Last December, Joan Kichman couldn’t move out of bed. A fused bone at the base of her neck temporarily paralyzed the vibrant 83-year-old from Mechanicsburg, PA.

“I was very active and this just broke my heart,” Kichman told McKnight’s Home Care Daily.

Kichman’s physician first advised surgery. But when she balked at that idea, he prescribed in-home physical and occupational therapy. Kichman began receiving treatment in March from Fox Rehabilitation, which specializes in in-home geriatric rehabilitation. Today, Kichman said she’s moving easily around her apartment.

“We started with simple stuff — just getting my toes to move and now I walk all over with a walker. I can get up and down steps too. They taught me how to do that,” Kichman said.

Veteran physical therapist Tim Fox started the rehabilitation business that bears his name 22 years ago in Cherry Hill, NJ. He said he had grown frustrated with the limited treatment he was providing home health patients following surgery or a hospital stay.

Tim Fox

“The typical number of home health agency visits today for physical therapy ranges from three to six, if you’re lucky,” Fox told McKnight’s Home Care Daily. “Therapeutic exercise is no different than medicine. It needs to be dosed at a very specific frequency, duration and intensity to be effective. If you don’t dose it properly, it doesn’t work.”

After discovering Medicare Part B covers outpatient services like physical and occupational therapy, Fox launched his business. He educated physicians about the benefits of physical and occupational therapy over surgery and drugs. Focusing specifically on in-home geriatric therapy, Fox Rehabilitation has aggressively expanded to 21 states, conducting about 1.8 million in-home visits annually.

Growth opportunity

In 2018 Medicare no longer limited how much it will pay for medically necessary outpatient services in one calendar year. A physician must review and recertify a plan of care at least every 90 days. That has provided opportunities to grow business.

Through its extensive marketing and sales team, Fox also encourages physicians to use its services to help older patients build and maintain strength as a way to mitigate falls, which often lead to more expensive medical treatment down the road. 

“Why do we always have to engage our patients after the fall, after the functional decline? Let’s get ahead of these things. They are really quite simple to get ahead of,” Fox said.


Last September, Fox Rehabilitation named company veteran Robyn Kjar CEO. Kjar told McKnight’s Home Care she has been in contact with the Centers for Medicare and Medicaid Services (CMS) Innovation Center on ways to further expand in-home services.

Kjar is also working on university partnerships in an effort to develop a pipeline of therapists. She estimates about half of the 600 clinicians Fox Rehabilitation will hire this year will be new graduates.

Robyn Kjar

“We have a very rigorous new graduate program where newly graduated clinicians who are interested in going into geriatrics can come on board , work under a master clinician and really learn the ropes of being in the home,” Kjar said.

Medicare approved 90 days of in-home therapy for Joan Kichman. She said she felt more comfortable getting therapy in her home and thought there were fewer distractions in her apartment than at a rehab clinic.

“They got me on my feet and I’m doing extremely well. I can take care of myself now,” Kichman said.