Physiotherapy is a healthcare discipline that focuses on treating injuries, illnesses, and disabilities by using a range of physical methods such as exercises and stretches. Home care in physiotherapy involves providing treatment and care to patients in the comfort of their own homes. This type of care is extremely important and can be life-changing for patients who are unable to visit a physiotherapy clinic due to mobility issues, transportation problems, or other reasons.  This mode of care provides a personalized and customized approach to treatment that is tailored to meet the unique needs of each patient. It allows patients to receive treatment in a comfortable and familiar environment, which can reduce stress and anxiety and promote faster healing.

In order to understand the behind the scenes of homecare in physiotherapy, we interviewed one of the most passionate and caring neurological physiotherapist, Dr. Pallavi. She is a remarkable neuro-physiotherapist who has dedicated her life to improving the lives of her patients. She is a true gem in the healthcare industry who has made it her life’s work to provide specialized care to those who need it the most, in the comfort of their own homes.

The interview was designed to help us, the audience understand more about home-based care and what goes on behind the scenes. The interview was very interactive and the contents are as follows – 


Interviewer – “Can you tell us a little bit about your background and what stemmed your interest in the field of neurological physiotherapy?”


Dr. Pallavi – “I graduated my Masters in 2014 and since my third year I was interested in neuro-physiotherapy and wanted to take it up as a career. When we started the third year and started to assess, it just amazed me that, you know, with our therapeutic techniques and exercises, these neuro patients are actually walking and they’re, you know, actually gaining lost function. So I found that very fascinating in my third year, and luckily, I got a great mentor also, my neuro professor, someone who was really passionately teaching neuro to all of us. Neuro-physiotherapy was something that was still evolving, you know, which was still not very popular commercially. Nowadays also if you think physiotherapy then I think sports and ortho are like something which comes to people’s minds first. Even in Mumbai City, which is very urban, people still have no idea what neuro physiotherapy is. So imagine the condition of rural areas. But somehow, that was my interest and I took up the challenge and worked very hard during my masters but obviously, it was a very fruitful journey.”


Interviewer – “What inspired you to concentrate more on homecare? What made it different?”


Dr. Pallavi – “The initial two years I worked at Bombay Hospital were very happy. You can call it a honeymoon phase. I was learning a lot and was very happy. I was not really bothered about the pay and I was more focused on forming professional connections there, which was happening beautifully. I was learning lots of things and made some kickass professional connections like neurologists, surgeons, and intensivists. so many people were, you know, they were like every day, we were in contact and I was really enjoying my work there after two years. Yet somewhere inside me, I felt dissatisfied. I was telling her that maybe I can focus on Bombay Hospitals as a part-time job and can carry out something else meanwhile so that I get more experience. I was bringing in a lot of work in the OPD so she was clearly not very happy about the decision of part-time therapy, but then it was just boiling in my head that I want to do something different. I really didn’t wish to continue working under someone. I wanted something that is more sustainable in terms of finances and something that is more like self-employment where I’m doing something for myself. There is nothing like the feeling of working for yourself and having that entrepreneurial attitude. I think every physio is an entrepreneur and that was stuck in my brain right from the start. I always used to think that we all are entrepreneurs. I think that the entrepreneur attitude was always there in my mind so one fine day, I was not able to take it, the kind of stress I was going through, like the dilemma, was there whether to continue work or not continue. And then I finally resigned and thought it was the right time to jump into home sessions in Mumbai. I think the overall mentality of people in Mumbai is such that they don’t really like going anywhere because of traffic, pollution and so much commute issues. In Mumbai, people prefer home sessions. My exposure was always to the South part of Bombay so I was always involved in the therapy of particular high-class or elite people. When I started getting more and more home visits I thought, why not convert it into a business and make it like a full-fledged full-time? I knew that there are many limitations to being a home care physio, but I thought that there is nothing like being self-employed where you’re working for yourself.


Interviewer – What barriers do you face as a physiotherapist who mainly focuses on homecare?


Dr. Pallavi – The major challenge is the pay is not stable. Some months the money is flowing in and you’re on cloud nine and there are some months typically the holiday months, where the income is low. Also, even the doctors, they take the vacations, right? So the people who are referring cases to you are not admitting new cases. The months of May, December, and January are the typical months where the income drastically is down. During those times I find the need for doing a side hustle like for example telerehabilitation, convincing some of the patients to continue the session even if they are on the holiday. My side hustle is obviously the Good Physioproject where I take my webinars and master classes. So that income also adds up. If you’re considering home-based rehab as a business model or as a career, you can’t just do purely home sessions. Even if you’re doing a job, you can’t be doing only a job, you need to have some side hustle, which will give you some income in case of emergencies. 

The travel and commute are also an issue because some patients, they might need just one consultation but they have to travel a lot and sometimes I have to take an auto or taxi then go to a station and take a train, get down, take another cab or take another auto or bus and then have that one-hour consultation and going back. So I think the commute and the financial instability are the major barriers I personally face.


Interviewer – How do you manage your time when you have to travel and commute so much? How do you formulate protocols and keep track of documentation?


Dr. Pallavi – What I do is when I’m traveling in Bombay since the distance and the travel time is too much, I keep my content creation, my editing, all of that during the traveling hours so if I am in the auto for one hour or one and a half hour at times or in the train, I edit everything on my phone or I carry laptop at times and I do everything during my traveling hours. By the end of the day, I don’t have a load of content creation or my master class. I mostly deal only with Neuro patients when it came to like the home care part. I don’t see ortho patients and haven’t for the past four years. By doing so I have limited the number of patients I see in a day. I choose my patients accordingly. I am at that point in my career where I choose exclusive cases and I treat them only. I make sure that my days are over typically by six o’clock, and I don’t take anything after that. So once I come home, I relax. I have my own time.


Interviewer – What do you find most rewarding about home care?


Dr. Pallavi – Money and finance-wise, homecare is really good because you are seeing the patient and providing them with a tailored plan and hence you can charge more. Apart from that, I think the most rewarding thing is the satisfaction you get as a home care physio because you’re seeing limited patients which results in less burnout. It’s flexible. One day if you’re not feeling too well you can cancel the session and can just maybe have your own time. It’s completely under your own control. Nobody is telling you a protocol to follow. Also, a lot more brainstorming happens in the home care rehabilitation so I think that’s an important point here. Like, less burnout happens. There are pros and cons of everything but feel it’s like 70% you are feeling more rewarded and then 30%, that instability part is there, which I think when you are working under someone, or the ratio is different.


Interviewer – Can you give us a glimpse of what a typical day in your life looks like?


Dr. Pallavi – I start my day depending on my caseload but typically I start by nine o’clock in the morning. I eat my breakfast and if I’m going to see back-to-back patients, then I carry my lunch. So that’s one drawback of being in-home care, you have to plan your day accordingly. So, I usually start by nine in the morning and then I reach the patient, place at 10. I prefer that I see patients within one vicinity at the same time so that I don’t have to travel a lot because Bombay is really bad in terms of traveling. I don’t go beyond certain stations per se because that’s too much for me and even one minute here and there also in Bombay, the entire schedule is ruined. So if I’m, I’m catching a nine or five train every day, I have to catch nine or five trains every day, otherwise, my entire schedule is gone, so I make sure that I make a proper monthly schedule, weekly schedule, and a daily schedule so that I know what patients are going to need today’s session, which patients are going to need thrice a week, twice, a week session. So you need need a good planner for that so then the day becomes easy. I always start my day in a place that is very far from my place because I have the energy to travel and then I end my day around my area so I can quickly come home after my days ended. 


Interviewer – What skills do you think are required to become a great therapist who specializes in home care?


Dr. Palavi – I think not only in-home care, but in general, I think therapists have to be creative. Your creativity is your biggest strength. It can make you completely different from the other therapists who sometimes work like technicians to be very honest. I think that creativity part is very crucial for physio and when it comes to home care, every house is different, and the area is different. Even if the diagnosis remains the same or the clinical picture looks the same, your treatment will change from house to house. The environment of the therapy is different for every individual because we are giving them therapy at their comfort level, which is their home. So, I think the more creativity you use, you can gain better functional outcomes out of your therapy. The most important thing when it comes to home care I think the environmental assessment, which starts on day one. You have to analyze the patient’s surroundings and perform a full home evaluation. You have to keep an eye on every corner which you can utilize for your exercise session. I use my creative skill and I observe the home environment thoroughly, so I think creativity is one area in which the physios are still lacking, they are not using creativity in the sessions. Apart from creativity, time management and professionalism are two other skills a therapist must have to be successful. 


Interviewer – Finally, what advice would you like to give to physios who want to specialize in-home care?


Dr. Pallavi – My first advice to all the physios is when you are deciding that you want to be home care, stop calling yourselves freelancers. We are not freelancers. We are consultant physiotherapists. It is degrading to be recognized or identified as a freelancer. Another thing is you have to make a lot of professional connections, and you have to be shameless. So you have to be stupid, you have to be shameless, you have to go, you have to talk, you have to give your business cards, I carry my business card everywhere. Okay, even in my functions, even if I’m going anywhere I tell them that this is my card. 


When you are considering a home care session, you’re going to someone’s house, right? So you need to look presentable and professional at the same time. Don’t be very shy to tell your charges. Be confident when you’re telling your charge and have one fixed charge for the first session and tell them that my first session is a fixed charge and later on whatever sessions will happen, will depend if it’s a short session or a long session. If you carry yourself with more confidence and professionalism, then the patient is yours, especially the neuro patient because they are going to remain with you for a longer period.


In conclusion, home care physiotherapy is a crucial service that provides personalized and effective care to patients in the comfort of their own homes. While there are certainly pros and cons to every profession, the benefits of home care physiotherapy are clear. It allows patients to receive therapy in a familiar and comfortable environment, and it can help them achieve better outcomes in their recovery. However, it is important to note that being a home care physiotherapist is not without its challenges. It requires patience, empathy, and a deep understanding of the unique needs and circumstances of each patient. It takes a special kind of person to excel in this field, but for those who are up to the challenge, it can be an incredibly rewarding career. Overall, home care physiotherapy plays a vital role in helping patients regain their strength, mobility, and independence. As the demand for this service continues to grow, we must recognize and appreciate the hard work and dedication of the professionals who provide it.


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