home health as a new grad ot

Home Health as a New OT Grad: Should You Do It?

Home health as a new grad occupational therapist: Should you do it?

I first published this article with the answer to this question wayyy back in 2016 (my, how time flies) and I still haven’t changed my stance on the issue. 

While there is always a great need for quality home health therapists, since more and more patients are getting pushed from the hospital straight to home instead of rehab, I will still tell you that this OT setting isn’t the best choice for new graduates.

Why I Don’t Recommend Home Health as a New Grad

Home health occupational therapists are amazing and so many of my acute care patients benefit greatly from home health services once they leave the hospital. Personally, my mom got discharged home way too soon from rehab (after only one day due to insurance issues!) after breaking her hip, and her home health OT was truly a godsend while I was still out of state.

I absolutely don’t want to discount the benefits home health occupational therapists provide their patients, but as a new grad, it’s still the one setting I don’t recommend.

Here’s why…

Mentorship as a new OT or COTA is SO important for growth as a therapist. When you’re practicing in home health, you really lose out on that crucial mentorship that new grads need their first year.

When you’re around other therapists every day, you learn new ideas and can expand your toolbox. You also aren’t totally alone if your patient becomes unstable or if you’re in a bind due to a fall or any other issues. 

home health new grad mentorship

Some home health companies may provide you with some mentorship off the clock, but finding true mentorship in this setting is hard to come by. Even if you have a mentor you can call in the evenings, it benefits you more to be practicing around other therapists during the day as well.

“But I Heard Home Health Pays the Best!”

According to BLS data, home health practitioners make an average of $105,700 per year (for full-time therapists!). This can be well over $10,000 more per year than other OT settings.

Choosing the highest paying job may be a tempting choice when you’re strapped with student loans, but know that you can always transition to this setting once you’ve gotten a few years of experience in places like hospitals, rehab, or an outpatient setting, as examples.

I’ve heard many therapists tell me that it’s harder to go from home health to another rehab setting after doing home health for a few years. Therapists say that they feel embarrassed asking questions to other rehab OTs after coming from working in the home health setting for a few years; they feel like the questions they have are for things they should already know from experience.

It isn’t their fault, they just didn’t get to be around other OTs to learn a lot of the essentials. If this is your situation, please never be embarrassed to ask questions!

So When Should You Start Your Home Health Career?

I recommend waiting to become a home health occupational therapist after getting at least 1 year of other OT experience after fieldwork.

You’ll have more of an understanding of occupational therapy interventions, medical conditions, transfer techniques, and everything in between. With that experience, you will feel much more prepared than if you started fresh out of fieldwork. 

A Few Other Things

Other things to keep in mind even as a seasoned OT interested in home health is that you will more than likely get paid per visit, not hourly. You likely will not get paid for drive time.

If your client doesn’t come to the door, cancels last minute or refuses, you’re usually out of luck for getting paid for not only that visit but the time you spent driving to and from.

In addition, there will be a hefty amount of paperwork per visit with its own set of rules and regulations. There is a combined stress that comes from being a new grad in a new environment and having to figure out the extensive paperwork on top of it. Keep in mind, you don’t get paid for extra documentation time.

home health as new grad

Notes can take 2-3x as long to complete than in an inpatient or outpatient setting. Adding in extensive drive time to different counties with the increased paperwork (and minimal experience) can be a recipe for burnout.

Save Home Health for Later if Possible

This article isn’t meant to discourage you from ever going into home health OT. 

It’s certainly different from working in a hospital or outpatient setting, but certainly home health is not a “bad” setting! Several of my PRN coworkers that work in home health as well love it for the flexibility and true occupation-based nature of working in patients’ natural environments. 

But save home health for when you’re ready! Get a bit of experience under your belt. There will always be jobs in home health, especially with the continuous Medicare changes and the constant push for home health instead of rehab.


What are your thoughts about new occupational therapy grads working in home health for their first job? Have you started out in home health yourself? We’d love to hear about your experiences and advice in the comments below!

This post was originally published on May 1, 2016 and last updated on October 27, 2023.

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  • Nancy Olson November 16, 2016   Reply →

    I am a newly graduated COTA. I am considering HHC as I am finding the heavy push for productivity numbers at the expense of good, quality patient care to be daunting. I hate that the patients represent numbers only and you have to indulge in productivity protection activities. I hate to be clock watching every second, afraid I will get chastised, or worse, fired if those all important numbers are not met. I did my FWII at a home care agency so I have an idea what that is like. I think if I get a chance to be hired on to one I will take the chance that I will like it better than the numbers driven SNF.

    • Sarah Stromsdorfer, OTR/L November 16, 2016   Reply →

      I totally understand the stress that you feel in the SNF setting. Since you’ve done your Level II in home health, you’ll definitely have an advantage over someone like me who would have felt totally lost in it as a new grad. I hope you’re able to do whatever works best for your situation with the least amount of stress 🙂 If you do go the home health route, this post might also be helpful: https://www.myotspot.com/home-health-occupational-therapy-must-haves/

  • Diane July 28, 2017   Reply →

    I just hit the 6 month mark as a new grad COTA working in home health. It has been very challenging but not impossible and honestly may have ruined me for any other setting. I do wish I had more people to talk to and get mentorship from but have adapted by taking the opportunity for continuing ed, talking to OTs other staff etc. I am trying to get better about picking up the phone and just talking to other team members as well . You cant be a lone ranger out there. You really have to be accountable, self starter, very flexible, very willing to just get in there and trust your training and learn. I cannot say that my days are predictable or boring and that keeps me going when the going gets tough. Would love to find an online forum of new practitioners in different settings.

    • Sarah Stromsdorfer, OTR/L July 30, 2017   Reply →

      Thank you for sharing, Diane! Being alone at the start of your career might be one of the hardest aspects but I’m glad to hear it’s been manageable for you. I believe there is a specific group on Facebook called “Home Health Occupational Therapy” that may be helpful for you when you feel like you need someone to bounce ideas off of.

  • Lyndsey August 5, 2018   Reply →

    I am a new grad and I have been doing part-time HH for 3 months now, I really enjoy it. Yes, I get the new grad nerves, but I always remind myself that I have a million resources, OT friends to bounce ideas off of, and the determination to learn! It is so flexible and good pay, they also pay for my milage. I had no experience in HH in my level IIs, just outpatient and SNF (which I currently do PRN for both also). Basically, I am a new grad with A HUGE VARIETY of patients, if i do not know something, I find someone who does. I take one day at a time and focus on my clients for that day. You have to have good time management also. Anything is possible! My goal is to do all 3 settings (SNF, HH, outpatient) for one year for experience.

    • Sarah Stromsdorfer, OTR/L August 7, 2018   Reply →

      Thanks so much for sharing your experience, Lindsey! I think it’s great that you’re open to working in those other settings along with home health. You’ll have such an amazing skillset right out of school!

  • Amanda March 14, 2019   Reply →

    Hi! I’m a recent graduate (Dec. 2018) and am considering working home health, even if part time. Just a few days ago I interviewed with a home health care company and they made it seem like I would be able to be in contact with the other OT who currently works full time and manages multiple COTAs. I don’t have experience working with COTAs, but I was a home health aide for over 2 years. I feel like I would be able to transition into the role of a home health OT fairly smoothly since I do have that experience. What are your thoughts about this? Thanks!

    • Sarah Stromsdorfer, OTR/L March 16, 2019   Reply →

      At the end of the day it’s totally up to you but the major disadvantage of home health as a new grad is that since you’re on your own, you’re not really able to build your skillset since you aren’t around other therapists to learn from. You might not get a solid mentorship either since there is only the one other OT who is likely going to be super busy with their own responsibilities managing their caseload and the COTAs. Just something to consider 🙂

  • Jennifer Barnes, OTR/L May 25, 2019   Reply →

    I agree not the best setting for a new grad. I started at a snf and then with the same company also ended up doing a little outpatient, and home health with lots of mentor ship. I Learned a lot and set Me up for great success in home health. I work full time in home health now for the last 5 years and love it. I will probably never leave it. I encourage new grads to really purse continuing Ed in whatever you are passionate about to help if you are on your own as well.

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