Three Choices at the End of Life

by guest author Barbara Karnes, RN

Cure, Life-Sustaining, or Comfort Care

When someone is facing a life-threatening illness, they and their loved ones are often asked to make medical decisions they never expected to face. Unfortunately, most of us don’t fully understand the choices before us. Knowing the difference between cure, life-sustaining treatment, and comfort care can help you make decisions that honor the kind of life – and death – you want.

Cure, life-sustaining treatment, and comfort care. These are the three paths available when we are faced with a life-threatening illness.

Cure

Cure means providing a return to a “normal” functioning life. I put normal in quotes because the word can be misleading. What is normal for one person may not be normal for another. Cure implies being able to participate in and enjoy the activities of everyday living. It means the malady is gone or controlled.

Life-Sustaining Treatment

Life-sustaining treatment means keeping the physical body alive by whatever means are deemed necessary. Many people refer to these treatments simply as “life support.” They can include artificial nutrition and hydration, ventilators, dialysis, respirators, and other advanced medical procedures. The goal becomes preserving life, even when the quality of life is greatly diminished.

Quality Improvement Project Hospice Domains

Comfort Care

Comfort care focuses on the quality of the life you are living rather than simply the length of that life. It includes physical care along with emotional, mental, and spiritual support. Comfort care addresses what is most important to your well-being now that your body is no longer able to meet all of your needs. It also guides and nurtures your family and those closest to you as everyone prepares for the end of life while continuing to live fully each day.

"Fix" or Provide Care?

We often get so caught up in getting “fixed” at any price that we lose sight of what our goal really is. Treatment does not necessarily mean cure. Yet most of us assume that if we do everything possible, we will get better. Sadly, too often we sacrifice the quality of the life we have today while pursuing a cure that may no longer be possible.

When deciding between cure, life-sustaining treatment, or comfort care, information and knowledge are vital components to making decisions. We need honest conversations about the likely outcome of treatment, the chances of success, life expectancy, and quality of life. Once you’ve had those conversations and decided what kind of living is most important to you, share those wishes with your physician, your family, and those closest to you—and put your decisions in writing.

There is no right or wrong choice. There is only the choice that best reflects your values and how you want to live the time you have.

# # #

Tim Rowan The Rowan Report

Barbara Karnes, RN, is an award-winning end-of-life educator, award-winning nurse, NHPCO Hospice Innovator Award winner 2018, and 2015 International Humanitarian Woman of the Year

While at the bedside of hundreds of people during the dying process, Hospice Pioneer Barbara Karnes noticed that each death was following a near-identical script. Each person was going through the stages of death in almost the same manner, and most families came to her with similar questions. These realizations led Barbara to sit down and write Gone From My Sight, the “Little Blue Book” that changed the hospice industry.

Gone From My Sight is the original, and remains the most widely used, patient/family educational booklet on the signs of approaching death. It has been in print continuously since 1985 and has sold over 35 million copies worldwide. With its publication and distribution, Barbara created one of the most important tools in the end-of-life movement today.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

The Broadway Secret

by Aaron Marcum

The Home Care Back Stage

The Broadway secret every home care owner needs to know

A few years ago, I took my daughter to see “Wicked” in London’s West End.

From the moment the lights dimmed, we were transported. The performances were flawless, the choreography mesmerizing, and the vocals spine-tingling. For two and a half hours, we sat captivated by what appeared to be theatrical magic.

It looks like magic

But here’s what struck me as I watched: what we were experiencing wasn’t magic at all. It was the result of an incredibly sophisticated operation happening behind that curtain—an operation most audience members never think about.

Dan Sullivan, founder of Strategic Coach, calls this the “Front Stage” and “Back Stage” of your business. And it’s a framework that every home care owner needs to understand.

The Home Care Back Stage

What Makes Broadway, Broadway?

When you pay for a West End ticket, you’re not just paying for talented actors. You’re paying for a lighting crew coordinating hundreds of cues per show, costume designers managing dozens of quick changes, sound engineers balancing multiple wireless microphones in real-time, stage managers calling hundreds of technical cues with split-second precision, and a production team that rehearsed for months before opening night.

The Front Stage—what the audience sees—only shines because of an exceptional Back Stage.

Your home care business has the same dynamic

Front and Center

In our industry, the Front Stage is your care professional arriving at Mrs. Johnson’s home at 9 AM. It’s the smile, the gentle assistance with morning medication, the conversation during breakfast, and the compassionate help with bathing and dressing.

That’s what your clients see. That’s what their families remember. That’s how your business gets judged.

But we all know that caregiver showing up prepared, on time, and trained isn’t an accident.

Behind the Scenes

Your Back Stage makes it possible: 

  • Care Coordination ensures the right caregiver with the right skills is scheduled for the right client. When this system fails, clients feel it immediately.
  • Billing Systems that work seamlessly mean caregivers get paid accurately and on time—because nothing destroys Back Stage morale faster than payroll errors.
  • Compliance Infrastructure keeps you operating legally and safely, protecting both your clients and your business.
  • Recruitment and Hiring processes that attract quality candidates. With projections showing a national shortage of 151,000 caregivers by 2030 and 355,000 by 2040, your Back Stage recruiting determines whether you have anyone to put on the Front Stage. As a side note, I personally believe the shortages are greater than this.
  • Training Programs that don’t just check boxes but actually prepare caregivers for real situations. The 2025 Activated Insights Benchmarking Report found that agencies offering 8+ hours of orientation training had median revenue of $2.4 million compared to $2.03 million for those with 3 or fewer hours.
  • Retention Strategies because the average caregiver costs $2,600 to replace Activated Insights. Your Back Stage culture determines whether caregivers stay or leave.
Home Care Broadway Back stage
Home Care Broadway back stage

The Numbers Tell a Sobering Story

Here’s the reality: the home care industry’s turnover rate reached 79.2% in 2023 Home Health Care News—the highest it’s been in five years. Think about that. In an agency with 100 caregivers, you’re replacing nearly 80 of them every single year.

But it gets worse. Nearly four out of five caregivers leave their job within the first 100 days of employment. That means the caregivers you just spent weeks recruiting, screening, and training? Most of them won’t even make it through their first three months.

When your Back Stage is weak, these statistics become your reality.

The "Community Theater" Problem

We’ve all attended shows where you could tell the Back Stage was struggling.
Maybe you’ve seen a local production where an actor missed their entrance, the lighting was off, a scene change took too long, or the sound cut out.

You couldn’t see the Back Stage problems, but you absolutely felt them.
The same thing happens in home care.

A weak back stage

When your Back Stage is weak:

  • Caregivers show up late (or not at all) because scheduling is chaotic
  • Families receive incorrect bills because systems are disconnected
  • Care quality suffers because training is inconsistent
  • Your reputation erodes one Front Stage failure at a time

Your clients might not know your payroll system crashed or that your care coordinator called in sick for the 4th time this month, but they experience the consequences.

The Broadway Standard Question

So here’s the question every home care owner must ask:

Is your business operating at Broadway standards, or community theater? Be honest.

When you look at your Back Stage operations:

  • Can your care coordinators instantly access complete client information?
  • Do your caregivers have clear protocols for every situation they might encounter?
  • Is your billing accurate enough that families rarely question an invoice?
  • Do you have documented processes, or is everything “in someone’s head”?
  • Could your business run smoothly if your top coordinator was suddenly unavailable?

The best home care agencies—the ones with waiting lists and stellar reputations—aren’t just lucky. They’ve built Broadway-quality Back Stage operations.

They’ve invested in systems, training, and processes. They’ve documented their playbook. They’ve made the Back Stage so strong that the Front Stage can shine consistently, every single day.

Because here’s what I learned watching “Wicked”: excellence isn’t about one amazing moment. It’s about a thousand excellent decisions that happen when no one is watching. 

The question is: what's happening in your Back Stage?

Want to build your Broadway-worthy Back Stage?

Stay in the know with strategies, insights, and practical resources designed specifically for home care owners. Subscribe to receive updates, newsletters like this, and tools that will help you elevate both your Front Stage performance and Back Stage excellence. Because your caregivers—and your clients—deserve a five-star experience every single time.

# # #

Aaron Marcum Home care and Broadway
Aaron Marcum Home care and Broadway

Aaron Marcum is an entrepreneur and thought leader who has dedicated his career to transforming the home care industry and nurturing business leaders.

As the founder of Home Care Pulse (now Activated Insights), he pioneered the Best of Home Care® program, revolutionizing quality standards in senior care across North America. His expertise as a Certified Blue Ocean Strategy practitioner and former Certified EOS Implementer has helped shape some of home care’s most respected brands.

© 2026 This article originally appeared in Aaron Marcum’s newsletter and is reprinted here with permission. For more information or for permission to use this material, please contact Aaron Marcum.

Hiring and Retaining Professional Caregivers

by Roger McManus, MBA

Hiring and Retaining Professional Caregivers

What Really Keeps People in This Work

People who work in home‑based care, whether licensed home health clinicians or trained home care aides, do something unusual in the healthcare world. They walk into a stranger’s home and step into the middle of that person’s daily life. Their role is to try to help them stay, or get, healthy, stable, safe, and dignified. All this happens in someone else’s environment. That fact impacts the hiring and retention challenge for agencies.

While somewhat overlapping, home health and home care are different fields. Home health visits are shorter, clinically focused, and built around medical goals. Home care shifts are longer, non‑medical by law, and often revolve around companionship, safety, and daily living support. But the shared denominator, the home environment, creates a common reality. Agencies must find and keep people who can handle the emotional, practical, and interpersonal demands of working inside a client’s private world.

Long-term retention depends significantly on the caregiver’s ability to adapt with a chameleon-like mindset. 

The Home Environment Changes Everything

A hospital or clinic has structure; a home does not. Workers deal with cluttered living rooms, anxious adult children, and unpredictable pets. They see clients who may be having a good day, a bad day, or something in between. They have to be able to read the situation, adjust their tone, and figure out how to help without dominating.

This is not a skill you can measure with a résumé alone. Agencies that hire well look beyond credentials. They look for temperament — calmness, respect, patience, and the ability to stay professional even when the environment may be anything but.

Retention starts with hiring people who can work in this setting.

Brown v D.C.
Hiring and Retaining caregivers

Why Turnover Hits Home Based Care Harder

Turnover in this field isn’t just inconvenient. It’s disruptive in ways that office‑based healthcare rarely experiences.

When a home health clinician leaves, cases get reshuffled, documentation gets delayed, and continuity of care suffers. When a home care aide leaves, long‑standing client relationships can collapse overnight. The Patient is most aware.  Families notice. Referral partners notice. 

Workers leave for predictable reasons:

  • Home health clinicians may feel isolated or overwhelmed by documentation and case complexity.
  • Home care aides may feel undervalued or stuck in roles with no visible progression.
  • Both groups may struggle with inconsistent schedules, long drive times, or emotionally draining cases.

Retention improves when agencies acknowledge these realities instead of treating turnover as “just part of the industry.”

Creating a Support System That Actually Works

The best retention strategies aren’t flashy. They’re consistent, practical, and rooted in what workers experience every day.

Home health clinicians need clinical leadership that is reachable. Not a voicemail box. Not a once‑a‑week check‑in. They need someone who answers the phone when a wound looks worse, when a medication list doesn’t match the chart, or when a family is spiraling. Caregivers knowing they have that backup reduces burnout more than any bonus ever will.

Home care aides need respect and inclusion. They may not have medical licenses, but they are the ones who see the client’s real daily life. Agencies that treat aides as essential contributors, not interchangeable labor, see stronger loyalty and longer tenure.

Across both groups, communication is the glue. Workers stay when they feel connected to a team that listens and responds. 

Logical Rewards

Incentives That Make Sense in the Field

Many agencies try bonuses, gift cards, or occasional “thank you” events. Those gestures are fine, but they rarely change long‑term behavior. Logical rewards do.

These incentives tie directly to the realities of home‑based work:

  • Readiness bonuses for workers who reliably take short‑notice visits.
  • Incentives for on‑time arrival, complete documentation, or strong client feedback.
  • Skill‑tier pay ladders that reward additional certifications or specialized training.
  • Continuity bonuses for maintaining long‑term client relationships without disruption.

These rewards reinforce the behaviors that stabilize the agency. They’re not random. They’re strategic.

Onboarding and Training:

The First Impression That Never Goes Away

Retention begins the moment a new worker walks through your door. A chaotic onboarding process sends a message that “this agency is disorganized.” A clear, supportive onboarding process sends the opposite message that “we know what we’re doing, and we want you to succeed.”

Home health clinicians need onboarding that covers real‑world clinical scenarios, documentation expectations, and the unpredictable nature of home visits. Home care aides need onboarding that prepares them for communication challenges, safety issues, and the emotional realities of working with seniors.

Ongoing training matters just as much. Workers stay when they see a path forward, something to grow into, not just a job to survive.

Retention Is Not HR, It is Strategy

Agencies that retain their workers don’t just solve staffing problems. They build a competitive advantage. Families trust agencies whose workers stay. Referral partners prefer agencies that don’t constantly reshuffle cases. Regulators appreciate agencies with consistent documentation and stable clinical outcomes.

Retention is not a side project. It is a core business function.

# # #

Roger McManus

Roger McManus is the author of several books on entrepreneurship, including “Entrepreneurial Insanity in the Home Care Business,” which he co-wrote with Tim Rowan. He advises Home Care owners and HR professionals on techniques for recruiting, retaining, and rewarding caregivers.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This excerpt was provided to The Rowan Report and is printed with permission. 

The Caregiver’s Mindset

by Roger McManus, MBA

This chapter is part of the upcoming book, The Intuitive Caregiver. It is designed to strengthen in-home caregiving skills with clear, practical, real‑world guidance.

The Caregiver's Mindset

Professional care begins long before knocking on the door

Caregiving does not start with a task list, nor does it begin when you help someone stand, prepare a meal, or assist with bathing. It begins the moment you walk through the door — with your attitude, your awareness, and the way you choose to show up.

A caregiver’s mindset is the foundation of every caregiving activity that follows. Yes, skills matter. Sure, training matters. But the mindset you bring into someone’s home determines whether your presence feels calming or stressful, respectful or intrusive, steady or unpredictable.

This chapter helps you understand what it means to “show up” as a professional caregiver — not just in what you do, but in how you think, how you observe, and how you treat the person and their home.

Enter with Humility and Respect

Professional caregivers enter with humility by:

  • looking before touching
  • asking before moving anything
  • treating every object as meaningful
  • remembering that routines exist for reasons you may not yet understand
  • Even something as simple as moving a chair or adjusting a blanket can feel like an intrusion if you do it without asking. Respect for the home is the first sign of respect for the client.

Caring Begins with Attitude

Your Job is Stability, Not Control

Many older adults feel vulnerable when someone new enters their home. They may worry about losing independence, privacy, or dignity. They may fear being judged. They may feel embarrassed about needing help.

Your role is not to take over.
Your role is to create stability.

Stability comes from:

  • predictable routines
  • calm communication
  • steady follow‑through
  • respecting the client’s pace and preferences
  • Caregiving is not about being fast. It’s about being reliable. When you move calmly and consistently, the client feels safer — and safety leads to cooperation.

Entering Someone Else’s World

A client’s home is not your workplace.
It is their private space — the place where they feel most themselves.

When you enter that space, you are stepping into someone’s history, habits, routines, and memories. You may see clutter, unusual décor, or ways of doing things that don’t match your own. None of that is your business (though it may suggest you send your agency’s Occupational Therapist to professionally assess safety issues). Your job is not to judge the home. Your job is to respect it.

You Are A Guest, Not A Manager

Even when a client needs significant help, the home remains theirs. You are there to support, not to run the household.

Professional caregivers avoid the trap of “fixing” everything. Instead, they:

  • collaborate rather than dictate
  • offer choices rather than instructions
  • adapt to the client’s rhythms rather than imposing their own
  • For example:
    Instead of saying,
    “Let’s get you dressed now.”
    You might say,
    “Would you like to get dressed before breakfast or after?”
    Choices restore control.
    Control restores dignity.
    Dignity builds trust.

Your Work is Emotional First, Before Physical

Caregiving is not just a list of tasks. It is a relationship.

Many clients are grieving — not always the loss of a person, but the loss of abilities, independence, or identity. They be frustrated by what their body can no longer do. They may be embarrassed to need help. They may be afraid of what comes next.

Your presence can either increase that fear or reduce it.

Emotional safety is the foundation of physical care. Caregivers support emotional safety by:

  • listening without judgment
  • acknowledging feelings without trying to “fix” them
  • offering reassurance through tone and patience
  • giving people time to process and respond
  • You are not just helping with daily activities.
    You are helping someone navigate a changing life.

Professionalism is A Daily Practice

Professional caregivers represent their agency, their training, and the caregiving profession itself. Clients notice everything — and they should. They are trusting you with their home, their health, and their dignity.

Professionalism shows up in:

  • punctuality
  • appearance
  • communication
  • boundaries
  • documentation
  • confidentiality

It also shows up in the small things:

  • put your phone away
  • stay focused on the client
  • avoid prying, personal conversations
  • maintain a calm presence even when the day is difficult

Professionalism is not about being perfect. It is about being consistent.

Understanding the Client's Reality

Before you ever walk through the door, the client is already living with pressures, fears, and adjustments to dependence that you may not see.

Loss of Control Is the Central Theme

Most clients do not ask for help because they want it. They ask because they no longer have a choice. That loss of control can feel humiliating, frightening, or deeply unfair.

Even small tasks — tying shoes, opening containers, getting out of a chair — may require assistance for the first time since childhood. Every request for help carries some emotional weight. Feeling like a helpless child carries more.

The Home Is Their Last Stronghold

For many clients, the home represents independence, identity, and safety. When a caregiver enters that space, the client may worry that:

  • their privacy will disappear
  • their routines will be disrupted
  • their preferences will be ignored
  • their home will no longer feel like their own

Respect for a person’s home environment is not optional — it is foundational.

Judge Not...

A caregiver may simply be observing the environment to understand needs, but the client may interpret that as criticism.

They may think:

  • “My home is a mess.”
  • “I’m not doing enough.”
  • “They must think I’m failing.”

Neutral language and gentle pacing reduce this fear.

Fear of Decline Is Always Present

Even when clients don’t say it, they are often thinking:

  • “What happens when I get worse?”
  • “Will I lose my home?”
  • “Will I become a burden?”

You cannot remove these fears, but you can avoid triggering them. Predictability and calmness go a long way.

The First Visit Sets the Tone

A caregiver’s first visit is more than an introduction — it defines the entire relationship. Clients quickly determine whether you will make them feel safe, respected, and understood.

Arrive Calm, Prepared, and Unhurried

Your arrival should feel like relief, not disruption.

Introduce Yourself Clearly

Clients should never have to guess who you are or why you’re there.

Observe Before You Act

The first visit is not the time to reorganize or “improve” anything. It is the time to learn.

Ask Permission for Everything

Even small actions require permission. Asking restores control.

Match the Client’s Pace

Your pace should never exceed theirs.

Keep the First Visit Simple

The goal is rapport, understanding, and emotional safety — not efficiency.

Heart of the Chapter

Caregiving begins with a mindset, not a task.
Caregiving begins with humility, awareness, and respect.
Caregiving begins with the attitude that you are entering someone else’s world — and your presence can either bring calm or create stress.

When you show up with steadiness, patience, and professionalism, you create the foundation for everything that follows.

# # #

Roger McManus

Roger McManus is the author of several books on entrepreneurship, including “Entrepreneurial Insanity in the Home Care Business,” which he co-wrote with Tim Rowan. He advises Home Care owners and HR professionals on techniques for recruiting, retaining, and rewarding caregivers.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This excerpt was provided to The Rowan Report and is printed with permission. 

Response to HHS Reports

FOR IMMEDIATE RELEASE

Contact:                       Colleen Knudsen
cknudsen@leadingage.org
202-508-1215

Post-Acute Care Medicare Advantage Coalition Statement on OIG Reports Confirming Barriers to Post-Acute Care in Medicare Advantage

Washington, D.C, June 16, 2026. The Post-Acute Care Medicare Advantage (PAC MA) Coalition issued the following statement in response to the U.S. Department of Health and Human Services (HHS) Office of Inspector General’s (OIG) two new reports, The Three Largest Medicare Advantage Organizations Denied Requests for Long-Term Acute Care and Inpatient Rehabilitation at Some of the Highest Rates and Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials:

Post-acute care MA Coalition

Coalition Statement

The PAC MA Coalition has long championed critical yet commonsense and necessary reforms to ensure Medicare beneficiaries’ access to medically necessary care across all post-acute settings. These June 2026 OIG reports provide important, independent confirmation of what providers and Medicare beneficiaries have experienced for years: Medicare Advantage (MA) plans are using prior authorization (PA) and similar tactics to restrict beneficiaries from receiving the services that Medicare Advantage Organizations (MAO) are legally required to provide. 

Across the post-acute care (PAC) continuum, OIG found concerning denial patterns, wide variation of the rate of denials among MA organizations, and high rates of successful appeals. Even when a denial is later overturned, the patient may still have faced unnecessary care delays, a prolonged hospital stay, an interruption in recovery, or placement in a less appropriate care setting. Given each PAC setting’s distinct role and value in the rehabilitation continuum, these outcomes can cause significant disruptions in patients’ recovery trajectory and place patients at higher risk for complications and readmissions – all of which produce poorer outcomes and increase costs for the Medicare program. 

For Medicare beneficiaries recovering from serious illness, injury, surgery, stroke, or other complex medical events, timely access to the right post-acute care setting is essential. These decisions are not simply administrative; care in the appropriate setting can affect whether a patient regains function, avoids complications, returns home safely, or receives the services needed to recover altogether. 

The Coalition is also concerned by OIG’s findings regarding third-party contractors and vendors involved in PA decisions. MAOs remain responsible for ensuring that their contractors, which may deploy algorithmic or artificial intelligence-supported tools in PA decision-making, comply with Medicare coverage rules. High denial overturn rates should prompt closer CMS oversight of whether these entities are applying Medicare standards accurately and enforcement with meaningful penalties when there are patterns of non-compliance. 

The OIG reports underscore the need for better data, transparency, and stronger accountability. The Coalition urges the Centers for Medicare and Medicaid Services (CMS) to implement OIG’s recommendations to collect detailed, request-level PA data–including standardized service type, contractor involvement, denial rationales, decision timelines, appeal outcomes, and information on continued-stay requests. CMS should make these data publicly available and also examine why denial and overturn rates vary so widely across plans and contractors and take corrective action, where appropriate. 

The Coalition further urges OIG and CMS to conduct a similar review of MA practices affecting home health services. Home health providers report that even when care is approved, MA plans frequently authorize fewer visits than clinically appropriate and reimburse at rates significantly below traditional fee-for-service (FFS) Medicare. As a result, patients may be left without the full scope of services they need to recover safely at home. 

MA plans are required to provide access to Medicare Part A and Part B services in a manner comparable to traditional FFS Medicare. The OIG reports make clear that stronger oversight, greater transparency, and more consistent enforcement are needed to ensure MA beneficiaries receive the post-acute care they are entitled to under Medicare, in the most clinically appropriate setting. Our groups collectively applaud the OIG’s observation that, “as enrollment in Medicare Advantage continues to grow, so does the urgency and importance of ensuring that MAOs are delivering on the value that the Federal Government pays them to provide.” 

The PAC MA Coalition therefore stands ready to work with CMS, Congress, OIG, MA organizations, and other stakeholders to address PA, reduce unnecessary administrative burden to providers, ensure adequate payment, and protect timely access to medically necessary post-acute care. 

The PAC MA Coalition renews its request for CMS to standardize post-acute care prior authorization procedures across MA plans. Greater consistency, compliance, and accountability are needed to ensure decisions reflect traditional Medicare FFS standards. Expedited PA is essential so beneficiaries receive timely, medically necessary services and avoid unnecessary delays in recovery.”

# # #

About the PAC MA Coalition

Post-Acute Care (PAC) is made up of approximately 15,000 skilled nursing facilities (SNFs), 11,500 home health agencies (HHAs), 1,200 inpatient rehabilitation facilities (IRFs), and 370 long-term acute care hospitals (LTCHs), among other provider types.

The Post Acute Care Medicare Advantage (PAC MA) Coalition is comprised of LeadingAge, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), the American Medical Rehabilitation Providers Association (AMRPA), the National Alliance for Care at Home (the Alliance), the National Association of Long Term Hospitals (NALTH), and the Center for Medicare Advocacy. Together, the Coalition represents the interests of PAC providers and the Medicare beneficiaries who require their services.

The Coalition’s objective is to ensure Medicare beneficiaries enrolled in MA and Special Needs Plans (SNPs) receive comparable and timely access to Medicare Part A and B services as their Traditional Medicare counterparts, while also ensuring the financial viability of providers who participate in MA networks through adequate payment and reduced administrative burden.

© 2026 PAC MA Coalition. This press release was issued by LeadingAge and is reprinted with permission. For more information or to request permission to print, see contact information above.

Alliance Responds to CMS

FOR IMMEDIATE RELEASE

Contact:                                                            Hannah Kristan
communications@allianceforcareathome.org
202-355-1647

The Alliance Responds to CMS’s Announcement of Nationwide Enrollment Moratoria on Hospice and Home Health Providers

Washington, D.C, May 13, 2026. On May 13, the Centers for Medicare & Medicaid Services (CMS) announced a six-month national moratorium on hospice and home health enrollment in response to program integrity concerns within the Medicare programs. While the National Alliance for Care at Home (the Alliance) strongly supports efforts to root out bad actors who exploit these essential programs, undermine confidence in care at home, and threaten the patients and families who depend on it, the Alliance has long advocated for targeted strategies that distinguish between high-fraud markets and communities where fraud is not an identified problem and patients already face shortages of providers.

Concerns

The Alliance welcomes the Administration’s focus on combatting fraud, waste, and abuse and appreciates that CMS has indicated providers will still be able to conduct face-to-face recertification visits via telehealth during the enrollment moratorium, which will help avoid unnecessary care disruptions for patients and families. However, an enrollment moratorium does not distinguish between bad actors and compliant providers and will ultimately reduce competition and slow innovation. More importantly, an enrollment moratorium raises serious access-to-care concerns in areas where patient demand is growing or existing capacity is already strained, leading to longer wait times, reduced service availability, and fewer choices for patients – particularly in rural or underserved communities.

Less Severe Recommendations

Public reports show that fraud is concentrated in specific geographies and among specific actors, signaling that targeted reforms and oversight strategies are needed to identify and remove fraudulent entities from the Medicare program. The Alliance and other national organizations have repeatedly provided CMS with recommendations that focus on preventing bad actors from entering the Medicare and Medicaid programs and better leveraging existing tools to fight fraud without creating unnecessary burden for good-faith providers who are already meeting program requirements.  

Alliance responds to CMS moratoria

From the Alliance CEO

“The majority of home health and hospice providers deliver compliant, patient-centered, and clinically appropriate care to individuals with complex needs, often in their most vulnerable moments. CMS must use data-driven, risk-based program integrity measures and focus resources on boots-on-the-ground surveys and enforcement of existing oversight mechanisms that root out the blatantly bad actors without potentially limiting patient access to care or punishing high quality providers operating in good faith.” 

Jennifer Sheets

CEO, National Alliance for Care at Home

Final Thoughts

This moratorium, effective May 13, applies only to new providers and certain changes of ownership, and may be extended if CMS deems it necessary.  

The Alliance has been and will remain a proactive, constructive partner to Congress and federal regulators on program integrity efforts. The Alliance will continue to engage with the Administration on a path forward that holds bad actors accountable while protecting patient access to the safe, high-quality care at home they need and deserve. 

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org. 

©2026 by the National Alliance for Care at Home. For more information or to request permission to reprint, please see contact information above.

Purpose-Built AI: from Theory to Practice

by Isaac Greszes, Eleos

Purpose-Built AI

From Theory to Practice

This 4-part series has outlined how to evaluate, test, and use AI solutions, emphasizing outcome relevance, workflow fit in regulated environments, architectural scalability, and governance discipline. That framework was intentionally rigorous. In a market crowded with pilots and proofs of concept, it reflects the reality that AI outcomes are not accidental; they are the result of deliberate design choices.

This final chapter shares a real-life story of AI implementation using the Polaris AI Engine.

A Reference Implementation

One example of how these principles are applied in practice is Eleos’ Polaris AI engine.
Polaris was developed over more than five years to support regulated conversational care. Rather than relying solely on general-purpose language models, it combines commercial-grade multimodal infrastructure with proprietary clinical intelligence layers that encode documentation logic, reasoning patterns, and safety heuristics.

Purpose-Built AI Eleos Polaris

Key elements of this approach include:

  • Layered architecture, separating foundational AI capabilities from clinical logic and governance controls.
  • Expert-led refinement, with licensed clinicians continuously validating and updating clinical rules.
  • Application-layer tuning, allowing the system to improve without retraining on customer data.
  • Governance-by-design, with explicit boundaries around data use, monitoring, and risk management.

Clinical Control

Importantly, Polaris is not positioned as a fully autonomous system. Clinicians remain in control, using AI as a collaborative tool that reduces administrative burden while preserving clinical judgment.

This design reflects a broader principle: in regulated care environments, trust and adoption depend as much on restraint and transparency as on technical capability.

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Applicability in Care at Home

Care at home workflows differ across home health, hospice, and other palliative care settings. Documentation standards, visit structures, and regulatory requirements vary. Validation within each context remains essential.

At the same time, platforms built to handle high-variability conversational care share structural advantages when entering care at home environments; they:

  • Are designed to operate in unstructured, field-based settings.
  • Encode clinical reasoning rather than relying on generic text generation.
  • Incorporate governance and safety controls suited to regulated care.

For executives navigating pilot fatigue, this distinction matters. Platforms designed as infrastructure — rather than experiments — are better positioned to adapt responsibly as care at home AI adoption matures.

Final Thoughts

AI is here and it’s here to stay. Care at home agencies need to look to AI solutions in order to stay competitive. Knowing which solutions to review, what to look for, and how to move beyond the pilot phase begin with finding Purpose-Built Ai. Many thanks to our friends at Eleos for their expertise on this topic. Read the 4-part series.

# # #

About Eleos

At Eleos, we believe the path to better healthcare is paved with provider-focused technology. Our purpose-built AI platform streamlines documentation, simplifies compliance and surfaces deep care insights to drive better client outcomes. Created using real-world care sessions and fine-tuned by our in-house clinical experts, our AI tools are scientifically proven to reduce documentation time by more than 70% and boost client engagement by 2x. With Eleos, providers are free to focus less on administrative tasks and more on what got them into this field in the first place: caring for their clients.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Viventium Acquires Apploi

FOR IMMEDIATE RELEASE

Contact:                        Melissa Polly
mpolly@viventium.com

Viventium acquires Apploi to create a leading nationally scaled, healthcare-exclusive human capital management platform

Acquisition supports the full employee lifecycle, ensuring a better experience for caregivers and more stability for the organizations they serve

BERKELEY HEIGHTS, N.J.Feb. 4, 2026. Viventium today announced the strategic acquisition of Apploi, creating a category-leading human capital management (HCM) provider purpose-built for the post-acute market. This move establishes a new industry standard: a unified system of record that combines recruiting, credentialing, onboarding, payroll, and workforce management, including scheduling and time and attendance, with a foundation in healthcare compliance.

Tackling the Labor Shortage

Post-acute and long-term care providers currently face persistent labor shortages and a complex regulatory environment. Until now, the industry has relied on a fragmented mix of generalist software and disconnected point solutions that create data silos and administrative friction. The combination of Viventium and Apploi solves these challenges by providing a single, verticalized platform that manages the entire care staff journey across all 50 states.

Viventium Acquires Apploi

From Viventium

“Healthcare leaders are tired of fighting with fractured systems that weren’t built for their specific needs. By acquiring Apploi, we are creating the only scaled, healthcare-native platform that unifies everything from the first job application to the final paycheck. We are providing thousands of providers with the visibility and operational speed they need to manage their entire workforce, from clinical staff in the field to administrative teams in the office.”

Navin Gupta

CEO, Viventium

From Apploi

Adam Lewis, CEO of Apploi, added, “Our mission has always been to solve the staffing crisis in healthcare. Joining Viventium allows us to take that mission further than ever before. We are moving beyond just hiring to support the full employee lifecycle, ensuring a better experience for caregivers and more stability for the organizations they serve.”

Integration

The unified platform touches thousands of healthcare providers and hundreds of thousands of employees nationwide. By integrating Apploi’s recruiting and credentialing tools with Viventium’s premier payroll, HR, and workforce management engine, the company offers an unparalleled level of verticalized scale and compliance.

The acquisition officially closed on January 30, 2026. Goodwin Proctor LLP represented Viventium in connection with the transaction, while Houlihan Lokey served as financial advisor and Dentons served as legal advisor for Apploi. Financial terms of the deal are not being disclosed.

# # #

About Viventium

Viventium is the category-leading human capital management provider for the post-acute market. Built exclusively for healthcare, Viventium’s unified platform combines payroll, HR, recruiting, onboarding, and workforce management—including scheduling and time and attendance—into a single system of record. Serving clients in all 50 states and supporting nearly 800,000 healthcare employees, Viventium enables healthcare organizations to focus on what matters most: providing compassionate care. 

About Apploi

Apploi helps healthcare facilities stabilize their workforce and increase occupancy in the midst of a labor shortage with an all-in-one platform built to hire, onboard, and schedule top healthcare talent.

Working with over 9,000 healthcare organizations across the United States, the NYC-based tech company helps leaders solve the industry’s most pressing problem: how to provide superb care with few workers and more turnover. With the Apploi platform, facilities can manage the staff experience from job post through shift fulfillment—empowering teams to fill roles quicker, lessen agency dependence, and increase occupancy rates.

Purpose-Built AI: Evaluation to Execution

by Isaac Greszes, Eleos

Purpose-Built AI

From Evaluation to Execution

In part one of this 4-part series, we discussed how care at home agencies can realize the full impact of AI software that goes beyond the testing period. The best way to do this is to find purpose-built tech and evaluate AI solutions for real-world outcomes.

In Part two of this series, we outlined how care at home leaders should evaluate AI solutions — emphasizing outcome relevance, workflow fit in regulated environments, architectural scalability, and governance discipline. That framework was intentionally rigorous. In a market crowded with pilots and proofs of concept, it reflects the reality that AI outcomes are not accidental; they are the result of deliberate design choices.

This article examines what execution-ready, purpose-built clinical AI actually looks like in practice — and why certain platforms are structurally better positioned to deliver sustained value in care at home settings.

Market Tenure is a Weak Signal

As AI adoption accelerates across healthcare, many organizations default to a familiar proxy for confidence: market tenure. Vendors with early pilots, a growing logo list, or proximity to large EHR ecosystems are often assumed to be safer bets.

In emerging AI categories, however, tenure can be misleading. Early adoption frequently reflects experimentation rather than readiness. Platforms may perform well in narrow pilots while masking deeper limitations in clinical depth, scalability, or governance that only surface during broader rollout.

Design is a Better Measure

For care at home leaders under pressure to move beyond pilots, the more reliable question is not how long a vendor has been in the market, but how the system was designed to operate under real-world clinical and regulatory constraints.

Purpose-Built AI

What it Means Under the Hood

Generic AI tools often struggle in care at home environments. Here, it is worth examining what distinguishes purpose-built clinical AI at a structural level.

Purpose Built AI Evaluation to Execution

Clinical-grade platforms share several characteristics:

  • Clinical reasoning embedded in the system, not inferred from prompts. The AI reflects how clinicians assess, prioritize, and document care — rather than simply summarizing conversations.
  • Structured outputs aligned to documentation and reimbursement requirements, ensuring that generated content is usable without extensive manual correction.
  • Safety-aware interpretation of sensitive language, particularly in areas related to risk, decline, or end-of-life care.
  • Governance mechanisms baked into the architecture, including transparency, monitoring, and clearly defined limits on data use.

Conversational Care

Why are conversational care settings more challenging? Clinical insight derived from spoken interactions rather than structured inputs present some of the most complex challenges for AI systems.

Conversational care requires the AI to:

  • Interpret unstructured dialogue occurring in non-clinical environments
  • Distinguish clinically meaningful information from casual conversation
  • Recognize implicit risk signals and contextual nuance
  • Translate narrative interaction into structured, compliant documentation

Added Challenge

Behavioral health and substance use disorder care represent some of the most demanding examples of this complexity. Systems that perform reliably in these environments must handle variability, sensitivity, and regulatory scrutiny simultaneously.

This matters for care at home leaders because many of the same challenges — environmental variability, role-based documentation requirements, and safety-sensitive language — are present across home health and hospice workflows.

Next Steps

As organizations move from evaluation to execution, several questions can help distinguish platforms capable of delivering sustained value:

  • Can the vendor clearly explain how clinical reasoning is encoded in the system?
  • Are outputs structured to align with documentation, compliance, and reimbursement needs?
  • How is safety monitored and governed over time?
  • What mechanisms exist to adapt workflows without destabilizing operations?
  • Where does ROI typically emerge once AI is embedded into daily practice?
  • Answering these questions does not guarantee outcomes – but it significantly reduces the risk of prolonged pilots with limited impact.

Final Thoughts

The next phase of AI adoption in care at home will favor platforms built for durability, governance, and clinical trust. For leaders, the challenge is no longer whether AI can help, but how to select systems designed to deliver value beyond the initial pilot phase.

Understanding how AI was built — not just what it promises — is now a prerequisite for confident execution. Come back next week for the fourth and final installment in this serious where we will discuss a real-world implementation example.

# # #

About Eleos

At Eleos, we believe the path to better healthcare is paved with provider-focused technology. Our purpose-built AI platform streamlines documentation, simplifies compliance and surfaces deep care insights to drive better client outcomes. Created using real-world care sessions and fine-tuned by our in-house clinical experts, our AI tools are scientifically proven to reduce documentation time by more than 70% and boost client engagement by 2x. With Eleos, providers are free to focus less on administrative tasks and more on what got them into this field in the first place: caring for their clients.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Purpose-Built AI: Architecture, Scalability, Security

by Isaac Greszes, Eleos

Purpose-Built AI for Care at Home

Architecture, Scalability, and Security

In part one of this 4-part series, we discussed how care at home agencies can realize the full impact of AI software that goes beyond the testing period. The best way to do this is to find purpose-built tech and evaluate AI solutions for real-world outcomes.

Part two focuses on AI architecture, scalability and security.

Architecture and Scalability Across the Tech Ecosystem

AI does not operate in isolation. It sits within a broader ecosystem of EHRs, compliance programs, quality initiatives, and IT infrastructure.
For care-at-home organizations, long-term outcomes depend on whether an AI platform can:

  • Adapt to evolving documentation and regulatory requirements
  • Scale reliably during census fluctuations
  • Integrate cleanly with existing systems
  • Improve over time without creating operational drag

Health informatics research increasingly highlights risks such as model drift — where AI performance degrades as populations, workflows, or clinical practices change — reinforcing the need for continuous monitoring rather than one-time deployment.

purpose-built AI architecture and scalability

Vendors with limited clinical depth or brittle configurations may show early promise in pilots, but often struggle to sustain efficiency and ROI at scale.

Security, Governance

and the Link to Long-Term Value

HIPAA compliance remains foundational, but AI introduces additional governance considerations related to transparency, accountability, fairness, and ongoing risk management.

Healthcare organizations increasingly evaluate AI vendors based on:

  • Independent security and privacy assessments
  • Clear contractual boundaries around data use
  • Explicit retention and deletion policies
  • Documented processes for monitoring AI behavior over time

Expectations

Recent federal regulation, including the ONC’s HTI-1 Final Rule, formalizes new transparency and risk-management expectations for AI-enabled clinical systems — extending well beyond traditional privacy frameworks.

Emerging standards such as ISO 42001, focused on AI management systems, reflect a broader shift toward formal governance of AI in high-risk domains like healthcare. While adoption is still evolving, these frameworks provide executives with a useful lens for assessing vendor maturity.

Strong governance is not only a risk-mitigation strategy — it is a prerequisite for sustaining outcomes, protecting organizational reputation, and maintaining provider trust.

A Practical Takeaway

AI has demonstrated the potential to reduce administrative burden, improve documentation quality, and deliver measurable ROI in healthcare — including regulated, care at home settings.

However, results are not guaranteed. They depend on evidence-backed design, workflow alignment, scalability, and governance discipline.

For care-at-home leaders, the most reliable path to value is not adopting AI quickly, but evaluating it rigorously — with a focus on how the technology is built, validated, and governed.

For organizations navigating pilot fatigue, the critical shift is not testing more tools, but selecting platforms designed for scale, governance, and long-term operational impact.

# # #

This is part 2 of a 4-part series. Read part 1 and come back next week for part 3, “From Evaluation to Execution.”

About Eleos

At Eleos, we believe the path to better healthcare is paved with provider-focused technology. Our purpose-built AI platform streamlines documentation, simplifies compliance and surfaces deep care insights to drive better client outcomes. Created using real-world care sessions and fine-tuned by our in-house clinical experts, our AI tools are scientifically proven to reduce documentation time by more than 70% and boost client engagement by 2x. With Eleos, providers are free to focus less on administrative tasks and more on what got them into this field in the first place: caring for their clients.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com