By Thomas A. Parmalee
When Steven Kleinman, PT, MPT, MHA, began his career as a physical therapist, home care wasn’t part of his long-term plan.
“I thought home care was where old therapists went to be put out to pasture,” he admitted with a laugh. “I thought it would be easy. Boy, was I wrong. I’ve seen firsthand that the caliber of home care physical therapists is top notch.”
A decade after joining Valley Health System, he couldn’t imagine being anywhere else.
Today, Kleinman serves as rehabilitation manager for Valley Health Home Care, overseeing physical therapy, occupational therapy and speech therapy services across Bergen and Passaic counties in New Jersey. What began as a consulting assignment evolved into a leadership role responsible for more than 100 rehabilitation clinicians serving patients wherever they call home.
Along the way, Kleinman has witnessed the number of physical therapists at the operation increase by about 33% — and he’s navigated dramatic changes in home health reimbursement, patient complexity and clinical expectations. Yet one thing has remained constant.
“Our job is to restore function,” he said. “That’s what most people want when they come into home care — to restore function and improve mobility within their home.”
That philosophy has become the foundation of Valley Health’s rehabilitation program.
Rehabilitation Is More Than Therapy
Valley Health’s home care division provides Medicare-certified skilled nursing, rehabilitation, home health aide services and hospice care to about 2,000 patients, and home care to about 1,600 patients at any given time. While not every patient receives therapy, Kleinman believes nearly every patient can benefit from rehabilitation at some point in their care journey.
“I think the majority of these patients — probably all of them — could use some kind of therapy,” he said. “The question is what therapy, where and when.”
That perspective reflects a broader philosophy than simply helping patients recover from surgery.
Valley’s therapists routinely work with patients recovering from orthopedic procedures, strokes, ALS and a wide range of chronic conditions. Their objective isn’t simply improving muscle strength. It’s helping patients safely return to the highest level of independence, preferably at home.
“Our goal is focusing on function and getting them back to their baseline and getting them to be able to live comfortably,” Kleinman said. “Everything we’re doing is in the patient’s home.”
Discovering the Value of Home Care
Kleinman’s career began in outpatient rehabilitation, influenced in part by his own experience recovering from knee surgeries while growing up.
“I came from a sports background,” he said. “I’d been through physical therapy myself.”
After years in outpatient settings, including work with chiropractors and clinic management, he pivoted.
“I was looking for a new challenge, and based on my leadership skills, attention to detail with skilled documentation, and my ability to grow and manage clinics, I started looking to see what was out there,” he said.
A consulting opportunity with Valley Home Care changed everything.
Within six months, the organization’s rehabilitation manager retired. Kleinman applied for the position and never looked back.
What surprised him most was how clinically demanding home care really was.
“I learned very quickly that what our therapists do is a lot more than people realize,” he said. “You’re taking all of your physical therapy skills — strengthening, balance training, transfers — and applying them to a much more fragile population. It takes finesse.”
Home Care Has Changed Dramatically
Few people have experienced the impact of payment reform on rehabilitation as much as Kleinman.
“When I first started in home care, therapy was a huge payment driver,” he explained. “Everybody wanted more therapy visits. More visits meant more money.”
The arrival of the Patient-Driven Groupings Model fundamentally changed that equation.
“Now, therapy is much less of a payment driver,” he said. “Some agencies reacted by minimizing visits or spreading them farther apart. But that doesn’t always work for every patient.”
Instead of chasing either maximum visits or minimum utilization, Kleinman believes agencies should focus on delivering exactly the care each patient requires.
“It’s about finding that sweet spot,” he said. “The right number of therapy visits — not overutilizing, but not under-treating either.”
That balance has become even more important as Value-Based Purchasing increasingly rewards outcomes rather than volume.
Valley Health has consistently performed at the highest levels under the program, something Kleinman attributes to maintaining clinical excellence rather than chasing reimbursement metrics.
Patients Are Arriving “Sicker and Quicker”
One trend concerns Kleinman more than almost any other.
“We say people are leaving the hospital sicker and quicker,” he said.
Patients discharged home today often require significantly more support than they did just a few years ago.
“They have a lot more needs,” he explained. “It’s not just walking in and saying, ‘I’m here to do your therapy today.'”
Sometimes therapy begins with something much more basic.
“You walk in and the patient may have soiled themselves,” he said. “Before you ever think about exercises, you’re helping them get cleaned up, helping them feel human again.”
Only then can rehabilitation begin.
That patient-centered mindset extends beyond therapy itself.
Therapists frequently recommend adaptive equipment, suggest additional caregiving resources and collaborate with occupational therapists on simple modifications that dramatically improve daily living — from adaptive utensils to easier ways to dress or tie shoes.
“Sometimes it’s the simple things we all take for granted that make the biggest difference,” Kleinman said.
Measuring Success by Outcomes
For Kleinman, outstanding rehabilitation programs don’t distinguish themselves by the number of visits to a home.
“What separates an average rehabilitation program from an exceptional one?” he asked. “Outcomes — and strong clinical judgment.”
Among the measures Valley monitors most closely are Discharge Function Scores, which is part of the value-based purchasing ranking. “We monitor Value Based Purchasing scores, including discharge function scores and overall outcome scores, including ambulation, bed mobility, etc.,” he said.
Those numbers can indicate if performance starts to slip.
“If complaints start increasing or we see our scores dropping, those are signs that something needs attention,” he said.
Hiring Therapists Who Can Think
Like agencies nationwide, Valley Health continues recruiting therapists in an increasingly competitive labor market.
But Kleinman doesn’t necessarily look for the candidate with the longest résumé. He’s searching for critical thinkers.
“What I really want is someone who can think on their feet,” he said.
During interviews, he intentionally asks questions without perfect answers.
“I ask candidates, ‘What do you do when a patient says they don’t want therapy?'” he said.
Then he keeps pushing the conversation.
“I tell them there isn’t one right answer,” he said. “I’m trying to understand how they think.”
That same philosophy has convinced him that motivated new graduates can succeed in home care despite traditional assumptions.
“People used to tell me you shouldn’t hire new graduates for home care,” he said. “I always disagreed.”
Leading Therapists Who Work Independently
Managing more than 100 clinicians scattered across multiple counties presents unique leadership challenges.
Unlike hospitals or outpatient clinics, therapists spend much of their day alone.
Kleinman’s solution isn’t more oversight.
It’s more conversation.
“I always start by asking how they’re doing outside of work,” he said. “You have to get to know them as people.”
He believes employee engagement directly influences patient care.
“Happy staff equals happy patients,” he said.
That philosophy has helped Valley Health achieve unusually strong retention, with many therapists remaining until retirement.
“We really don’t have therapists leave because they’re unhappy,” he said. “Usually they’re retiring or relocating.”
AI and Advice for Agency Owners
Like many health care leaders, Kleinman is watching artificial intelligence closely. He recently attended an industry conference where AI dominated nearly every discussion.
Rather than viewing it as a replacement for therapists, he sees it as a tool that can improve clinical documentation and strengthen care planning.
“We’re using AI to help clinicians better understand patient needs,” he said. “It can help justify the care plan and improve documentation.”
But the clinical decision-making still belongs to therapists, he emphasized.
Asked what he’d focus on if he were consulting with a small- or mid-sized home care agency looking to strengthen its rehabilitation program, Kleinman said he wouldn’t begin with expensive technology or new equipment. Rather, he’d start with fundamentals.
“OASIS education,” he said without hesitation. (OASIS stands for Outcome and Assessment Information Set, which is a standardized patient assessment tool required by the Centers for Medicare & Medicaid Services for Medicare-certified home health agencies.)
Helping clinicians fully understand assessment, documentation and patient needs is what drives stronger outcomes and better care planning, he said.
Just as importantly, leaders should never lose sight of what life in the field is actually like, which is a mistake he often seems new clinical managers make.
“Don’t forget what it was like when you were in the field,” he said. “Sometimes, leaders get persuaded to push initiatives that may not be the best thing for staff.”
Compassion Still Comes First
Despite advances in reimbursement models, artificial intelligence and outcome measurement, Kleinman believes the qualities that matter most in home care have never changed.
Looking back on his years treating patients, one lesson continues to shape every leadership decision he makes.
“Empathy. Compassion. Treating everyone like they were your own family member receiving care,” he said.
Those values aren’t found in a reimbursement formula or quality score.
They’re found every day in patients’ homes, where restoring function often begins by restoring dignity first.
