Home Exercises Between Therapy Visits: An OT's Guide

The physical or occupational therapist comes two or three times a week, maybe less. They work with your parent for an hour or less, leave a sheet of exercises, and say "do these every day." Then the door closes and it's just the two of you.

I'm an occupational therapist. I've been the one leaving that sheet, and I've come back two days later to find it under the mail on the kitchen counter. This guide is for the days in between. Almost all of it is my practice as an OT, not a Medicare rule, and I'll say so as I go. Where Medicare does have a rule, I quote it.

None of this replaces what your parent's therapist tells you. If their advice differs from mine, follow theirs.

Why the Days in Between Matter

Think about the week. The therapist is there for a few hours of it. Your parent is home for all of it. The therapist's job at each visit is to check how things are going, teach the next step, and adjust. The practice that builds strength and balance happens on the other days.

In my experience, the patients who get the most out of home health are the ones who do a little every day, not the ones who work hard on visit days and rest the rest of the week. That's my observation from homes, not a number from a study.

Get the Program on Paper

Memory is not a good place to keep an exercise program, especially after a hospital stay. Ask for it in writing.

Medicare's rules help here. Every Medicare-certified agency must meet a standard on written information. It says: "The HHA must provide the patient and caregiver with a copy of written instructions outlining:" and then lists five things (42 CFR §484.60(e)). Two of them fit exercises:

Treatments its staff will give, "including therapy services" (§484.60(e)(3)).
"Any other pertinent instruction related to the patient's care and treatments that the HHA will provide, specific to the patient's care needs." (§484.60(e)(4))

Be clear on what that means. The rule does not say "an exercise sheet." It requires written instructions about the care the agency gives, including therapy. A written home program is the plain way to meet that for exercises. Ask for it.

Medicare's surveyor guidance adds two things. It says these papers go to the patient "no later than the next visit after the plan of care has been approved by the physician or allowed practitioner," and: "The written information should be updated as the plan of care changes." (State Operations Manual, Appendix B, G612.) That is guidance to the people who inspect agencies, not the rule itself. Still, if the exercises change and the sheet doesn't, ask for a new sheet.

What a good sheet has

This is my checklist, not Medicare's:

A picture or drawing of each exercise. Words alone are easy to misread.
How many. Repetitions, sets, and how long to hold, if there's a hold.
How often. Times a day, and days a week.
Where. Sitting in a chair, standing at the counter, lying on the bed.
When to stop and who to call. With the agency's phone number on the same page.

If anything on the sheet is unclear, ask the therapist to show it again while you watch, then have your parent do it while the therapist watches. That five minutes is worth more than any picture.

Do Only What the Therapist Gave You

The program is built for your parent's body, their surgery or illness, and their balance right now. So:

No exercises from the internet or TV. Even good ones. A move that's fine for most people can be wrong after a hip replacement or a heart problem.
No "more is better." If the sheet says 10, do 10. Extra reps on a tired body is how people get sore, discouraged and off track.
Do it the way they showed you. Same chair, same hand on the counter, same speed. Slow and steady is usually the point.

If a therapy assistant does some of the visits, the same goes for what they show you.

Make It a Routine

Exercises that depend on remembering get skipped. Exercises tied to something that already happens every day get done. My suggestions:

Pick a time and keep it. After breakfast works for a lot of people. Not right after a big meal, not late when they're worn out. If the therapist wrote a best time on the sheet, use it.
Tie it to a habit. After morning pills. Before the TV show they never miss.
Keep a simple log. A calendar on the fridge with a check mark for each day is enough. It also gives the therapist something real to look at.
Set up the spot. A sturdy chair with arms, that doesn't roll or slide. For standing exercises, a kitchen counter or a heavy table to hold on to. Not a chair back that can tip, not a walker unless the therapist said so.
Clear the floor around it. No rugs, cords or pets underfoot.
Dress for it. Loose clothes. Shoes with backs and non-slip soles, or whatever the therapist asked for. Not socks on a smooth floor.
Water nearby. And a phone in reach.

If You're the Helper

Your job is to watch, count, and keep it safe. It isn't to push.

Medicare's rules expect the agency to teach you, too. The coordination-of-care standard tells the agency to "Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care" (42 CFR §484.60(d)(5)). So if you're the one who will be there on the off days, ask to be at a visit, and ask the therapist to show you.

From my practice:

Count out loud. It keeps the pace slow and the number right.
Watch their face and breathing. Holding their breath, wincing, going pale, grabbing for support. Those are reasons to slow down or rest.
For standing exercises, stand close. Ask the therapist where to stand and where to put your hands. Many therapists will show you to stand on your parent's weaker side, but let them show you for your parent.
Don't pull on an arm to help them up. Ask the therapist how to help with standing.
Praise the effort, not the number. Ten slow ones beat fifteen fast ones.

When to Stop and Call

This part is general guidance from my practice, not medical advice. Your parent's therapist or nurse may give you a different list. Use theirs.

Stop the exercise if your parent has:

pain that is sharp, or pain that doesn't ease with rest
dizziness or feeling faint
shortness of breath
new swelling
numbness or tingling
a fall

Have them sit or lie down and rest. Then call the agency, even if it passes. They want to know, and it may change the program.

Call 911 for chest pain, passing out, trouble breathing that doesn't settle when they stop, signs of a stroke, or a fall with a possible broken bone or head injury. Don't call the agency first in an emergency. Call them after.

Whatever happened, tell the therapist at the next visit too.

Bad Days and Missed Days

There will be bad days. A poor night's sleep, a doctor's appointment, a day of feeling low.

A missed day is fine. Pick up the next day with the usual amount. Don't double up to make up for it.
On a tired day, doing part of the program is better than nothing, as long as it's the same exercises, not new ones. Ask the therapist which ones matter most for those days.
If bad days become most days, tell the therapist or nurse. Pain, tiredness and low mood can all be signs something needs a look.

Questions to Ask at the Next Visit

Bring the log, and bring these:

Which exercises matter most if we can only do some?
When do we make it harder, and how will you decide?
Is anything we're doing wrong? Can you watch one now?
Can we do any of these lying in bed, for bad days?
What will the program be after home health ends? Will you give us a final sheet?

If you want the agency's side of how therapists measure progress, our article on the 30-day therapy reassessment rule explains it.

After Home Health Ends

Home health has an end date. The exercises shouldn't.

Medicare's rules build that in. Every plan of care must include "Patient and caregiver education and training to facilitate timely discharge" (42 CFR §484.60(a)(2)(xiii)), and the coordination standard adds: "The HHA must provide training, as necessary, to ensure a timely discharge." (42 CFR §484.60(d)(5)). In plain words, the agency is meant to get you and your parent ready to carry on without it.

My suggestions for the last visits:

Ask for a final program in writing, with what to keep doing and for how long.
Ask what to do when it gets easy. More reps, a harder version, or a stop.
Ask whether your parent needs outpatient therapy next, and who would order it.
Keep the routine. Same time, same chair, same log. The habit you built is the thing that lasts.

Looking Up an Exercise

Sometimes the sheet goes missing, or a drawing is hard to read. We built a free home exercise library with more than 100 exercises a PT or OT commonly gives at home, grouped by position: in a chair, standing at the counter, lying down, and more. Each one has plain step-by-step instructions, and most have a picture. For example: sit to stand, heel raises and ankle pumps.

The library shows how an exercise is done. It doesn't set the numbers. Your parent's therapist sets the reps, sets and times a day, and those come from their sheet, not from us.

If your therapist printed their sheet from our free builder and made a share link, the sheet has a QR code at the bottom that says "Open on your phone." Scan it and the same program opens on your phone, with the pictures and the numbers the therapist set. The link holds the exercises and numbers only, not your parent's name, and it expires after 180 days. If yours has expired, ask the therapist for a new one or for the printed sheet.

Frequently Asked Questions

Does the home health agency have to give us the exercises in writing?

Medicare's rule says the agency must give the patient and caregiver written instructions outlining the treatments its staff will give, including therapy services, and any other pertinent instruction specific to the patient's care needs (42 CFR §484.60(e)). The rule does not name an exercise sheet. Ask the therapist for one anyway. In my experience, most will gladly write one.

Should my parent do extra exercises to get stronger faster?

No. Do the exercises the therapist gave, the number of times they wrote down. More is not better when someone is just out of the hospital. If the program feels too easy, tell the therapist at the next visit and let them change it.

What if my parent misses a day?

Pick up the next day with the usual amount. Don't double up to make up for it. If your parent keeps missing days because of pain or tiredness, tell the therapist. That's information they need, not a failure.

When should we stop an exercise and call?

Stop if your parent has pain that is sharp or doesn't ease with rest, dizziness or feeling faint, shortness of breath, new swelling, numbness or tingling, or a fall, and call the agency. Chest pain, or trouble breathing that doesn't settle when they stop, is a 911 call. This is general guidance, not medical advice.

Sources

Lost the picture for an exercise?

Look it up by name in our home exercise library: plain steps, and a picture for most. Your therapist's sheet still sets the numbers.

Look up an exercise

Home Exercises Between Therapy Visits: An OT's Guide for Families