OT Across America: Kansas City, KS with Ashleigh Heldstab, OTR/L

For our OT Across America: Kansas City, KS edition, we had the pleasure of interviewing Ashleigh Heldstab, OTR/L. Ashleigh is a new grad occupational therapist working in neuro-based home health. We really loved her positivity and passion for the OT profession and we were so inspired by her love for OT and her job.

Be sure to also check her out on Instagram at @bluebird_ot.

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Tell us about yourself and what drew you to occupational therapy.

I have always loved health and wellness. I got my undergraduate degree in community health from University of Kansas in Lawrence, KS. I graduated and went to work for a couple years in a corporate fitness setting. I was in downtown Kansas City in a corporate building that did accounting, and I helped run their fitness center.

It was great and it was semi-fulfilling but I was like “I can do so much more.” These people have a need but they don’t have a need-need. I was kind of doing research trying to figure out what my next steps were. And then my aunt-in-law [who is an OT] entered the family – she’s married to my uncle. She said “I think you might like occupational therapy” and so I shadowed her.

She does do more clinical work and I shadowed a couple other OTs and I was like “Oh my gosh, yes!” And so that’s when I decided to go back to school and I fell in love with it. I have yet to find something I don’t like about occupational therapy. I just graduated in May and I’m loving it.

What setting are you in and how long have you been practicing?

I got to start practicing and I got my license in July. I’m in a home health setting. I work with individuals who have had a traumatic brain injury. I’m really excited because Kansas just changed it so that in the future it’s going to be able to include anybody who has had an acquired brain injury, so it’s not just traumatic.

Now I can work with people who have had a stroke, and now they also are now including children. It’s good they can get those services earlier on.

Where do you practice?

I serve individuals on the Kansas TBI waiver so I work in Kansas City Metro on the Kansas side.

What does your typical day look like?

It’s a slow process when you’re in home health, at least with TBI diagnoses, to build up your caseload. I don’t have a ton of individuals on my caseload right now. I’ve got three right now which takes up about 12-15 hours a week.

Depending on what time I’m meeting with people, I will try and get out the door at 8:00. I’ll try to go to the library or wherever to work on notes or to do research because I’m still trying to get my feet under me. With TBI that can be really hard so I spend a lot of time just thinking “What do I do here?”

I will see people sometimes at 8:00 AM, and I have clients periodically throughout the day. My latest client goes until 5:30, so I’m always done by then. What’s nice is that I live right down the street so I can head right home after. When I’m not seeing clients I’m doing documentation and research.

Do you get your documentation done before a certain time?

Some days are better than others. When I work until 5:30 I just go home and I’m kind of done, and I’ll do it the next day. What’s nice is that I just have to make sure that I get my documentation done regularly. Unlike if you’re in a hospital you have to do it within 24 hours and I’m not bound by that which is nice.

I do SOAP notes for my documentation, we don’t have anything formal right now. I like to be able to really go in there and write and think a lot about it, and so I change it a lot before I submit it. So I kind of really like that I have that opportunity to take my time on it.

What is your productivity like for your setting?

We don’t have any productivity standards, expectations, or anything. I do work for a smaller company, so the owner really wanted to offer more options for individuals who’ve had a TBI and go on to the TBI waiver because prior to this company, they only had two different places they could go to get their services, and so now there are three options.

My boss and the owner of the company basically told me, “When you’ve got all the people that you want just tell me to stop and I’ll find somebody to help out.” My boss is very laid back which is something I’m very thankful for.

It’s also been kind of tough though. I’m the first OT that she hired and I knew going through the program neuro rehab is really the direction I wanted to go. I love it, that’s where I volunteer. I knew that’s where I wanted to go. This opportunity presented itself and I was a little nervous because finding mentors is a lot tougher because I don’t have one built into my setting.

Just having the flexibility that I do and right now I’ve got this time to kind of learn and go along finding the silver lining to not having many clients at the moment has been really helpful.

I’ve just loved it so much, and I’ve been so fortunate.

How many patients do you see in a day right now?

Right now, the most I’ll see in a day is three. So it’s from one to three. My goal is to have three each day. What’s also nice with the TBI waiver is that I get to choose how long I see people each time. So they get a lot more hours than you would see in a school setting. From my understanding, with Medicare home health, it’s more based on “you just get an hour with them.”

Most of my clients I’ll see for 2 to 2.5 hours at a time, which is so great. It’s nice because it means I have less driving that I have to do in a day. So I’ll only see three people where with your traditional home health, you’ll probably be trying to see like five or six in a day. It’s really awesome.

What are the most common diagnoses you see?

Traumatic brain injury is the most common. My patients also have had mental health diagnoses and other developmental diagnoses prior to getting the TBI. I see mostly traumatic and some acquired brain injuries.

What do you like most about your job?

Everything! I really enjoy the flexibility. Getting to work with people in their homes in their community is – you know – the OT dream. And just the people really, I’ve had really great people. My clients so far have been really awesome and kind and open to do whatever, so it’s awesome.

What are the biggest challenges in your job?

The biggest challenge is how long it takes to build a caseload. As I’ve said, I’ve been working there for almost two months now and I’m at three people. So, fortunately for me I am married. I’ve got my husband’s salary that I can rely on to pay the bills and I also teach yoga and I do part-time work for my dad (he owns a business). Fortunately I’ve got these other streams of income to rely on, but that is the hardest part that I’ve only got these three people right now.

And then also being a small company, my employer can’t pay as much as one might get from a more established company per hour. It’s by no means bad. You give and take some. But that would be the downside if I had to find one. Meeting my financial obligations through just this one job is going to take a long time.

What is the job market like for OTs in Kansas City?

I’ve found that it’s been kind of difficult for me, full time especially. I’ve only known maybe two or three people from my class that found full time jobs in the Kansas City area. Otherwise, there’s a lot of PRN positions to apply for, but even that as a new grad has been hard to come by.

If you have more experience, I’m sure that there are a lot more offers and availability. But full time occupational therapy positions just in general in Kansas City are so hard to come by.

Is there anything unique about occupational therapy in your region?

The only thing I can think of is that I know the Kansas government is trying to push through more telehealth because we have people all the way our in western Kansas and there’s not many OTs to service them.

Do you feel like OT is appropriately represented in your setting?

My patients don’t know what occupational therapy is. They have said “What are you doing?” and “What do you do?” Fortunately I have not been called a PT in this setting. I got called that all the time in fieldwork. Or the art teacher. I did a rotation in a psych center, and I got called the art teacher. I was like “You have no idea how bad I am at art, but OK.”

But, the people that I work with are what are called cognitive therapists and behavioral therapists which I had never heard of before, so they actually had to do a lot of advocating to me.

I have found that when we get into our meetings all together I’ve had to step up and say “This is my perspective on the patient, and this is something that we can work on and help with.” I don’t think it’s been awful like I’ve seen in some settings, but I think it’s been a learning experience for everybody.

As much as you’re willing to share, how would you rate the compensation in your area?

I think that it’s comparable to the national average. When I did my informal research, it looks like it runs about to the national average. It’s not a lot more, it’s also not a lot less.

What are your future plans for your career as an OT. Any certifications or another setting?

Definitely! I actually hope to have my own practice one day. I’m really pushing for the telehealth and for the OTs to have direct access, which is being talked about a little bit too. Neuro-rehab is always what I wanted to work with, and it’s still what I want to work with.

I got really lucky being able to work with these individuals right out of the gate. Right now, I’m just trying to learn as much as I can. I’m trying to figure out how the TBI waiver works. Yeah, I want to have my own practice and really focus on the health and wellness aspect.