variance (ANOVA) was conducted to determine whether a statistically significant difference was present between the 3 disciplines. Further Turkey’s post-hoc analysis was done to determine the differences amongst each discipline.

Results

Over the course of a month and with dissemination of the survey using several platforms including professional forums such as discipline-specific associations, authors place of employment and social media home health groups, responses were received from 179 PT and PTAs, 78 OTs and COTAs and 44 SLPs from the online survey. In addition to discipline, the survey collected limited demographic information to provide context to the sample. Respondents were asked to report their work location to help identify potential trends between urban and rural clinicians, as well as their state of employment. However, most responses provided only broad geographic information (e.g., state-level data), and many did not specify whether they practiced in rural or urban settings. As a result, while our dataset does confirm that participants were drawn from multiple regions within the United States, the level of detail was insufficient to analyze meaningful differences based on geography.

Comparison of Satisfaction Levels on different Home Health components between the 3 Rehabilitation disciplines

The study examined rehabilitation clinicians’ satisfaction scores on 5 key components of home health care. Following is the breakdown of satisfaction levels with each component between PTs, OTs and SLPs.

Scheduling

In this area of the home health care survey, all 3 disciplines—OTs, PTs, and SLPs reported high satisfaction levels. Specifically, 68.2% of SLPs rated this aspect as either “Satisfied” or “Very Satisfied,” followed by 65.4% of OTs and 63.1% of PTs. The satisfaction scores between the 3 disciplines are depicted in the graph below Figure 1.

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Figure 1.

Satisfaction levels for scheduling.

Traveling

This aspect revealed notable differences in satisfaction among the 3 disciplines. PTs reported higher satisfaction, with 68.7% rating it as either “Satisfied” or “Very Satisfied.” In contrast, only 43.6% of OTs and 43.2% of SLPs rated this aspect above neutral, indicating lower satisfaction levels with travel-related experiences in home health care (Figure 2).

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Figure 2.

Satisfaction levels for traveling.

Environment

This component of the survey showed higher satisfaction among OTs, with 68% rating it above neutral (i.e., “Satisfied” or “Very Satisfied”). PTs followed with 63.2%, and 60.4% of SLPs also rated this aspect above neutral. This is portrayed in a graphical form in Figure 3.

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Figure 3.

Satisfaction levels for environment.

Documentation

This component of the survey revealed higher levels of dissatisfaction across all 3 disciplines. Only 38.6% of SLPs rated it above neutral, followed by 35.2% of PTs and just 28.2% of OTs, indicating the lowest satisfaction among OTs. Notably, 42.3% of OTs reported being “Dissatisfied” with this aspect, compared to 26.8% of PTs and 20.5% of SLPs. This is depicted in Figure 4.

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Figure 4.

Satisfaction levels for documentation.

Job Satisfaction

Overall job satisfaction ratings showed minor differences across the 3 disciplines. SLPs reported the highest satisfaction, with 65.9% rating this component above neutral (“Satisfied” or “Very Satisfied”), followed by PTs at 62%. In contrast, only 52.5% of OTs rated their job satisfaction above neutral, indicating comparatively lower satisfaction. Additionally, 29.5% of OTs rated it below neutral (“Dissatisfied” or “Very Dissatisfied”), compared to 17.9% of PTs and 15.9% of SLPs. All the data is portrayed in the graphical form in Figure 5.

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Figure 5.

Satisfaction levels for job satisfaction.

ANOVA Test

The 1-way ANOVA test shows statistically significant differences across disciplines for Traveling (p < .001) and Job satisfaction (p = .001). No significant differences were found for Scheduling, Environment and Documentation as depicted below in Table 1.

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Table 1.

ANOVA Test Results.

One-way ANOVA (Welch’s)
	F	df1	df2	p
Scheduling	1.271	2	119	.284
Traveling	9.6447	2	100	<.001
Environment	0.0183	2	104	.982
Documentation	1.4866	2	103	.231
Job satisfaction	6.5855	2	109	.002

Further post-hoc analysis was performed for Traveling (Table 2) and Job satisfaction (Table 3) to investigate specific group differences.

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Table 2.

Post-Hoc Analysis Traveling.

Tukey post-hoc test – traveling	OT	SLP	PT
OT
Mean difference	—	0.053	−0.526***
p-value	—	0.96	<.001
SLP
Mean difference		—	−0.579**
p-value		—	.003
PT
Mean difference			—
p-value			—

**

p < 0.005. ***p < 0.001.

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Table 3.

Post Hoc-Analysis Job Satisfaction.

Tukey post-hoc test – job satisfaction	OT	SLP	PT
OT
Mean difference	—	−0.615*	−0.514**
p-value	—	0.011	0.002
SLP		—	0.101
Mean difference		—	0.853
p-value
PT
Mean difference			—
p-value			—

*

p < 0.05. **p < 0.005.

Post hoc analysis done for “Traveling” between the 3 disciplines are depicted in Table 2. Mean difference between OT and PT was −0.526 with a p-value of <.001 which is less than .05 showing statistically significant difference between the 2 groups. Whereas PT and SLPs show a mean difference of −0.579 with a p value of .003 showing statistically significant difference. This shows that PT had a statistically higher satisfaction rate for “Traveling” as compared to SLPs and OTs. While no significant difference was found between OTs and SLPs in this area.

The post hoc analysis of “Job satisfaction” as depicted in Table 3. shows OTs to have significantly lower satisfaction as compared to PTs and SLPs. The comparison between OT and SLP shows a mean difference of −0.615 and p value of .011 which is lower than the level of .05 showing statistically significant difference. The difference between OT and PT also shows statistically significant differences having a p value of .002 and mean difference of −.514. No statistically significant difference was found between PTs and SLP.

Discussion

This study explored discipline-specific satisfaction levels among home health rehabilitation clinicians, focusing on 5 operational components: scheduling, travel, work environment, documentation, and overall job satisfaction. Overall, SLPs reported the highest levels of job satisfaction, followed by PTs, while OTs reported the lowest. Scheduling was consistently rated as a strength across all disciplines, whereas documentation emerged as the least satisfying component. Significant differences were observed in travel satisfaction, with PTs reporting higher satisfaction than OTs and SLPs.

Scheduling was rated highly by all the rehabilitation disciplines on the satisfaction scores. This high satisfaction score most likely stems from the flexibility and autonomy that home health offers as compared to other settings. While most of the responses for scheduling were on the positive side of the satisfaction scores, it is crucial to acknowledge the underlying complexities that can impact therapists’ experiences. Factors like route management, triaging cases, patient time expectation, scheduling window and territory coverage all play an important role. These factors, if not effectively managed, can cause hindrance and make it challenging to maintain efficiency, leading to more dissatisfaction. New technologies like route optimization, geographically grouping patients, and correct delegation of cases could offer effective solutions to mitigate these challenges and further enhance scheduling satisfaction. ¹³

Traveling was a component that presented with notable divergence in satisfaction amongst the therapists. While PTs generally reported satisfaction, OTs and SLPs expressed greater dissatisfaction. Statistically, as per the 1 way ANOVA test there was a significant difference observed on this component of the survey. On further analysis using the post-hoc test, we noticed a significant difference (p < .05) in the traveling scores between OTs and SLPs as compared to PTs. The dissatisfaction scores for OTs and SLPs were higher as compared to PTs. This discrepancy likely stems from the larger geographical areas typically assigned to OTs and SLPs, due to the nature and distribution of their caseloads.^4,5 Although reducing travel distances may be challenging in this setting, agencies should consider supportive measures for OTs and SLPs such as mileage bonuses, adjusted productivity benchmarks, and wellness incentives to help offset the burden of long drives.

All 3 disciplines reported overall satisfaction with the work environment, which is a patient’s home in this setting. OTs indicated slightly higher satisfaction in this area compared to PTs and SLPs. This may be attributed to the nature of the OT role, which allows for more functional, hands-on engagement with activities of daily living, often making interventions more meaningful and easier to implement within the patient’s home. While most clinicians reported satisfaction with this aspect of home health care, it is important to recognize that working independently in the field can lead to challenges such as social isolation and safety concerns in certain home environments. To address these issues, agencies should implement proactive strategies, including regular staff gatherings to foster collaboration and connection, as well as thorough screening of patient homes to identify and mitigate potential safety risks.

In contrast to the ratings on the first 3 components, documentation received the lowest satisfaction ratings among all 3 disciplines. While documentation is often the least preferred aspect of patient care in many settings, home health introduces additional challenges. Clinicians are required to complete not only visit notes, but also multiple communication notes related to scheduling, interdisciplinary collaboration, physician collaboration, among others, largely due to the independent nature of fieldwork in this setting. Therefore, integrating artificial intelligence tools, such as speech-to-text technology, into the documentation process may help improve efficiency and ease, reducing the administrative burden on clinicians and enhancing overall job satisfaction. Implementing Artificial Intelligence (AI) in documentation has become popular and has shown to be as effective as compared to a clinician’s documentation. ¹⁴ Technologies like Ambient AI, where spoken word can be converted into script using machine learning technologies and large language models (LLM) like ChatGPT which helps in generating human-like text responses have been implemented widely in clinical documentation with greater success recently.^14,15

Finally, SLPs reported the highest overall job satisfaction within the home health setting, followed by PTs, while OTs reported the lowest satisfaction in comparison to the other 2 disciplines. This reporting was supported by statistics, on a post-hoc analysis as we concluded a statistically significant value (p < .005) for OTs as compared to SLPs and PTs. The reasoning for this remains to be studied further but the fact that only 8% of the OTs in the United States of America work in home healthcare settings, ¹⁶ likely contributes to increased driving time and workload. It further correlates with our earlier findings of OTs rating poorly on the travel satisfaction scores.

Significance and Practical Implications

This work contributes to the limited body of literature on discipline-specific experiences of home health rehabilitation clinicians. By identifying both shared challenges (e.g., documentation burden) and discipline-specific differences (e.g., travel satisfaction), our findings highlight areas where targeted organizational strategies could improve clinician well-being, retention, and ultimately patient care.

From a practical standpoint, agencies should prioritize:

Ultimately, understanding operational factors that shape clinician satisfaction is critical for addressing high turnover in the home health workforce. Our findings provide evidence to guide recruitment and retention strategies, while also identifying opportunities for future research into workforce optimization in this essential area of care.

Limitations and Scope for Further Studies

This study included quantitative analysis of the key factors identified in job satisfaction of rehabilitation clinicians in the home health setting. While differences were noted in traveling and overall job satisfaction among the 3 disciplines, a qualitative analysis explaining particular reasons regarding the rationale for the satisfaction ratings will provide a more in-depth insight into clinicians perceptions and thus offer a richer understanding that could inform targeted marketing and retention strategies for home health agencies. Additionally, further analysis of traveling scores amongst clinicians living in urban versus rural areas will give us better insight on how the satisfaction scores vary based on geographical location.

Conclusion

This study presents findings from rehabilitation clinicians regarding their satisfaction with key aspects of the home health setting. Results indicated that physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) reported similar satisfaction levels across domains such as job satisfaction, work environment, and documentation. However, statistically significant differences emerged in the areas of travel-related demands and overall job satisfaction. OTs and SLPs rated traveling less favorably than PTs, while OTs reported lower overall job satisfaction compared to both PTs and SLPs. Based on these findings, we offer recommendations for improving home health operations and propose discipline-specific strategies for recruitment and retention.

Supplemental Material