Home Health & Hospice

How often and how many goals should therapists have?

Homecare Insider, October 5, 2015

Discussion of therapy goals often includes debate around two specific issues regarding the number of goals that should be in a plan of care and the frequency at which these goals should be addressed in subsequent visits. There is currently no regulation that dictates a minimum or maximum number of therapy goals. Some of the documentation tools, both paper and electronic, provide a long list of possible goals that a therapist can choose from. This can inadvertently trigger more goals than are actually necessary and the idea that there “has to be” a goal for areas such as strength, range of motion, and balance in every care plan. Solid therapy goals reflect a level of focus on issues specific to the given patient and must be driven by functional relevance. It would be better to have two or three well-constructed goal statements than a list of 10 that are incomplete or fundamentally irrelevant to the patient.

The frequency at which each goal is addressed has once again been influenced in part by documentation tools available to the home health industry. Regulations that set standards for this do not exist, as the plan of care should move forward based on the patient’s needs and changes in condition and functional ability. Every goal does not have to be addressed on every visit. Think of it this way: We all had to crawl before we could walk. There will be things that need to be worked on earlier in the course of care in order to progress to other activities. Ultimately, the documentation has to support “goals met” at the time of discharge or explain why one or more goals were “not met.” The strategy to address every goal on every visit to ensure something is not missed along the way can lead to very repetitive documentation and undermine the ability to clearly show how the patient is benefitting from the skilled care being provided.