Occupational therapy caseloads

A care worker doing fifteen short calls in a tight geography loses little to any individual routing decision. An OT doing four assessments spread across a county can lose an hour to a poor ordering, because each leg is long and there are few of them to average out the mistake.

This is why entering accurate durations matters so much here. A 90-minute assessment recorded as an hour does not just make one visit wrong — it makes every subsequent arrival time wrong, and with only four visits in the day there is nothing to absorb the drift.

Initial assessment

Long — often 60 to 90 minutes, sometimes more. A day built on the assumption of 30-minute visits will be wrong by lunchtime, so enter the real duration rather than a service average.

Equipment delivery or fitting

Frequently constrained by something outside your control: a delivery slot, a contractor, or a family member needing to be present. These are the visits that most often justify a strict start time.

Follow-up and review

Shorter and far more flexible. These are the visits the scheduler can move around to absorb travel, so keeping their windows wide is what makes the rest of the day fit.

Joint visits

An assessment attended with a physiotherapist, social worker or family member. Where a second member of your own team must attend, set staff required to 2 so both diaries are held at once.

Major adaptation visits

Housing adaptations and complex assessments can run half a day. Treat them as the fixed point the rest of the day is built around rather than something to slot in.

The pattern that works is to let the constrained visits anchor the day and the flexible ones fill around them. Equipment fittings and visits with a third party present get a fixed time or a narrow window. Assessments and reviews get wide windows, and the scheduler uses them to soak up the travel between the anchored points.

If you constrain everything, you will get a plan that is really your own assumptions played back with more driving. The value comes from leaving the flexible visits genuinely flexible.

The routine for a service with four long visits a day looks nothing like one with sixty short calls. The decisions that matter are made when the week is planned, not when the day is generated.

1. 01

   Plan the week, then work a day at a time

   OT caseloads move more slowly than nursing ones — an assessment booked today may be three weeks out. Decide the week's shape first: which days are home visits, which are clinic, report writing or equipment ordering. Then schedule each visiting day individually, because that is where travel actually gets decided.

2. 02

   Be honest about visit length

   This is the step OT services most often get wrong. An initial assessment is not an hour: it is an hour with the person, plus setting up, plus the conversation at the door that always happens, plus notes. Enter the time the visit genuinely occupies rather than the contact time. Four visits underestimated by twenty minutes each is a day that ends eighty minutes late.

3. 03

   Group by geography before you group by anything else

   With few, long visits, travel is the largest controllable cost in the day. If the caseload allows any flexibility about which day someone is seen, use it to cluster visits in the same area onto the same day. A week planned this way rather than by referral order routinely saves a whole visit's worth of driving.

4. 04

   Mark joint visits as needing two staff

   Joint visits with a physiotherapist, a social worker or a second OT for a moving-and-handling assessment need two diaries to align at one address. Set staff required to 2 rather than booking two separate visits and hoping. These are the hardest appointments to place, so give them the widest window the referral genuinely allows.

5. 05

   Generate, and expect the day to look empty

   An OT day with four appointments and three hours of driving looks underused next to a home care round. It is not. Read the travel figures rather than the appointment count — that is the number that tells you whether the day is full, and it is the one that justifies the shape of the caseload to anyone asking.

6. 06

   Leave slack for equipment and follow-up

   Equipment deliveries, chasing an order, an unplanned call back to a client who has had a fall — these fill the gaps between visits and are the reason a day scheduled to the minute never works. Either build shorter working hours than the theoretical maximum, or leave a visit slot unfilled deliberately.

Fewer appointments means each disruption costs proportionally more. These are the ones worth having a habit for.

A visit needs rescheduling

Move it rather than deleting and re-adding. The occurrence keeps its setup — duration, staff required, any skills — so a rebooked assessment does not quietly become a thirty-minute single-handed visit because someone re-entered it from memory.

The caseload has clustered in one area

This is an opportunity rather than a problem. If several referrals have come from the same part of the patch, pull them onto the same day even if it means one waits an extra two days. The travel saved is often larger than the delay costs.

A joint visit will not fit anywhere

Double-staffed visits fail to place more often than any other type, because they need two people free at once. Widen the window before you do anything else. If it still will not fit, the honest question is whether it genuinely needs two people for the whole visit or only for part of it.

Assessments are consistently overrunning

Increase the standard duration rather than absorbing it. A service where every assessment runs twenty minutes over is not a service with a discipline problem; it is a service whose assumed visit length is wrong. Correcting it makes every subsequent day honest.

Specialist competencies are handled the same way as anywhere else in the tool — see staff, skills and start locations. If your therapists work from home rather than a base, setting start location per person is usually the single highest-impact change you can make to a rural OT round.