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Bringing Back The Home Visit

Photo by Paul Flessland

Imagine you are driving to work one day and suddenly you wake up in the hospital. You don’t remember what happened, but you have a bunch of doctors and nurses in your room and your family is putting their best brave face on for you. You’ve been in a car accident and have sustained a traumatic brain injury.

You go through the traditional inpatient and outpatient therapies and are eager to return to your normal life. As time goes on, though, you try to go back to work and return to meaningful life activities but they just don’t seem to be the same.

Your wife seems to mother you, which does not help you feel like a man, contributing family member or independent. Your children seem to avoid you and pretend they don’t hear your newly odd conversational skills. Work has been more than accommodating and has given you extra time to complete your tasks, but somehow you’re still behind.

You start to feel frustrated, which leads to your friends and family members walking on egg shells, eventually leaving you feeling alone and isolated. To make matters worse, your wife is now “taking the kids to Grandma’s” a little more than you would like…

This is where most folks are at by the time they get sent DeAnna Pinnow’s way. Pinnow is a speech language pathologist and the founder of Fargo-based About You Rehabilitation Services, the only home- and community-based cognitive therapy service in the entire state of North Dakota.

DeAnna Pinnow

DeAnna Pinnow

We spoke with Pinnow to learn more about what exactly that means and why she believes she’s filing a need that’s sorely lacking in the area.

 

Q+A

I’d assume most people are familiar with speech therapy, but what exactly makes your delivery model different?

Pinnow: “My company differs in the fact that it provides consistent home- and community-based therapy, which allows me to utilize real-life scenarios in the client’s environment as therapeutic tasks.

“The biggest cognitivecommunication breakdowns occur in my clients’ environments, and so why not treat them in their natural environment? As a graduate student at Michigan State, I conducted research on the differences between test-subject performance in the clinic versus in their home, and to say there’s a significant difference is an understatement.

“My company also provides communication-partner training, education, and adjustment counseling with family and caregivers. Being in my client’s environment makes them easily accessible, and they can also provide me with insight on their perception of their loved ones’ current level of independence and setbacks.

“We provide a service to families who can sometimes get sent home with little education and training, or they were too emotionally overwhelmed to absorb the information that was provided to them. We basically help individuals rehab at home instead of being sent to a rehabilitation facility or out of state.”

Why’d you decide to start your own practice?
Pinnow: “The reason I opened About You is that there is currently no one else in the state who provides a consistent home- and community-based option. I’m the black sheep of cognitive therapists at the moment. I felt an extreme sense of disservice to the community members who have returned home and their worlds are falling apart.

“The days of house calls have been long gone, however, being at home gives people unlimited possibilities to make gains in things that are most meaningful to them: communicating with their wife and kids, being able to be on time for work or appointments, washing the dishes without using the wrong soap. It’s the subtle things that are tough to catch if you’re not in their environment.

“And so I switched my thinking from ‘Somebody should really do something about that’ to ‘I’m going to be the one who does something about it.’”

Give readers some background on what home and community-based therapy is, exactly.
Pinnow: “I work with the individual and their family to teach strategies for impairments with reasoning, memory, attention, mental flexibility, social communication and perception. I also provide education, training, adjustment counseling to my clients and their entire family. We spend a lot of our time troubleshooting. We evolve their strategies as
their life evolves.

“I also work with their employer, I go to the job site, I observe what they have to do. And then we create all these strategies for that specific task that they’re doing.”

You were first exposed to this approach in Michigan, where you attended grad school and held your first therapy job. Talk about some of the differences between Michigan and North Dakota in terms of cognitive-therapy delivery and billing.

Pinnow: “In Michigan, I loved how they worked with everybody and not just the clients themselves. They drew in the caregivers; they drew in the case managers; they drew in the parents; they drew in the aunts and uncles; they drew in the friends, the boyfriends, the girlfriends; whoever was involved. We really tried to tap into them because we were only there for a certain amount of time. And they’re with that person 24 hours a day.

“Therapy in Michigan is highly competitive, and it’s not uncommon for a therapist or a case manager to get fired off a case. Folks can basically cycle through until they find someone they like.

“Whereas, in North Dakota, you get X amount of visits per year depending on your insurance company and you kind of get who you get. Being picky about your provider or getting a bigger return on your investment to go to therapy, you kind of throw the ball up and hope something sticks. Or you trial a few until you really find one that’s in line with your goals.

“So the learning curve for me was pretty steep, moving back here and getting to know the variety of insurance companies, the benefits that are involved with them, and how many sessions or what amount of services I could give to somebody until they’re cut off.

And at first, I kind of felt a little defeated.

“I was used to unlimited services with these folks, and brain injuries in Michigan and brain
injuries in North Dakota are the same, after all.

“It’s more of an insurance policy issue versus a state issue. I don’t want readers to think North Dakota isn’t trying to provide additional resources for folks. It’s just a work in progress. I’m also sure there are reasonings insurance companies have for the limited sessions they allow per year, but the truth is that they just aren’t enough.

“So anyway, I was thinking about it and thought, ‘How do I make it work if I only get these folks for 30 sessions per year?’ A year is a very long time. I decided I’m going to give my
clients the biggest bang for their buck. I’m going to come to them, and everything will be based off their life.”

How does the cost compare? What’s the catch, as far as how your clients pay for all these extra sessions and more customized care?

Pinnow: “They don’t. That’s the thing. I primarily bill through insurance. If somebody’s wanting to add more sessions and do private pay, we’re going to try to take a look at the treatment plan. Because I want to avoid additional costs for my clients. But we stretch their sessions so they’re longer.

“I see them for about twice as long, and we also eventually decrease the amount of sessions they need each week to try to stretch them to the end of the year.

“So let’s say I start seeing somebody twice a week. Eventually, I would like their family involvement to increase to the point where they don’t need me anymore. The goal is for them to not need me.”

To learn more about brain injuries and an organization helping to increase awareness about them at the state level:

North Dakota Brain Injury
Network

ndbin.org
1-855-866-1884
info@ndbin.org

DeAnna Pinnow, CCC-SLP
Licensed Speech Language
Pathologist
About You Rehabilitation Services
aboutyourehabilitation.com
701-721-9002

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Written by Nate Mickelberg

Nate Mickelberg is the former editor of Fargo INC! He holds his master's in journalism from the Medill School of Journalism at Northwestern University.

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