PT vs PTA vs OT vs COTA vs SLP in Home Health: Roles, Rates, and Fit

In home health, PT, OT, and SLP visits pay $60 (including evals and discharges), PTA and COTA visits pay $45, and an OASIS Start of Care pays $100. The roles differ in scope: evaluating clinicians build the plan of care, assistants deliver it, and every discipline runs 30 to 45 minute visits.

I staff all five therapy disciplines across Acadiana, so I get this question from two directions. Students and new grads ask which lane to pick. Practicing therapists ask what their license actually looks like in home health compared to the clinic or the SNF. Both deserve a plain answer, so here it is: what each role does in the home, what each earns per visit here, and who each path tends to fit.

What does each discipline actually do in the home?

The setting changes the job more than people expect. There is no gym, no parallel bars, no aide down the hall. It is you, the patient, and their actual house, which is both the challenge and the point.

Physical Therapist (PT). The PT evaluates, builds the plan of care, and treats: strength, balance, gait, transfers, fall risk, all inside the environment where the falls would actually happen. PTs also handle discharges, and they carry the evaluation responsibility that assistant visits build on.

Physical Therapist Assistant (PTA). The PTA delivers treatment visits under the PT’s plan of care: progressing exercises, training gait, working transfers, and flagging changes back to the PT. In home health, assistants carry a huge share of the visit volume, which is exactly why they are so consistently in demand.

Occupational Therapist (OT). The OT evaluates and treats the activities that make up a life at home: bathing, dressing, kitchen tasks, energy conservation, and the setups and equipment that keep someone independent. A bathroom you can actually see beats any clinic simulation of one.

Certified Occupational Therapy Assistant (COTA). Same pattern on the OT side: the COTA delivers treatment visits under the OT’s plan, working the daily-activity goals visit by visit. Around here, COTA coverage is some of the hardest for agencies to find.

Speech-Language Pathologist (SLP). The SLP typically evaluates and treats their own caseload: swallowing safety, speech and language, and cognitive-communication work, at the patient’s own kitchen table with the foods they actually eat.

Across all five, visits run 30 to 45 minutes, one on one, and caseloads here are clustered by city so the drives between visits stay short.

The rates, side by side

These are our published rates, the same for every therapist on the team, paid directly.

Role	What visits look like	Pay per visit
PT	Evals, plan of care, strength, balance, gait, transfers, discharges	$60
PTA	Treatment visits delivering the PT’s plan of care	$45
OT	Evals and treatment for daily activities, safety, and independence, plus discharges	$60
COTA	Treatment visits delivering the OT’s plan of care	$45
SLP	Swallowing, speech, and cognitive-communication care, eval through discharge	$60

Two clarifications, because the details matter. An OASIS Start of Care pays $100, reflecting the documentation load it carries. An OASIS discharge pays the base $60, and I would rather print that here than have anyone surprised later.

Why do evaluating clinicians earn more per visit?

It is a scope difference, not a value judgment. PT, OT, and SLP visits carry evaluation, plan-of-care, and discharge responsibility, and the $60 rate covers all of it: regular visits, evals, and discharges alike. Assistants work within an established plan, and the $45 rate reflects that scope. A great PTA is not a discount PT; they are a different job, and home health does not run without them.

If you want to see how either number turns into an effective hourly once you account for clustered visits and short drives, the math is worked out in what home health therapists actually earn per visit in Acadiana, and the calculator on our careers page lets you slide the numbers yourself.

Who does each path fit?

PT or OT fits you if you want the evaluation responsibility: sizing up a person and a home, building the plan, and owning the outcome. In home health you are the clinical decision-maker in the room, with nobody looking over your shoulder. That independence is either the best part of the job or the intimidating part, depending on the therapist.

PTA or COTA fits you if you love the treating itself: the visit-by-visit progress, the relationships, the craft of getting someone stronger in their own living room. Assistants also get the most schedule leverage from home health volume, because treatment visits are the bulk of what agencies need covered, week in and week out.

SLP fits you if you want your own caseload with real autonomy and work that families feel immediately. Swallowing and communication goals land differently when they happen at the family table instead of a clinic room.

And students deciding between lanes: do not pick by the rate card alone. Pick the work you can love visit after visit; the discipline determines your days far more than the $15 gap between rates does. Whichever license you land, home health will have room for it here.

One more fit question: the contract itself

Every one of these positions is 1099 contract work, where you pick your cities, your days, and your visit volume. That structure fits some seasons of life beautifully and others not at all, regardless of your discipline. I wrote an honest breakdown of that tradeoff, benefits and all, in PRN vs W-2 for therapists.

The bottom line

Five disciplines, one field: PT, OT, and SLP visits pay $60 here, PTA and COTA visits pay $45, and an OASIS Start of Care pays $100, published for everyone and the same for everyone. The roles differ in scope, the days feel remarkably similar: clustered visits around Lafayette, Broussard, New Iberia, Carencro, and the towns between, 30 to 45 minutes with one person at a time.

Whichever set of letters follows your name, if that kind of workday sounds right, apply in two minutes at our careers page. You will hear from me, a fellow clinician, by the next business day.