The practice of physical therapy is continually evolving to meet the needs of homebound individuals requiring skilled home healthcare (HHC). This is specifically challenging given a history of variation in entry-level academic preparation among physical therapists (PTs) as the profession has evolved from Bachelor's to Doctoral-prepared entry-level clinicians over the past few decades. Additionally, it is notable that provisions for education on HHC documentation requirements, particularly the Outcome and Assessment Information Set (OASIS), are not a required element of entry-level doctor of physical therapy programs. The American Physical Therapy Association (APTA)-Home Health (HH) Section recognizes the potential for knowledge gaps among PTs practicing in the HHC setting and is uniquely positioned to respond to the needs of its membership. The mission of the APTA-HH Section is to provide a means by which "PTs having a common interest in the delivery of physical therapy in the home and other alternative settings within the community may meet, confer, and promote these interests" (HH Section-APTA, 2017).

Robin Childers, CAE, Executive Director of the HH Section-APTA feels the home care section, composed of 2,400 members, is positioned with a voice in both the APTA and the National Association of Homecare and Hospice. This is advantageous in that it offers opportunity for large industry-wide engagement. She states this vantage point has offered section leadership insight into the bubbling questions in the industry about what is being done to prepare PTs to work in HHC. Specifically, what is being done to assure the distinctive challenges of HHC physical therapy are being adequately addressed? This question, in combination with an appreciation on the part of the HHC section to establish minimally expected skills of PTs practicing in the home, birthed the vision for the APTA-HH Section's Advance Competency in Home Health.

"The Advance Competency in Home Health program provides the comprehensive orientation needed to launch more PTs into the home care setting and better prepare these professionals for success" (APTA, n.d.-a). Robin Childers suggested this competency should be considered by PTs new to HHC, PTs already practicing in HHC, and agencies that provide PT to patients and clients in their homes. The competency encompasses a detailed orientation to the practice setting, up-to-date regulatory requirements, and education on evidence-based assessments and best practice models in the HHC practice setting.

William Walsh, PT, MA, MBA, COS-C, GCS, and Chris Childers, PT, MS, GCS, Co-Directors of the Advance Competency in Home Health, have been instrumental in the instructional design and implementation of this specialized program that was slated to "go live" in June 2017. The competency is composed of five online courses totaling 20 hours of foundational instruction and testing, four hours of elective online course work, and 15 hours of in-person skill demonstration, practice, and testing. The Home Health Care Clinical Assessment module emphasizes the Center for Medicare and Medicaid Services Conditions of Participation and OASIS required assessment components. Mr. Walsh states this module emphasizes the cardiopulmonary and musculoskeletal systems as these are drivers of the OASIS assessments and are fundamental to evaluating the whole person. The module titled Medication and Pharmacology for the Home Health Therapist aims to expand beyond medication awareness to include the pharmacologic impact of medications on exercise and exercise dosing. This knowledge is especially valuable to PTs involved in the case management of patients as it is essential in identifying noncongruent medication profiles and medication-related fall risks (Arena et al., 2015). Home Health Regulation and Documentation provides the learner with skills to document with intention toward optimal reimbursement, whereas the module on Ethical Considerations for Physical TherapistsPractice in the Home Health Setting taps into unique issues of the HHC practice setting. Mr. Walsh further confirms topics such as "providing care in a private home, securing medical records in a vehicle, and inappropriate patient requests (e.g. Will you drive me to the store?)" will be among the ethical issues addressed in the module. Chris Childers indicates the Balance and Falls: Factors, Measurements and Interventions for Home Health module was designed in-line with national fall initiatives and evidence. She further states instructional topics are inclusive of valid and reliable outcome measures, home environment, and psychosocial assessment relevant to HHC practice and evidence-based fall prevention intervention including Stopping Elderly Accidents, Deaths, and Injuries (STEADI) and the Otago Exercises. Elective courses are in final development and are anticipated to be available to consumers in early fall, 2017. Elective topics currently in development include neurologic, orthopedic, cognitive and mental health, and incontinence-related conditions, among others. The program Co-Directors encourage section members and PTs participating in the course work to voice ideas for future elective content options. All online learning modules are available at the APTA Learning Center (APTA, n.d.-b) using search terms "Home Health."

Mr. Walsh suggested the in-person content aims to synthesize the didactic materials into real-time application by "showing PTs how to use the skills in a one-hour evaluation and then providing return demonstration." He stated the International Classification of Function, Disability and Health Model will provide a framework for clinical decisions from which clinicians will determine what tests and measures to choose in varied patient scenarios. The first of these in-person courses is tentatively slated for September 23-24, 2017, at Chatham University in Pittsburgh, Pennsylvania, with future preconferences workshop planned at both the 2018 and 2019 APTA-Combined Section Meetings. The Co-Directors envision future options for agencies to host the in-person training course work as a benefit to local PTs in regards to geographical proximity and to agencies as they raise the minimum bar of competency for their staff. A complete breakdown of associated costs for a la carte component parts is available on the HH Section website. The cost for all five online courses (20 hours), elective course work (4 hours), and on-site learning course (15 hours) is $993 for section members, $1,200 for APTA nonsection members, and $1,690 for non-APTA members. Preconsideration of the cost of APTA and HH Section membership would be prudent for individuals considering course participation.

Plans for competency renewal are underway and will likely be required at 5 years to assure PTs are current in both their clinical approach and documentation and regulation requirements. Plans to roll this competency out for physical therapist assistants are forthcoming and while students are welcome to complete the online training modules the in-person education is currently only available to licensed PTs. For complete details or to contact the home health section leadership interested individuals and agencies are encouraged to visit http://www.homehealthsection.org.

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