It’s one in the morning and my eyes are wide open. Random thoughts are running through my head. How will I pay my bills? More importantly, how will I pay my staff? How will our patients receive the care needed during this unprecedented time? During my morning commute, there are no cars on the road. Most businesses are shut down. In my 27 years of owning an outpatient therapy center and as an OT, I have never witnessed such a disaster as COVID-19. 

COVID-19 is making a drastic impact on the entire world at this juncture, including healthcare clinics. Many clinics are being forced to shut down due to state mandates. Some states don’t consider occupational therapy (OT) an essential service in times such as this. As of this writing, the state of Virginia has permitted outpatient therapy clinics to remain open; however, our cancelation rate is at 50%, and our referral patterns are drastically reduced at this point. Because of this impact, I had to lay off four employees last Friday. As a business owner, this is the hardest thing to face. We are doing all that we can to serve our existing staff and patients. We have developed a strict screening process for patients and staff, and we are very diligent with our infection control procedures at this juncture. During times such as these, we must be innovative in order to meet the needs of those we serve.

Supporting OT Patient Progress During COVID-19

Patients can continue with their existing home programs during this time of physical isolation. Teletherapy is a viable option for patients unable to attend therapy clinics. Telehealth platforms enable the clinician to ensure compliance with currently prescribed programs and it creates a venue for patients to communicate with OT’s about their current injury or illness. 

Telehealth Barriers to Overcome During COVID-19

However, there are barriers to consider when implementing telehealth. This may include the lack of internet coverage in rural areas and there may be a reimbursement limitation to consider. Moreover, the OT manager must ensure their liability/malpractice includes a provision for telehealth services. The OT manager must be vigilant in advocating for telehealth services, as we have no way of knowing how long this pandemic will last. 

There are some cases where teletherapy may not be an option, such as wound care, manual procedures, palpation exams, functional capacity evaluations, impairment ratings, dry needling, application of modalities, and any procedures that require our hands to accomplish the outcome. As a clinician, we must consider the limited feedback we receive when we are unable to place our hands on those we are serving. 

Utilizing Collaboration to Ensure Care

During this time, we also must educate family members and caregivers. The caregivers should be kind, supportive, and willing to serve as an OT extender for those who are unable to attend the OT clinic for direct services. Also, during this time, the OT must consider interprofessional collaboration. We must all work together to ensure our patients are receiving adequate care. 

Long-Term Impact on OTs and Next Steps

Over the long haul, this will have a drastic impact on the fiscal soundness of any OT organization. Our offices are triaging patients and remaining open for critical patients. We are limiting the number of patients in the clinic to no more than 10 people at one time. We have closed one clinic two days a week and another clinic has been cut back to four days a week. For patients who are unable to attend the clinics, we offer telehealth services and electronic visits. We are calling patients at home to ensure they have what they need to continue home programs.

Focusing on the Big Picture

As an occupational therapist, one must consider their occupation/purpose. My purpose is to continue the provision of OT long after the COVID-19 pandemic is gone. The way we provide services may look different now, but I am confident we will come through this and will be stronger on the other side. 

Now more than ever, we need to focus on evidence-based practice to provide the necessary care that results in optimal outcomes in the most cost-effective manner. 

Ellen Hudgins OT COVID-19

Author: Ellen Hudgins, OTD, OTR/L, ITOT

Dr. Ellen Hudgins is a graduate of the post-professional Doctor of Occupational Therapy program at Rocky Mountain University of Health Professions (RMUoHP). She currently is the president and co-owner of Progressive Therapy, as well as an Assistant Professor and Elective Track Director for the RMUoHP Doctor of Occupational Therapy program.