Interoperability

Clinical

by Rowan Report | May 16, 2025 | Clinical, Interoperability, Regulatory

by Ben Rosen, Sr. Client Success Manager, Netsmart

Interoperability

What you need to know and how it affects you

For over two decades, tech companies and government agencies have been moving toward the goal of interoperability in healthcare technology. At long last, standards and protocols are in place — and continually being improved — to support open data exchange networks. As a result, healthcare providers, including human services, post-acute providers, and specialty practices, have more opportunities to participate in alternative payment models and adapt more readily to the evolving payment landscape.

Interoperability in Healthcare

What's driving the need for change?

Government regulatory agencies, together with payers and healthcare organizations, have long recognized the need to improve care coordination among healthcare providers. Making it easier to share information via a nationwide data sharing network is a critical component of this effort.

End Game

The ultimate goal of providing access to complete, accurate patient information is to help drive down costs to providers and electronic health record (EHR) users. Through exhaustive work and years of innovation, we’re seeing the tangible outcome of this effort. Information now flows seamlessly across multiple healthcare networks. Using a concise view of the data, we can focus on broader population health initiatives that improve outcomes for chronic conditions, reduce emergency department (ED) visits, and prevent hospitalizations. The interoperability market is moving ahead at blazing speeds. Therefore, we must understand the players who are the driving forces behind the movement.

The Interoperability Highway

Who are the players and how do they work together?

Healthcare technology is complex. It’s not surprising, then, that getting the disparate systems to share information seamlessly and securely is a complicated process. In the last decade an increasing number of vendors, organizations, and healthcare players started working together to advance a useful interoperability market.

Some of the larger players in this space include government and regulatory agencies. To understand the role these entities play and how they coordinate with other organizations and efforts, let’s compare the process to building a national highway system.

Building an open data exchange network

Assistant Secretary for Technology Policy and Office of the National Coordinator for Health (ASTP/ONC): This federal agency sets the vision, rules and regulations for health information technology policy. Compare it to the Federal Highway Administration (FHWA), the federal agency that provides stewardship over the construction, maintenance, and preservation for all interstate highways.
Trusted Exchange Framework and Common Agreement (TEFCA): Established by the ASTP/ONC, TEFCA sets the rules for health data exchange over the network. This is similar to plans or blueprints for highway construction. This would also include engineering, construction and safety standards for the highway.
The Sequoia Project (RCE): The Sequoia Project is the Recognized Co-ordinating Entity (RCE) for TEFCA and is appointed by the ASTP/ONC. The Sequoia Project is a non-profit, public-private collaborative that leads the implementation project for nationwide data exchange. They approve and help regulate the TEFCA exchange, via QHINs. The Sequoia Project can be compared to a construction manager that approves contractors and oversees quality control measures to ensure standards are met.
Qualified Health Information Networks (QHIN)s: QHINs are data sharing networks built to operate the exchange network as outlined by TEFCA. In our analogy, QHINs are the highways, and the companies that build QHINs can be compared to the construction companies that physically build and maintain the roadways themselves.

Now that you’re familiar with the entities involved in developing the standards for interoperability and building the data exchange networks that make it a reality, we will next look at how these enhanced capabilities can impact your organization.

This is part one of a four-part series covering the forces that are driving interoperability, as well as the future vision of open networks, and what it all could mean to your organization. Check back for part 2, “How TEFCA affects your technology and what the heck is a QHIN?” coming soon.

# # #

Ben Rosen is a senior client success manager and business unit owner for the interoperability solution suite at Netsmart. With more than a decade of healthcare experience, Ben has led numerous initiatives to integrate healthcare systems and enhance data sharing across the care continuum. His dedication to advancing healthcare interoperability drives his active involvement in industry initiatives and standards organizations, where he provides insight for frameworks such as HL7 FHIR, USCDI and others. Ben holds a Bachelor of Science in kinesiology from Kansas State University and a Bachelor of Science in nursing degree from the University of Nebraska Medical Center.

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Netsmart blog and is reprinted here with permission. For more information or to request permission to print, please contact Netsmart.

Home Care Nurses’ Proud History

Caring for the Caregiver

by Elizabeth E. Hogue, Esq. | May 9, 2025 | Caring for the Caregiver, Clinical

by Elizabeth E. Hogue, Esq.,

It's National Nurses Week!

Home Care Nurses, it’s National Nurses Week, May 6 – May 12, 2025, so we are celebrating the profession of nursing!

Home Health Nurses Have a Proud History

Home care nurses have an especially proud history. Perhaps the definitive book on home care nursing is No Place Like Home: A History of Nursing and Home Care in the United States authored by Karin Buhler-Wilkerson in 2001. As Buhler-Wilkerson makes clear, home care nursing in the U.S. is modeled on care provided in patients’ homes that was initiated by William Rathbone in Liverpool, England, in 1859.

The Start of Home Health Nursing

Rathbone first encountered a home care nurse, Mary Robinson, during the illness of his wife. Rathbone persuaded Robinson to work with him in an experiment to provide care for the sick poor in their homes while simultaneously teaching them how to take better care of themselves. Robinson was so shocked and overwhelmed by the work that she was ready to quit after the first three months. A key difficulty was recruiting nurses for such difficult work. Rathbone then enlisted the help of Florence Nightingale.

Nightingale viewed the care of patients in their homes as one of nursing’s most important tasks and threw her wholehearted support behind Robinson’s efforts. According to Buhler-Wilkerson, Nightingale said, in a widely read article published in 1876, that nurses who visited patients in their homes “were not, she assured her readers, some new form of cooks, relief officers, district visitors, letter writers, store keepers, upholsters, almoners, purveyors, ladies bountiful, head dispensers, or a medical comfort shop; they were simply nurses.” Their goal, according to Nightingale, was to “get people going again” with a “sound body and mind.” Nightingale was unsuccessful in recruiting nurses to help Rathbone and Robinson, so Rathbone started a school to train home care nurses.

The Homecare Model Comes to the U.S.

The model of homecare nursing that developed in England was very attractive to women in the U. S. around the turn of the century. Buhler-Wilkerson describes the ideal home care nurse at this time as follows:

“As nurse-author Mary Gardner suggested, the ideal visiting nurse was a faultless creature ‘possessing all the virtues, combining the experience of age with the enthusiasm of youth, and also having a sense of humor, which is perhaps the only thing which will make the years’ of this kind of work possible.’”

Not for the Faint of Heart

The work was extremely arduous. As Buhler-Wilkerson says in her book:

“Many nurses, while attracted to visiting nursing, found the work too mentally and physically exhausting. Walking long distances in all kinds of weather, climbing endless flights of stairs, cleaning and disinfecting patients’ rooms, changing beds, and being constantly exposed to disease were all part of the visiting nurse’s daily routine. The ‘delicate’ nurse found this an impossible undertaking, but even the strongest became exhausted – even sick – at the end of a day of work…Fatigued, discouraged, and often sick, many nurses left for more lucrative or easier work…As a result, the turnover was high and replacements difficult to find. With a large proportion of the staff leaving, each year seemed a new enterprise.”

Karin Buhler-Wilkerson

No Place Like Home:, A History of Nursing and Home Care in the United States

Sound Familiar?

The same description certainly fits home care nursing today. The work of home care nurses is difficult, but crucial to our country. Hats off to homecare nurses today and every day!

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

©2025 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

Ensuring HIPAA Compliance in Healthcare Communication

Admin

by Rowan Report | Mar 31, 2025 | Admin, Clinical, HIPAA

by Devin Paullin, CGO at Skyscape Buzz

Ensuring HIPAA Compliance

Communications Requiring HIPAA Compliance

While patient communication requires HIPAA adherence, so does any discussion between other parties. Essentially, any time PHI is discussed, a degree of confidentiality must be involved. For example, the Health Insurance Portability and Accountability Act (HIPAA) requires that sensitive patient data be protected when shared or discussed among:

Healthcare Providers and Patients
- Any time a caregiver, staff member, doctor, nurse, or any other employee communicates with a patient, resident, or client, outside of face-to-face meetings, it must be done securely in a way that meets HIPAA standards.
Healthcare Professionals Among Themselves
- HIPAA compliance must be met when healthcare professionals discuss PHI within their department or collaborate with external departments.
Healthcare Providers and Insurance Companies
- Insurance providers require patient details and sensitive PHI. Still, anything that makes information vulnerable to interception must be fully compliant with HIPAA standards.
Healthcare Organizations and Third-Party Associates
- Third parties that need to handle PHI (e.g., IT consultants, collections agencies, or other vendors) must do so in a way that protects patient data. To safeguard communication, healthcare organizations should ask outside associates, vendors, or agencies to sign a business associate agreement (BAA) and/or Data Processing Agreement (DPA). This is a formal agreement to comply with HIPAA standards and ensure accountability.
Healthcare Organizations and Public Health Authorities
- Some diseases or conditions require healthcare professionals to report to public health authorities (e.g. COVID-19 information during the pandemic). This communication requires stringent security measures and protection of PHI.

Why HIPAA Compliance Matters

In healthcare, effective communication is essential for providing high-quality care. However, without HIPAA compliance, the risk of data breaches increases. Implementing secure, HIPAA-compliant communication systems ensures the protection of Personal Health Information (PHI) while improving overall operational efficiency.

Key Benefits of HIPAA-Compliant Communication

Protects Patient Privacy and Data Security
- HIPAA-compliant platforms use advanced encryption and access controls to prevent unauthorized access. This protects patient information, including medical histories, diagnoses, and test results.
Enhances Communication Efficiency
- Secure messaging platforms streamline communication between patients, caregivers, and healthcare providers. These tools eliminate inefficient methods like phone calls and ensure real-time communication.
Strengthens Collaborative Care
- Providing high-quality healthcare often involves a team of professionals working together. Whether it is a hospital placing a patient in rehabilitation or home care, coordinating with intake team, care team and providers,collaboration is key. HIPAA-compliant communication tools allow these professionals to securely share critical patient information, ensuring everyone has the details they need to deliver cohesive, well-informed care.
Reduces Legal and Financial Risks
- Compliance with HIPAA regulations minimizes the risk of violations, protecting organizations from hefty fines and legal repercussions.
Maintains Patient Trust
- Patients are more likely to engage openly with healthcare providers when they feel confident that their sensitive information is protected.

How to Ensure HIPAA Compliance in Communication

To comply with HIPAA regulations, healthcare organizations should adopt the following secure communication methods:

Encrypted Emails
- Ensure emails containing PHI are encrypted and, in some cases, require patient consent.
Secure Messaging Platforms
- Use platforms specifically designed for HIPAA compliance for text-based communication.
HIPAA-Compliant Voice Calls and Telehealth
- Ensure voice and video communication channels are encrypted and secure.
Patient Portals
- Provide secure portals with two-factor authentication for patients to access their medical information.
Secure File Sharing
- Use encrypted systems for sharing patient documents and medical records.

Implementing HIPAA-Compliant Communication Platforms

Adopting a HIPAA-compliant communication platform requires a thorough evaluation of existing systems and policies. Organizations should consider the following steps:

Conduct a Communication Audit
- Identify all channels currently used for healthcare communication and assess their compliance.
Choose a Secure Platform
- Select an all-in-one communication solution designed to meet HIPAA standards.
Establish Access Controls
- Implement role-based access to ensure only authorized personnel can view PHI.
Provide Staff Training
- Educate employees on the importance of HIPAA compliance and how to use secure communication tools.
Monitor and Evaluate
- Regularly assess communication practices to identify and address vulnerabilities.

Final Thoughts

HIPAA-compliant communication is not just a legal obligation—it’s a commitment to patient privacy, security, and high-quality care. By implementing secure communication platforms, healthcare organizations can enhance efficiency, foster trust, and reduce the risk of data breaches. Investing in compliance is an investment in the long-term success and reputation of your organization.

# # #

Devin Paullin HIPAA Compliance in Home Healthcare

Devin Paullin is an award-winning innovator and executive in Healthcare Technology, having developed successful products, solutions, and partnerships in Life Sciences, Post-Acute Care, SDOH, and Long-Term industries.

He is currently Chief Growth Officer for Skyscape which provides Buzz, an all-in-one, real-time HIPAA-compliant clinical collaboration and communication platform that enables the entire staff (admins, operations, clinicians, caregivers, partners, patients, and families) with the tools to communicate securely, easily, in groups or one to one, and affordable, by any mode they choose. Visit Buzz or contact them to learn more about Buzz by Skyscape today.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Gaslighting Patients and Caregivers

Admin

by Elizabeth E. Hogue, Esq. | Mar 31, 2025 | Admin, Caring for the Caregiver, Clinical

by Elizabeth E. Hogue, Esq.

Gaslighting

Gaslighting, According to:

Nurse Professional Liability Exposure Claim Report: 4th Edition issued by Nurses Service Organization and CNA, for the period from 2016 to 2019 nurses who prvided services to patients in their homes; including those providing home health and hospice, and palliative care; were the most vulnerable of all nursing specialities to professional liability claims.

A Dubious Distinction

This is the first time that nurses in home care topped the list since the reports were first compiled in 2008. Home care nurses accounted for 20.7% of claims, which represents an increase of 12.4% over the previous number reported in 2015. Adult medical/surgical nurses topped the list in past reports.

Tell me Why

These factors may contribute to increases in claims against home care nurses:

Lack of institutional support for home care nurses that is routinely received by nurses in hospitals and other facilities
Growing popularity of home care
Rising acuity of home care patients
Lack of 24-hour oversight of patients
Absence of equipment in patients’ homes that is readily available in institutional settings to help identify patients at high risk for negative outcomes

According to the Experts

However, the nonprofit organization Emergency Care Research Institute (ECRI) says that eroding trust is a major threat to patient safety in 2025. ECRI ranks “gaslighting,” or dismissing concerns of patients and caregivers, as the top issue. In other words, nurses aren’t listening to patients and their caregivers! There is an old adage that says that if practitioners would just listen to their patients, patients will tell them what is wrong (i.e., the diagnosis). Perhaps, then, the best way to avoid negligence and resulting lawsuits is to listen to patients and caregivers.

Gaslighting Safeguards

Other strategies that nurses can use to protect themselves from malpractice claims include:

Stay up to date on education and training
Document assessments of patients in a timely and objective manner
Go up the chain of command when concerned about the well-being of patients
Maintain files that demonstrate character; such as letters of recommendation, notes from patients, and performance evaluations

Of course, complete, accurate and contemporaneous documentation may provide the best defense of all!

Final Thoughts

An increase in malpractice claims against home health and hospice nurses is a significant new industry development. It’s time to move risk management, with a focus on listening to patients and caregivers, higher up the list!

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

©2025 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

Enabling Care Through AI

Admin

by Rowan Report | Mar 31, 2025 | Admin, Artificial Intelligence, Clinical, Partner News

by John Crighton, CTO at Curantis Solutions

Enabling Care Through AI: Ethical Issues

Recently, artificial intelligence (AI) has become an essential component of healthcare organizations. AI is revolutionizing hospice and palliative care by enhancing patient care and optimizing workflows. Its impact is undeniable in these sensitive and life-changing fields. At Curantis Solutions, we are proud to apply AI-driven solutions to support caregivers while upholding ethical standards, enabling care through AI.

The Importance of AI in Hospice and Palliative Care

Hospice and palliative care are primarily based on empathy, understanding, and individual approach. When applied correctly, AI can enhance these core principles in several ways:

Improving Efficiency
- Some of the time-consuming tasks, such as entering assessment notes, reviewing recent documents before a patient meeting, or creating a summary of recent documentation in preparation for a team meeting, can be performed or assisted by AI. By automating these administrative tasks, caregivers can spend more time providing direct patient care.
Predictive Analysis
- AI tools can analyze the patient’s data and predict the possible changes in the patient’s condition, which will help to prevent complications.
Individualized Care Plans
- Based on the patient’s history, AI can help clinicians in the development of care plans that are more accurate in meeting the needs of the patient. Although the idea of using AI in hospice and palliative care is fascinating, it is crucial to approach this issue with caution and always pay attention to ethical issues.

Ethical Issues in the Use of AI in Hospice and Palliative Care

As the industry incorporates AI into our products and agencies, we need to consider ethical implications such as those shown below:

Privacy and Data Protection Issues
- Hospice and palliative care deal with the patient’s private details. At Curantis Solutions, we ensure that all AI-powered tools comply with the highest security and privacy standards, safeguarding patient data at every step.
Bias and Fairness
- The way AI systems are developed, they are only as good as the data that is used in their development. At Curantis Solutions, we strive to recognize and eliminate any possible prejudice in the AI systems that we develop to benefit all patients.
Transparency and Accountability
- It is important that the caregivers and the patients know how the AI is being used and how the decisions are made. We try to make our AI solutions as transparent as possible, and we ensure that the final decisions are always made by humans. Hospice and palliative care are very personal. This field is defined by the human component, and AI should only supplement it and not replace it. The solutions that we provide are intended to assist clinicians in order to maintain the sanctity of every patient.

A Future of Kindness with the Help of AI

The healthcare sector is changing rapidly, and AI is coming in to improve hospice and palliative care. At Curantis Solutions, we are proud to apply AI in a way that enhances the human factor, ethical values, and the capacity of the caregivers to offer the best care possible to the patient. Therefore, it is possible to envision a future where technology and empathy coexist to ensure that every patient gets the care they require. Leverage AI to reduce administrative burdens for hospice and palliative care.

About Curantis Solutions and AI

The goal of Curantis Solutions is to assist hospice and palliative care providers in the provision of patient-centered and compassionate care. This post discusses how AI can be used in this mission and how it can be done ethically.

We accomplish this in the following manner:

Working in partnership with specialists
- We partner with clinicians, ethicists, and AI experts to guarantee that our solutions are appropriate for the context of hospice and palliative care).
Revisiting the Model
- AI is not set and forgotten; it needs to be assessed and improved on an ongoing basis. We also regularly check the efficacy of our AI tools to ensure that they are accurate, fair, and reliable.
Enabling Care Teams
- Our solutions which are supported by AI are meant to support the skills of the care teams and not to replace them. Thus, we lessen the burden of documentation to allow the providers to focus on the patient and their families more often.

# # #

John Crighton is a seasoned technology leader, with over 25 years of experience in software development innovation and best practices.

John most recently served as the Chief Technology Officer for Lightning Step, a Behavioral Health SaaS EHR with over 100,000 users. John served on the executive team that scaled the business, contributing to the 40x revenue growth and eventually to a successful exit. Prior to that, John managed a custom development team at Openlink Financial and was responsible for product quality at SolArc Software. John was part of the management team that led Mission Critical Software to a successful IPO and went on to management roles with JMI Software, NEON Systems, and NetIQ.

John is a veteran of the US Army, and graduated Summa Cum Laude from the University of Houston with a Bachelor’s of Business Administration.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Curantis Solutions blog and is reprinted in Healthcare at Home: The Rowan Report with permission. For further permission to reprint, contact Curantis Solutions.

Dementia Care Model Test

Clinical

by Rowan Report | Mar 21, 2025 | Clinical, CMS, Partner News

FOR IMMEDIATE RELEASE

Contacts: PocketRN
William Leiner
Chief Operating Officer
will.leiner@pocketrn.com

Daughterhood
Becca Dittrich
becca@daughterhood.org

PocketRN and Daughterhood Announce a National Strategic Partnership to Test Medicare Dementia Care Model Developed by Centers for Medicare & Medicaid Services

Guiding an Improved Dementia Experience (GUIDE) Model, a Centers for Medicare & Medicaid Services Innovation Program, Aims to Increase Care Coordination, Support for Caregivers

WASHINGTON, D.C., MARCH 18, 2025 – Today, PocketRN, a leader in virtual nursing, and Daughterhood, a leading non-profit organization empowering family caregivers with community and resources, announced they will form a National Strategic Partnership to test the Centers for Medicare & Medicaid Services (CMS) alternative payment model designed to support people living with dementia and their caregivers.

Under CMS’ Guiding an Improved Dementia Experience (GUIDE) Model, PocketRN will be one of almost 400 participants building Dementia Care Programs (DCPs) across the country, working to increase care coordination and improve access to services and supports, including respite care, for people living with dementia and their caregivers.

Launched on July 1, 2024, the GUIDE Model will test a new payment approach for key supportive services furnished to people living with dementia, including: comprehensive, person-centered assessments and care plans; care coordination; 24/7 access to an interdisciplinary care team member or help line; and certain respite services to support caregivers. People with dementia and their caregivers will have the assistance and support of a Care Navigator to help them access clinical and non-clinical services such as meals and transportation through community-based organizations.

“We couldn’t be more thrilled to bring our revolutionary nurse-led care model to the millions of dementia patients and families who need it most. With PocketRN, patients and families get unwavering support from a Nurse for Life as they navigate the complexities of managing dementia at NO cost to them. Nurses are hands-down the best clinicians to be the ‘glue’ for patients and their families throughout their dementia journey–they’ve been doing so forever, and it’s high-time their work is valued by our system.”

Jenna Morgenstern-Gaines

CEO, PocketRN

“We are so excited to embark on this partnership that will bring invaluable expertise and resources to the dedicated dementia caregivers in our Daughterhood community. Dementia caregiving is a uniquely complex and deeply emotional journey—one that requires not only knowledge and support but also compassion and resilience. This partnership will further empower caregivers with the tools, guidance, and encouragement they need to navigate this journey with confidence, connectivity, and care.”

Anne Tumlinson

Founder, Daughterhood

PocketRN and Daughterhood’s partnership in delivering the GUIDE Model will help people living with dementia and their caregivers have access to the education, supports, and services they need to feel more empowered and less alone in their journey – including unique “circle” community groups, podcasts, educational videos, and other curated resources. The GUIDE Model also provides respite services for certain people, enabling caregivers to take temporary breaks from their caregiving responsibilities. Respite is being tested under the GUIDE Model to assess its effect on helping caregivers continue to care for their loved ones at home, preventing or delaying the need for facility care.

More information on CMS’ GUIDE Model

# # #

About Daughterhood

Daughterhood is a 501(c)(3) organization that fosters community that empowers individuals to navigate the practical and emotional complexity of caregiving. Its unique blend of “circle” community groups, blogs, podcasts, and curated partner resources gives family caregivers emotional relief along with real, practical, and tangible solutions to navigate the stress, overwhelm, and confusion they often face – and to do so with the support of others on a similar path. For more information, visit https://daughterhood.org/ or engage with Daughterhood on LinkedIn, Facebook, and Instagram.

About PocketRN

PocketRN gives patients, families, and caregivers a Nurse for Life. Its mission is to close the gap between home and healthcare by: enabling nurses to care proactively and continuously at the top of their license, enabling caregivers with peace of mind and the confidence to support others, and enabling patients to access whole-person, trusted, empathetic care when and where they want it. PocketRN is the glue that holds together fragmented experiences in care so that partners, clinicians, patients, and families get back more of what they need: quality time. For more information, visit www.pocketrn.com or engage with PocketRN on LinkedIn, Facebook, and Instagram.

More Violence in Care at Home

Admin

by Elizabeth E. Hogue, Esq. | Mar 21, 2025 | Admin, Caregiver Safety, Caring for the Caregiver, Clinical

by Elizabeth E. Hogue, Esq.

Violence Against Home Care Providers Continues

Violence in Care at Home Continues…

Sadly, but not surprisingly, the violence against field staff caring for patients in their homes continues. Here’s a recent example:

On February 28, 2025, a hospice nurse in Texas was accosted inside a patient’s home while she was attempting to provide care. The man who accosted her inside the home followed her outside with a rifle and fired at her as she fled. The nurse was uninjured, but her car was struck by at least one bullet.

Then, still armed, the man went back inside the patient’s home where he stayed close to the patient while pointing his rifle at deputies. Law enforcement officers were able to communicate with him and de-escalate the tense situation. The man was booked into the county jail on a charge of aggravated assault with a deadly weapon and bond was set at $250,000.

By the Numbers

According to a recent analysis of Bureau of Labor Statistics data, healthcare is one of the most dangerous places to work. Homecare field staff members who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies, and home medical equipment (HME) companies may be especially vulnerable. Contributing to their vulnerability is the fact that they work alone on territory that may be unfamiliar and over which they have little control. Staff members certainly need as much protection as possible.

Violence Policies Needed

First, regardless of practice setting, management should develop a written policy of zero tolerance for all incidents of violence, regardless of source. This policy should include animals. The policy must require employees and contractors to report and document all incidents of threatened or actual violence, no matter how minor.

Beyond Reporting

Emphasis should be placed on both reporting and documenting. Employees must provide as much detail as possible. The policy should also include zero tolerance for visible weapons. Caregivers must be required to report the presence of visible weapons.

UCHealth SAFE Program

Below are some additional important actions for healthcare organizations to take that are based on the UCHealth SAFE Program:

Encourage staff members to STOP if they feel unsafe for any reason.
If danger is not imminent, workers should pause to generally ASSESS their environments. Staff members should think about what happened and observe what is currently happening. Is there, for example, mounting frustration or anger?
Staff should then FAMILIARIZE themselves with the area. Who is the patient? Where is the patient? Are there any factors that might escalate behaviors? Staff members should also consider putting themselves in positions where they have a route to escape, if necessary.
ENLIST help. Getting help may, for example, include pushing panic buttons on mobile devices.

In Their Own Words

Here is what Chris Powell, Chief of Security at UCHealth, said in Becker’s Hospital Review on June 4, 2024:

“You can’t just talk about the shrimp and give you a good picture. We have to talk about the roux and the rice and everything else that goes into this for a good picture to be painted so people have an understanding. We want to solve this with an electronic learning or a 15-minute huddle, but we can’t. This is continuous and a persistent pursuit toward educating, communicating, recognizing, responding to, reporting and recovering from workplace violence.”

Chris Powell

Chief of Security, UCHealth

Final Thoughts

Every caregiver matters. The healthcare industry has lost caregivers to violence on the job in the past. Let’s do all that we can to avoid similar events in the future.

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

©2025 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

HIPAA Compliance in Communication

Clinical

by Rowan Report | Mar 21, 2025 | Clinical, HIPAA, Regulatory

by Devin Paulin, Skyscape

The Critical Importance of HIPAA Compliance in Home Healthcare Communication

The Rise of Messaging Apps and Healthcare Communication

Nearly 44% of the global population (3.5 billion people) rely on messaging apps to communicate. Unfortunately, available consumer SMS, text, and even “secure” messaging apps like WhatsApp, Apple Message, or Google Messages do not come with safety and security features specifically required to be compliant in the healthcare industry.

Still, consumer SMS apps are quite often used for healthcare communication in which Personal Health Information (PHI) is shared, and many individuals don’t understand the level of risk or that this is a violation of the law.

HIPAA Compliance in Communication Advantages

Group and Individual texting are a proven, timesaving, real-time communication tool in healthcare, and must be done through a HIPAA-compliant messaging platform. Secure platforms can improve privacy and security while maintaining compliance in such a sensitive industry.

There are many reasons why HIPAA compliance is vital for secure communication in home healthcare.

HIPAA Compliance in Communication - Not Just for Doctors and Nurses

HIPAA compliance is not just for medical clinics and hospitals. HIPAA compliance extends to all types of services that hold healthcare information. Physical Therapy, Personal Care, Home Health, Wellness, Behavioral Health, Assisted Living, and many more all fall under HIPAA. Most importantly, ALL providers, staff members (full or part-time), contractors, and third-party partners who come in contact with PHI are subject to HIPAA law, violations, and fines.

We're too Small for Violations to be Noticed, Though

Wrong. We regularly speak to many owners and staff members of large and small Home Health Care, Assisted Living, Hospice and Palliative, Mobile Imaging, PT and Rehabilitation, and Behavioral Health across the country. Many openly operate under the false assumption that their business is too small to be noticed by the U.S. Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR), who is responsible for enforcing the HIPAA Privacy and Security Rules. That is not how it works.

Complaints logged by those within or close to your business alert the OCR to possible HIPAA violations. These can be from current and former staff, patients, clients, business partners, or anyone who claims to have witnessed a HIPAA breach. This can include disgruntled employees and whistleblowers. Even for companies that are HIPAA compliant, any breach is to be reported by an employee assigned as the security officer.

HIPAA Compliance in Home Healthcare by Type

HIPAA mandates compliance for all communications involving PHI. Some key examples include:

Provider-to-Patient Communication
- Secure platforms are necessary when caregivers contact patients outside of in-person visits.
Provider-to-Provider Communication
- Sharing PHI within or between departments must meet HIPAA standards.
Provider-to-Insurance Communication
- Insurance companies require sensitive patient data, which must be securely transmitted.
Provider-to-Third-Party Communication
- Any third-party associates handling PHI must have a signed Business Associate Agreement (BAA) and adhere to HIPAA regulations.
Provider-to-Public Health Authorities
- Reporting communicable diseases or pandemics requires secure communication.

Consequence of HIPAA Violations

HIPAA violations can have severe consequences, including:

Financial Penalties
- Fines range from $100 to $50,000 per violation, depending on the level of negligence.
Reputational Damage
- Data breaches erode patient trust, leading to a damaged reputation.
Legal Consequences
- In cases of willful neglect, organizations may face lawsuits or criminal charges.

Final Thoughts

Understanding and adhering to HIPAA regulations is crucial in home healthcare. Compliance not only safeguards sensitive information but also strengthens patient trust and ensures ethical operations.

# # #

Devin Paullin is an award-winning innovator and executive in Healthcare Technology, having developed successful products, solutions, and partnerships in Life Sciences, Post-Acute Care, SDOH, and Long-Term industries.

He is currently Chief Growth Officer for Skyscape which provides Buzz, an all-in-one, real-time HIPAA-compliant clinical collaboration and communication platform that enables the entire staff (admins, operations, clinicians, caregivers, partners, patients, and families) with the tools to communicate securely, easily, in groups or one to one, and affordable, by any mode they choose. Visit Buzz or contact them to learn more about Buzz by Skyscape today.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Nursing Facility Compliance Guidance

Admin

by Elizabeth E. Hogue, Esq. | Mar 13, 2025 | Admin, Clinical, Regulatory

by Elizabeth E. Hogue, Esq.

Nursing Facility Compliance Guidance

Takeaways for Hospices

In November of 2024, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued revised “Nursing Facility Industry Segment-Specific Compliance Program Guidance.” This guidance describes:

Risk areas for nursing facilities
Recommendations and practical considerations for mitigating risks
Other important information that the OIG believes nursing facilities should consider when implementing, evaluating, and updating their compliance and quality programs

Guidance Extends to Post-Acute Providers

The guidance targets nursing facilities. Howeve, it also clearly states that post-acute providers other than nursing facilities should use the guidance in their compliance efforts. The OIG says: “We encourage all long-term and post-acute providers to establish and maintain effective compliance and quality programs.” Guidance for nursing facilities, for example, specifically addresses relationships between nursing facilities and hospices.

The OIG...

First...

acknowledges that nursing facilities may arrange for hospice services for patients who meet the eligibility criteria and who elect the hospice benefit.

Then...

reminds facilities and hospices that requesting or accepting remuneration from hospices may subject both parties to liability under the federal anti-kickback statute. This applies if the remuneration may influence nursing facilities’ decisions to do business with hospices or induce referrals between the parties.

Goes On...

points out that nursing facilities that refer patients for hospice services who do not qualify for the hospice benefit may be liable for submission of false claims.

Nursing Facility Compliance Guidance OIG

Additionally...

says that hospices are permitted to furnish noncore services under arrangements with other providers or suppliers, including nursing facilities. State Medicaid Programs pay hospices at least 95% of the Programs’ daily facility rate. Hospices are then responsible to pay facilities for patients’ room and board.

Finally...

provides a list of suspicious arrangements between nursing facilities and hospices, including: (1) referrals of patients to hospices to induce hospices to refer patients to facilities, and (2) solicitation or receipt of hospices of goods or services for free or below fair market value, including nurses or other staff to provide services at facilities for nonhospice patients and monetary payments for:

referrals of patients to hospices to induce hospices to refer patients to facilities
solicitation or receipt of hospices of goods or services for free or below fair market value
- solicitation of nurses or other staff to provide services at facilities for nonhospice patients
- monetary payments for:

- - Room and board for patients in excess of what nursing facilities receive directly from Medicaid if patients are not enrolled in hospices. Additional payments must represent fair market value of additional services actually provided to patients that are not included in Medicaid daily rates.
  - Additional services for residents that include room and board payments to hospices from Medicaid Programs
  - Additional services for patients that are not included in room and board payments from Medicaid Programs at rates that are above fair market value
  - Provision of services by nursing facilities to hospice patients at rates that are above fair market value

Final Thoughts

Hospices are surely under fire these days from fraud enforcers. Engaging in the practices described above is likely to draw attention by enforcers and possible enforcement action.

# # #

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

No portion of this material may be reproduced in any form without the advance written permission of the author.

©2025 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

Humana Thyme Agreement

Clinical

by Kristin Rowan | Mar 7, 2025 | Clinical, Hospice, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Palliative Care for Medicare Advantage Members

Cancer is one of the highest leading causes of death in the United States, second only to heart disease. The challenges for cancer patients are not only physical, but emotional and financial as well. The consequences of these challenges are often devastating to the patient and their families. Providing additional care, support, and pharmaceutical interventions through value-based care can improve patient outcomes and reduce out-of-pocket costs.

Thyme Care

Thyme Care is a Nashville-based cancer treatment center that operates in seven states. The centers provide not just treatment, but cancer care navigation, designed to work within the value-based framework, keeping the patient at the center of care. Thyme Care includes an oncology care team, a patient app with multiple resources and 24/7 access to support. Patient surveys track symptoms and reduce barriers to care. This approach combines cancer treatment and palliative care for whole-person cancer care support.

Palliative Care

Palliative care works alongside medical care to improve the quality of life for the patient, addressing physical, emotional, and spirtual needs. Strictly speaking, it is not medical care, and not specifically covered by most insurance plans. The out-of-pocket costs for palliative care can be extremely high, making this kind of care an inaccessible amenity for most patients.

Value-Based Care

Value-based care reimburses care providers partially based on patient outcomes and patient satisfaction. Providers also share the financial risk of care with health insurance companies. Care providers who can both improve outcomes and patient satisfaction can be reimbursed more through health insurance plans, which can cover the costs of palliative care, even when it is not explicitly covered by the plan.

Humana

Humana is a payer with plans for Medicare, Medicaid, and Individual/Family beneficiaries. The Medicare Advantage value-based care plans allow Humana to disperse payments for covered services in partnership with care provider teams across a patient’s care journey. The better the outcome and satisfaction, the more Humana can pay a provider for care. Better outcomes often means reduced hospital visits, a longer time at home before requiring skilled nursing facilities, and lower costs.

Humana Thyme Palliative Care Collaboration

The recently announced partnership between payer and provider will give eligible patients access to palliative care support as part of the whole-person cancer care navigation provided by Thyme. Humana patients can also receive, as needed, 24/7 virtual care, medication guidance, symptom management, chronic condition management, community-based resources, financial assistance, transportation, food assistance, and/or access to stable housing.

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

Prior Authorization Requirement Removed by UnitedHealthcare

Clinical

by Kristin Rowan | Mar 7, 2025 | Clinical, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Easier Access to Home Health

Prior authorization requirements can be cumbersome, delaying or even preventing care in some cases. Patients who need prior authorization to get he care they need also generally have form after form to fill out or to have completed by their PCP or hospital physician, who doesn’t have time for adequate visits, much less more paperwork.

As part of their ongoing efforts to reduce prior authorization volume by 10%, UnitedHealthcare has just announced a change in their home health services requirements.

Limits on Where Changes Apply

Beginning April 1, 2025, UHC will no longer require prior authorization or concurrent reviews for home health services managed by Home & Community (formerly naviHealth). This is the next step in an ongoing effort to modernize the authorization process and simplify health care for its members and providers.

These changes will apply to Medicare Advantage and Dual Special Needs Plan (D-SNP) beneficiaries in 36 states and the District of Columbia.

Alabama
Alaska
Arkansas
California
Colorado
Connecticut
Florida*
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas

Kentucky
Louisiana
Maine
Maryland
Massachusetts
Nebraska
Nevada
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Oregon

Pennsylvania
Rhode Island
South Carolina
Tennessee*
Texas
Utah
Virginia
Washington
Wisconsin
Wyoming
Washington, D.C.

*In Florida and Tennessee, the changes will not apply to D-SNP plans that are not managed by Home & Community.

Prior Authorization Additional Information

You should continue to request prior authorization and concurrent review through March 31, 2025. UHC reminds all providers that following CMS guidelines for providing home health care services is still required. And in states where a Medicare denial is required to get Medicaid prior authorizations, providers should submit their requests through the UHC provider portal.

The available information on this pending change is limited. We will provide updates should they become available. Please contact UHC directly through the provider portal if you have specific questions.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

Agency Management System for Fractional Home Care

Admin

by Tim Rowan | Mar 7, 2025 | Admin, Clinical, Product Review, Vendor Watch

by Tim Rowan, Editor Emeritus

Agency Management System for Fractional Home Care

There is a growing service sector within Home Care to provide in-home care to seniors living in Independent Living and Assisted Living facilities. We described the basics of the way it works in last week’s interview with Jessica Nobles. She pointed out that there was no software available for the kind of scheduling required by this type of home care. She wound up creating her own software to schedule on-site caregivers performing visits that can be anywhere from five-minutes to full, four-hour shifts.

Right after building the customized scheduling tool, Ms. Nobles met Tim and Gina Murray, who had been through an identical experience with their own agency, Aware Home Care. The difference between their stories was that both the Nobles’ and the Murray’s, after selling their respective agencies, embarked on different paths. Jessica and Clint went the consulting route and Tim and Gina formed a software company, CinchCCM, Community Care Made Easy. We spoke to them this week to hear the rest of the story.

Agency Management System Win-Win-Win

At no cost to the residential facility itself, a home care agency places one or more caregivers on the premises. IL or AL residents join a kind of co-op to be eligible to request in-home services. Some agencies who offer this service accept requests for traditional shifts, five-minute check-ins, and pretty much everything in between.

Many request regular morning breakfast help, others tuck-in services. Most agencies in this sector allow registered members to request unscheduled, as-needed help. To accommodate the needs of all members, an agency will add caregivers as the number of participants grows. The Murray’s outlined the benefits to all involved.

Caregivers like predictable income. They are paid for their entire time on-site, whether they are in a member home or on call between visits.
IL and AL owners find that the level of care keeps residents in their facilities longer by delaying the need to move to a nursing facility.
Families gain peace of mind, knowing their older loved ones have a caregiver nearby and on call all day, sometimes overnight.
Home Care agencies report enhanced caregiver satisfaction and retention, along with a steady, predictable payroll.

Clearly, agency management software was not intended to automate this type of arrangement.

Not Your Parents' Agency Management System

The Murray’s designed a system that displays schedules on a color-coded, calendar grid, with a column for each day and row for each 15-minute unit. Then they began to add features.

caregivers can tweak scheduled visits by drag and drop
remote family members can see scheduled and completed visits as well as caregiver notes
on the system’s mobile app, each caregiver can see the schedule of all other on-site colleagues. If a client unexpectedly needs more time and a caregiver has another visit coming up, that caregiver can find an available colleague and ask, through a secure message on the app, for someone to fill in.

on the system’s mobile app, each caregiver can see the schedule of all other on-site colleagues. If a client unexpectedly needs more time and a caregiver has another visit coming up, that caregiver can find an available colleague and ask, through a secure message on the app, for someone to fill in.
a management dashboard displays real time charts of caregiver utilization and gross profit. Agencies with multiple sites can report each site’s data separately and roll all sites up into one combined report.

Tim Murray explained that version 5.0 is nearly finished and ready to be released later this year. “It has been a long, slow development process,” he said, “and the first version was functional but simple. Adding the mobile app was a big step forward and very popular with the field staff. Management reports and real-time charts brought CinchCCM from a scheduling application to a full agency management system.”

Pricing, Growth, Evolution

CinchCCM is priced per client, based on average daily census at the end of each month. The Murray’s found this policy to be both manageable and fair. Their customers have a predictable revenue stream if most residents choose the monthly retainer option, and they have a predictable software cost for budgeting.

As word spread and software sales grew, Tim and Gina Murray sold Aware Home Care, formed a corporation, and turned their efforts to feature development, customer support, and sales. Those efforts have led to growth to 60 clients across the country. “As the so-called fractional home care concept grows,” Gina Murray concluded, “we want to be there to make it a smooth experience for those who give it a try.”

# # #

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2025 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

Fractional Home Care

Admin

by Tim Rowan | Feb 27, 2025 | Admin, Clinical, Recruitment & Retention

by Tim Rowan, Editor Emeritus

Solve Nagging Problems; Raise Revenue

Along with the rest of the Private Pay sector, Jessica Nobles’ Eastern Tennessee agency was struggling with caregiver recruitment and retention. Finding good people is less than half the battle. To keep them, you have to pay a competitive wage and provide enough hours to ensure that wage translates into an attractive and predictable monthly income. We spoke with Jennifer, Founder of Home Care Ops, last week to learn one of her solutions.

Fractional Home Care

What Nobles calls “Fractional Home Care” is providing services in a senior living community with one or more caregivers stationed on site. Residents pay a membership fee or pre-purchase a package of hours. The agency is thus guaranteed a small revenue base and clients are free to request services for a few minutes or a few hours on an as-needed basis.

“Our caregivers love this arrangement because it virtually guarantees them full-time pay. They remain on site at the facility for a contracted shift, which can be their choice of daytime or night hours. If demand warrants it, we will assign more than one caregiver at a time.”

Jessica Nobles

Founder, Home Care Ops

She added that the advantage to the agency is that nearly all of a caregiver’s day is paid hours. There are no mileage reimbursements and no paying for travel time or idle time. “Think of it as a co-op,” she continued. Ten clients can share one caregiver. They get all the care they need and our caregivers are earning for their entire day.”

The benefit accrues to independent living communities as well. Their arrangement with an outside Home Care agency means they no longer have the burden of hiring and retaining a caregiving staff of their own and their residents get better care. The residents pay for the services, not the facility, and they have the option of using the on-site caregivers as needed or through the pre-purchase plan of a block of ten or twenty 15-minute units.

A Typical Scenario

Jessica offered an example of how Fractional Home Care often works. An Assisted Living Facility resident lives independently but occasionally needs help with showers, or help getting to and from the community center, etc. In a typical home care setting, that person would have to bring in a caregiver for four, six, or eight hours, though less than an hour is needed. The family speaks with the onsite agency to arrange for the specific help needed, whether it is a few minutes

every other day or an hour every day. The agency offers a membership at flat fee and both parties get exactly what they need. The caregiver is available to add other residents to his or her schedule, making it possible to achieve a 40-hour work week.

“Some patients might need traditional daily care as they might get from any other agency,” Jessica explained. “They can contract for that for around $1,600 per month. Our caregiver can come multiple times a day since there are no drive time concerns.” She said that not every client needs a membership program. Some prefer pre-sold units, perhaps buying five 15-minute visits in advance. “They never have to pay for down time. Our caregivers never sit idle should their work be done before their shift is up.”

Fractional Home Care Improves Agency Reputation

Jessica has found that her agencies have earned a reputation for such excellent care that they have occasionally replaced franchise home care organizations locally that have national contracts with national ALFs. Some of these facilities have been dissatisfied with the care they were getting with their national organization’s contracted agency. When this happens, they seek a local agency to replace them. Jessica has seen this several times when the franchise was not staying on site.

“We explain our fractional model, with someone on site at specified times when at least three residents have signed on, and one caregiver per 10 clients. The more clients who sign up, the more caregivers we station at the facility. This leads to an additional benefit for the ALF. This level of service delays the day the family decides to move Mom from their community to a nursing facility.”

Fractional Home Care has been so successful, the word spread to other residential communities. Nobles’ company had had to turn some away. When that happened, she and her partner and husband began to teach the system to other agencies.

There was one obstacle, she admits. There were no Agency Management Software systems that could be adapted to the fractional way of providing care. She and her team finally created their own…right before she found one on the market that met their needs. Jessica introduced us to Tim and Gina Murray, co-founders of Cinch CCM. Jessica recommends Cinch CCM to fractional home care agencies. We have scheduled a demo and will have a review in the near future.

# # #

About Jessica Nobles

With over a decade of Private Duty Home Care leadership and knowledge, Jessica Nobles worked her way up through every position from Caregiver, Operations Coordinator, Franchise Developer, and Independent Agency Owner. As the founder and operator of Nobility Care Solutions, she grew her revenue to six figures within the first year of business through grassroots marketing, creative community engagements, and referral partnerships. She is also the Executive Administrator for Home Care Ops where she coaches, consults, and empowers other home care owners and operators to create operational systems and strategies that build lasting business success and consistently increases revenue.

Tim Rowan is a 30-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Safeguarding Caregivers from Violence

Admin

by Kristin Rowan | Feb 27, 2025 | Admin, Caregiver Safety, Caring for the Caregiver, Clinical

by Kristin Rowan, Editor

We’ve published and talked a lot about caregiver safety, lone worker safety, and keeping your caregivers safe. Until the risk of violence to care at home workers is 0%, we will continue to provide this information and urge you to implement plans to lower the risk.

It’s nice to see that we’re not the only ones. Much of the following information comes from Lockton Affinity Home Care, along with reports from the U.S. Bureau of Labor Statistics and the Centers for Disease Control and Prevention.

Workplace Violence in Care at Home

Workplace violence is at a much higher risk among home care workers than other professions. The U.S. Bureau of Labor Statistics says that home health aides and home nursing assistance are five to seven times more likely to experience workplace violance than the average U.S. worker. Workplace violence can include verbal, non-verbal and written harrassment, bullying, sexual harassment, and physical attacks, up to and including death. A study from the CDC is discouraging:

Violence Stats from Centers for Disease Control & Prevention

18% to 65% of workers experiencing verbal abuse from patients
As many as 41% workers have reported sexual harassment
Between 2.5% and 44% of workers have reported being physically assaulted

Negative Consequences to Your Agency

According to Lockton, caregivers are impacted by violence in more ways than one. In addition to the physical and mental harm done by the violence itself, caregivers suffer from lower job satisfaction and higher burnout rates. They also may provide lower quality of care. Some start abusing drugs and alcohol. All of these lead to higher employee turnover and greater cost to the agency to hire and train new staff. Additionally, the poor quality of an abused worker can damage an agencies efficiency as well as their reputation.

Collect information and monitor conditions in the environment

Training, Policies, and Reporting

Lockton offers some specific recommendations to reduce the likelihood of your caregivers experiencing workplace violence.

Home care businesses should implement a monitoring and reporting process to demonstrate their commitment to recognizing and mitigating the risks associated with workplace violence.

By proactively managing workplace violence risks, your business can enable staff protection and support, align with regulatory compliance, emphasize a culture of safety, inform data-driven decision-making and contribute to the overall well-being of both employees and clients.

Implementation recommendations include:

A zero-tolerance policy towards workplace violence.
Policies and rules on the safety of lone caregivers in the field, such as regular cell phone contact or check-ins, and conducting home visits in pairs and/or with security escorts.
Rules and strategies related to visits in homes where violence has occurred in the past.

Require staff to participate in ongoing education and training

Many incidents of workplace violence go unreported in the industry. Caregivers may perceive incidents as minor or as part of the job, leading to a lack of action and normalization of such behavior.

Training employees on the types of physical and nonphysical acts and threats of workplace violence can increase awareness and reduce normalization. Additional education and training can focus on how to:

Assess the work environment and surroundings for safety, including the presence of drugs of abuse, drug paraphernalia, weapons, and aggressive pets.
Recognize signs of imminent violence, including verbal abuse and aggressive body language and/or posturing.
Employ verbal de-escalation techniques.
Utilize escape and egress techniques.

Create and maintain a culture of safety and quality throughout the organization

Identify an individual to be responsible for your organization’s workplace violence prevention program. They can implement policies and a standardized process to report and follow up on events or near-misses. Data collection and simple, accessible reporting structures show commitment to providing a safe and secure work environment. Regularly reporting incidents and trends to governance promotes transparency and further establishes accountability for the program.

Post-incident support services can also have great value for home healthcare workers’ well-being. These services may include peer support, formal debriefing, trauma-crisis counseling and employee assistance programs.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 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

Perfect Storm

Admin

by Rowan Report | Feb 20, 2025 | Admin, Clinical, CMS, Regulatory

by Hannah Vale, CMO HealthRev Partners

Care at Home Industry Faces Perfect Storm

Industry Challenges in 2025

The care at home industry is grappling with an unprecedented crisis as staffing shortages, technological hurdles, and complex reimbursement models converge to create significant operational challenges. Industry experts warn that without immediate intervention, patient care could be severely impacted.

Staffing Crisis Reaches Critical Levels

The staffing shortage in home health care has intensified dramatically since the COVID-19 pandemic. Carole Carlson, Registered Nurse (RN), Administrator at Avant Home Care, is a veteran with 36 years of experience in the field. She reports unprecedented difficulty in recruiting registered nurses.

“We’re seeing a mass exodus of healthcare workers who have found remote work alternatives. This exodus has also led to a significant caregiver shortage, causing a decline in non-skilled care services.”

Carole Carlson

Administrator, Avant Home Care

RN Shortage

“The other issue is the RN shortage. This is our first time ever experiencing an RN shortage. We are not even getting applicants, whereas in the past we have always had nurses apply and were able to hire within a relatively short period of time,” Carlson added.

Michael Greenlee, Founder and CEO of HealthRev Partners, notes that the shortage is systemic, with insufficient new workers entering the field to meet growing demand. The situation is particularly dire in rural areas, where agencies face additional challenges in attracting and retaining staff.

Connectivity Issues on Top of Documentation Burden

The documentation requirements for home health care are proving to be a major source of burnout among nurses. Pointedly, in rural areas, the problem is exacerbated by poor connectivity:

Many patients still rely solely on landlines
Large areas lack cell coverage
Limited or no WiFi access is common

These issues often force nurses to complete documentation after hours, significantly impacting their work-life balance. Greenlee suggests that emerging satellite connectivity solutions could potentially address these issues in the future.

EMR Limitations

Electronic Medical Record (EMR) systems, while essential, present their own set of challenges. Agencies find that basic systems require multiple costly add-ons for full functionality.

Carlson identifies several gaps in current EMR systems:

Lack of built-in HIPAA-compliant dictation capabilities
Limited care plan template libraries requiring extensive manual input
Need for multiple add-ons to achieve full functionality

These limitations are forcing agencies to invest in additional software solutions, further straining already tight budgets.

Medicare Advantage Complicates Operations

The growing prevalence of Medicare Advantage plans is adding another layer of complexity to home health care operations. In one agency’s case, Medicare Advantage patients now represent 30% of their 160-patient census, equal to traditional Medicare patients. Each Medicare Advantage plan comes with different requirements, creating a significant administrative burden for agencies.

“Keeping up with the varying billing requirements across plans is a constant challenge for our small staff,” Carlson notes. “The need to maintain efficient workflows with clearinghouse and software updates for different payers is putting additional strain on already stretched resources”

Final Thoughts

As the care at home industry navigates these multifaceted challenges, experts stress the urgent need for comprehensive solutions to ensure the continued delivery of quality care to an aging population increasingly preferring to receive treatment at home.

# # #

Hannah Vale, M.Ed. is a dynamic leader bringing a wealth of experience and marketing innovation to her role at HealthRev Partners. Hannah is dedicated to helping post acute agencies streamline processes, optimize reimbursement, and embrace tech-driven solutions. She is recognized as an advocate for empowering agencies with the tools and knowledge they need to drive successful growth. A lifelong learner and former educator turned entrepreneur with a proven track record in launching and scaling businesses, passionate about creating impactful strategies that unite purpose and business. Hannah is also the co-host of the Home Health Revealed podcast, where she discusses industry insights and shares stories from experts in all things pertaining to home health, hospice, and palliative care. Hannah holds a Bachelors Degree in Education from Cleveland State University and a Masters in Educational Leadership from Evangel University.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com