How to Choose a Home Physiotherapy Provider: 11 Criteria You Can Check Yourself

When arranging home physiotherapy for a family member, the first question is often which provider is better, followed straight away by how much each session costs. But once the quotations of three or four providers are laid side by side, the fees turn out to be similar, and there is no way to tell what difference in service an extra hundred dollars or so is supposed to buy.

The 11 criteria below have one thing in common. A family can ask about them before deciding to use a provider, and the provider's answers can be checked objectively, so there is no need to go by instinct or to trust a claim to be “experienced”. Two of the criteria are set out explicitly in the Code of Practice for Registered Physiotherapists issued by the Physiotherapists Board.

1. Is the therapist full-time or part-time?

This is the point that the fewest families ask about, but it explains the gaps in service best. Full-time and part-time models each have advantages and disadvantages, and neither is necessarily better.

In other words, employing part-time therapists is not itself a problem. The problem is relying entirely on part-time staff without supervision. A safer approach is to ask the provider directly: is the visiting therapist a full-time employee of your company? If the therapist is part-time, who reviews the clinical assessment and treatment plan?

2. Does the provider employ therapists directly, or subcontract?

Of the three employment models in home physiotherapy, layer upon layer of subcontracting (known colloquially as passing on a subcontract again and again) is the only one that does the patient harm without any benefit. Full-time and part-time each involve trade-offs, but the subcontracting model has nothing to recommend it.

The difference does not lie in subcontracted therapists being of poorer quality, because the person taking the case can equally be an experienced registered therapist. The real difference is who bears the cost if something goes wrong when no employment relationship exists. Some providers have no standing team of therapists of their own and look for staff outside only after receiving an enquiry. If an older person falls during training, or a family complains of improper treatment, the provider will present itself as a middleman and not as the employer, and where responsibility lies becomes unclear.

The other cost shows up in the fee. Between the fee the family pays and the payment the therapist actually receives, there are often several layers of commission. What gets squeezed is not the middleman's profit but the effort and time the therapist is willing to give at the patient's home. Unpaid work such as writing the case notes, reviewing progress and explaining the condition to the family is often the first to be dropped once pay is cut.

When asking about the employment model, you must therefore ask plainly and never accept a vague answer: is the visiting therapist an employee of your company, or a subcontracted partner? If the other side avoids the employment relationship with terms such as “partner therapist”, “medical network” or “assigned as appropriate”, the answer is already clear.

3. How does the provider recruit therapists?

A way of working does exist in the industry in which a provider sends the case details to therapists' WhatsApp groups, and whoever is willing to take the case at the lowest price gets it. Under this system what the provider is screening for is price and not talent, and the person finally sent to the home may be whoever is least busy that day and not whoever suits the patient best.

A proper provider will have clear recruitment criteria, including a qualification threshold, an interview process, an assessment during a probation period and internal supervision arrangements. There is no need to press hard when enquiring. Whether the other side can state its recruitment standards specifically is enough to tell the difference.

4. Is every session handled by the same therapist?

Progress in rehabilitation takes time to build up. A therapist remembers which knee hurt more last time, knows which words encourage an older person to stand, and is clear about the height of the thresholds at home. These details are hard to put down in full in a case record. Changing staff often means starting again from zero in every session, and an older person's patience often cannot stand being put through this repeatedly.

When enquiring, it is worth asking more specifically: can you guarantee that every session is handled by the same therapist? If that therapist is on leave or leaves the company, how is the case handed over to the person taking over? A bare reply of “we will try to arrange it” and a clear account of the handover procedure are two quite different things.

5. Can an assistant properly follow up the exercise prescription from the therapist?

Many providers first have a physiotherapist assess and draw up a plan, and then send a physiotherapy assistant to the home to carry on the regular training. There is nothing wrong with this division of work in itself, and the fee is also more affordable. The condition is that there is a tight handover between the two: the assistant must be clear about the purpose of each set of movements, the number of repetitions, and in what situations they must stop at once and report to the therapist.

It follows that the key is not whether an assistant will be sent to the home. It is whether the therapist really carries out the duty of supervision. Families can ask the provider how often the therapist reassesses the patient, and what the reporting system is if the assistant finds that the older person cannot complete a movement.

6. Are written treatment records kept?

Item 2 of Appendix I of the Physiotherapists Board's Code of Practice for Registered Physiotherapists lists “failing to carry out adequate assessment, planning, implementation and supervision, and failing to keep adequate case records” as an example of neglect of professional responsibility to patients. In other words, case records in home physiotherapy are not an add-on at extra cost. They are a basic requirement of professional conduct.

For the family, treatment records have three practical uses: to check clearly the training completed in each session, to compare recovery progress objectively, and to have a formal document for handover at a follow-up appointment or when being referred to other allied health services. When enquiring, you can ask directly: is there a written record after each session? Can the family read it?

7. Is the provider willing to give the therapist's professional qualifications?

Physiotherapists in Hong Kong are regulated under the Supplementary Medical Professions Ordinance (Cap. 359), and the Physiotherapists Board keeps a list of registered persons for public inspection. So confirming whether someone is a registered therapist never needs to rest on simply trusting a word. Families can check it themselves.

Three steps to check a visiting therapist:

• First ask for the name and registration number—This should be asked before deciding to use the service, and not left until the therapist is at the door ringing the bell. A proper provider does not mind giving this information.
• Check against the Board's list yourself—The Physiotherapists Board's website has a list of registered persons, and members of the public can go online to check a therapist's name and registration status.
• Then look at the qualifications themselves—Professional qualifications include the institution graduated from, years of clinical experience and which kinds of condition the therapist is good at treating. A provider willing to make its therapists' backgrounds public is usually not afraid of families comparing different providers.

When booking a service, families have the right to ask at the enquiry stage for the name and registration number of the visiting therapist.

8. Can the provider share earlier cases of the same kind?

For reasons of patient privacy, a provider will not, and should not, make patients' names and photos public. But a provider with real hands-on experience should be able to describe past cases specifically: which kind of condition was handled, what obstacle was met, how long the training lasted, and how the patient's mobility finally changed. A provider that can give a clear account of the actual difficulties and limitations usually does have clinical experience. A provider that can only answer in general terms that “there are many successful cases” often cannot stand up to further questions.

9. What qualifications do the staff who answer enquiries and follow up cases have?

Many providers have ordinary customer service staff deal with enquiries, record the condition, give quotes and arrange times. The problem is that judging how serious a condition is, suggesting the hours for each session, and deciding whether to begin with a full assessment or arrange an assistant to follow up directly all involve clinical professional judgement. If these are handled by customer service staff with no medical background, mismatches are quite concrete: underestimating the hours needed, matching the wrong specialty, and not finding the problem until the therapist arrives at the door.

When enquiring, it is therefore worth asking one more question: is the person who answers enquiries and matches staff a physiotherapist? At Nova Health, all WhatsApp enquiries are answered in rotation by full-time registered physiotherapists, so that matching of staff and suggestions on hours are checked by a therapist in person from the enquiry stage, and are never left to sales staff or outsourced customer service.

10. Can the training equipment be brought to the home?

The core of home treatment is clinical assessment and exercise prescription, and equipment is only a supplement. Whether it can play that supporting role depends on whether the equipment can be carried upstairs without trouble. Many families in Hong Kong live in public housing flats or old tenement buildings, where a chair and a floor mat in the living room are already about the limit, and large rehabilitation machines are simply not practical. The equipment that really suits the home mainly includes the following types.

Put the other way round, if the whole session only connects the patient to a device while they lie down, and the therapist looks at a phone throughout, this cannot be called home physiotherapy, and at most it is a visit to switch on a machine. Where larger equipment needs to be rented (for example a post-operative cold therapy machine), it should be part of the overall treatment plan and not simply a selling point. The GameReady cold therapy machine rentaloffered on this site is used together with exercise training at the patient's stage of post-operative rehabilitation.

11. How can you observe the therapist's communication with the older person?

This is the hardest point to judge before booking, but it directly affects the result of rehabilitation the most. The biggest difference between home treatment and going to a clinic is that, at home, the older person does not go along with things just because the surroundings are unfamiliar. An older person who does not want to move simply does not want to move. This is especially so for patients who have had a stroke or have dementia, where how to bring out their motivation to train is itself a key part of the treatment.

At the first assessment, families can watch a few things closely: does the therapist speak to the family or communicate directly with the older person? Does the therapist use language the older person can understand to explain why a set of exercises is being done? When the older person cannot manage, does the therapist adapt and guide in another way, or just push? Professional qualifications can be checked from a curriculum vitae, but communication skills have to be observed in person in the first session. The first assessment is therefore both the therapist's chance to examine the patient and the family's chance to judge whether the therapist is up to the job.

Checklist of questions to ask

When should a therapist be arranged to visit for an assessment?

If a family member's fitness has clearly declined after leaving hospital, walking has started to become unsteady, there has been a fall, or it has been a good while since a formal assessment of physical function, do not wait for the situation to get a little worse before deciding. The registered physiotherapists of Nova Health provide home physiotherapy and can visit the home to assess the patient's mobility, fall risk and home environment, and then draw up a rehabilitation plan that can be kept up. The hours of service needed and the home physiotherapy fees are suggested after the first assessment according to actual need, and a whole course of treatment is never required before the condition is understood. To learn about the team structure and how therapists are matched, see the introduction to the service team and how matching works.